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ADHD Atten Def Hyp Disord (2011) 3:77234 DOI 10.



Springer-Verlag 2011

3rd International Congress on ADHD From Childhood to Adult Disease

26 29 May 2011 Berlin Germany

Editors: Manfred Gerlach, Wurzburg, Germany Peter Riederer, Wurzburg, Germany Andreas Warnke, Wurzburg, Germany



In the name of the World Federation of ADHD it is our pleasure to welcome you here in Berlin to the 3rd International Congress on ADHD: from Childhood to Adult Disease. After the incredible success of the Vienna meeting two years ago almost 2,000 participants from 70 countries attended Berlin is the ideal setting to elucidate and discuss the current advances in basic science and clinical research that contribute to our understanding of ADHD as a lifespan disorder. In this volume, abstracts for the Plenary Sessions (PS) and Hot Topic Symposia (HT) precede the poster (P) abstracts. Submitted abstracts are not edited in any way. The PS are organised in ve topics in the following sequence: Update on Diagnosis, Classication and Aetiology of ADHD in Childhood, Adolescence and Adulthood; Update on Neurobiology of ADHD; Course, Differential Diagnosis and Co-morbidity of ADHD; Update on Treatment of ADHD in Childhood, Adolescence and Adults; Persistence of ADHD: Brain Imaging, Genetics, and Treatment. The 16 HT cover the latest clinical and research developments in the expanding eld of ADHD and related disorders. We are pleased to report that we have received more than 500 poster abstracts, the largest number ever since the World Federation of ADHD began the series of congresses in 2007. We organised the 41 Guided Poster Tours so that presentations of the different topic categories are represented uniformly. The general topic headings are those of Aetiopathogenesis, Biomarker Candidates, Co-morbidity, Diagnosis, Epidemiology, Experimental Models, Genetics, Imaging, Life Quality, Miscellaneous, Non-Pharmacological Treatment, Pathophysiology, and Pharmacological Treatment. We would like to encourage you to not only view these selected posters, but to also engage in an active discussion and exchange of ideas with our young colleagues. The abstracts submitted by young scientists have been read by the Scientic Programme Committee to select the eight most meritorious. The authors of these abstracts have been invited to deliver a presentation during the two Young Scientists Award Sessions (YSS). This approach is intended to highlight the importance of original scientic contributions of young colleagues at the congress. We thank all the speakers, contributors, and sponsors of the 3rd International Congress on ADHD: From Childhood to Adult Disease and welcome you to what we are sure will be a very enjoyable and highly informative congress.

Andreas Warnke Congress President President World Federation of ADHD

Manfred Gerlach Chairman Scientic Programme Committee



Friday, 27 May 2011, 08.3010.30 PS-01 Update on diagnosis, classication and aetiology of ADHD in childhood, adolescence and adulthood
PS-01-01 Key clinical developments relating to the diagnosis of ADHD L. A. Rohde* * Porto Alegre, Brazil Objective: To present and discuss recent research data on controversial clinical aspects of ADHD diagnosis in modern nosological systems. Method: A comprehensive non-systematic review of papers related to clinical aspects of ADHD diagnosis that need to improve in future classication systems. Results: The following aspects are addressed: developmental approach during childhood & adolescence, dimensional approach, compatibility between DSM/ICD, cultural adequacy of wording and thresholds, gender adjustments, inclusion of neurobiological or neuropsychological markers, Weight of all symptoms to capture the latent construct, ADHD types, age-of-onset of impairment, integration different information sources, exclusion of ADHD diagnosis in PDD, challenges for the diagnosis of ADHD in adults. Conclusion: Although ADHD is an extremely well investigated disorder with superior validity over most mental disorders and even over several medical conditions, several clinical aspects should be better conceptualized in future classication systems.

PS-01-03 Are sensation seeking and hyperactivity in both ADHD and mania reecting an autoregulatory attempt to stabilize wakefulness (vigilance)? U. Hegerl*, P. Schonknecht, T. Hensch, S. Olbrich, M. Kluge, C. Sander * Leipzig, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) and mania show broad symptom overlap and high comorbidity exists between ADHD and bipolar disorder. A recently presented vigilance regulation concept suggests that in both ADHD and mania an unstable wakefulness (vigilance) regulation is a central pathogenetic factor leading to attention decits and, in vulnerable subjects, additionally to hyperactive, impulsive and sensation-seeking behaviour. The latter behavioural pattern is interpreted as an autoregulatory attempt to stabilize wakefulness by increasing external stimulation (1,2). Indeed, under quiet resting conditions, both patients with ADHD and mania show rapid drops to lower vigilance stages (e.g. assessed by an EEGalgorithm of vigilance, VIGALL). Interestingly, the opposite is found in patients with major depression who show a sensation avoidance behaviour (3). In both ADHD and mania, sleep decits aggravate the dysregulation of vigilance as well as the symptomatology indicating that the unstable vigilance is not a consequence of mania or ADHD but a causal pathogenetic factor. Further lines of evidence supporting the vigilance regulation concept of ADHD and mania will be presented. The concept explains the therapeutic effects of psychostimulants in ADHD by their vigilance stabilizing properties. There is scattered but surprisingly strong evidence that psychostimulants are not detrimental in acute mania but might have similar rapid therapeutic effects as observed in ADHD (4). The therapeutic role of methylphenidate in acute mania will be studied in an international controlled trial. 1) Hegerl et al. 2010, Current Opinion in Psychiatry 2) Hegerl et al. 2009, Pharmacopsychiatry 3) Hegerl et al. 2011, World J Biol Psychiatry 4) Schonknecht et al. 2010, Biol Psychiatry

PS-01-02 Different psychopathological dimensions in adult ADHD M. Rosler*, W. Retz * Homburg, Germany Objective: The diagnosis of Attention Decit Hyperactivity Disorder (ADHD), as described by DSM-IV, is based on 3 major psychopathological symptom domains: inattention, hyperactivity and impulsivity. The question remains open whether the DSM-IV symptoms are adequate to fully characterize adult ADHD. Several authors (e.g. Wender) have suggested that the picture of the adult disorder may somewhat different from the childhood and adolescent situation. There is an ongoing discussion about the relation of emotional dysregulation and disorganization and adult ADHD respectively. Method: This is about a review concerning diagnostic concepts elaborated particularly for the use in adult ADHD. Moreover we report on clinical treatment studies refering to the responsiveness of the symptoms of emotional dysregulation and disorganization. Results: The prevalence of symptoms of emotional dysregulation and of disorganization is on the same level as the classical symptoms of inattention, hyperactivity and impulsivity in clinical populations. Both groups of symptoms show a favourable response to pharmacological treatment. The observed effect sizes are not different from those of the classical symptoms. Conclusion: There is growing evidence that emotional dysregulation and disorganisation are intrinsic components of the psychopathology of adult ADHD.

PS-01-04 Environmental inuences in ADHD J. Buitelaar* * Nijmegen, The Netherlands Objective: To critically review the evidence for environmental inuences on ADHD. Method: Systematic review of primary papers and reviews retrieved by a search on papers published in PubMed in the years 1990-2010 Results: Twin studies indicate that genetic factors do not entirely explain the phenotypic manifestation and the developmental course of ADHD (Burt, 2009). About 30% of the variance in ADHD traits is due to either unique or shared environmental factors (Wood et al., 2010). Among the environmental factors found to be relevant for the development of ADHD are, in particular, pregnancy and delivery complications, low birth weight, premature birth, and exposure to toxins in utero (e.g. nicotine and alcohol) and childhood (e.g. lead) (see for a review Banerjee et al., 2007). Psychosocial adversity (e.g. parental psychopathology, deprivation and parenting factors) are also of importance (e.g. Biederman et al., 2002a; Stevens et al., 2009; Buschgens et al., 2008). A critical review of the evidence for a role of environmental factors related to ADHD indicates however that reects various methodological limitations of the literature (Linnet et al., 2003; Banerjee et al., 2007; Coghill & Faraone, 2010). For


80 some factors there is sufcient evidence from the literature (premature birth) or suggestive evidence (low birthweight and maternal smoking) that they play a role. For others there is (yet) insufcient evidence (alcohol, drugs, psychopathology parents, delivery problems, severe head injury, deprivation and psychosocial adversity) for their causal relationship with ADHD. Studies into environmental inuences are complicated by gene-environment correlation, and gene-environment interaction. These may lead to underestimate the effect size of environmental inuences. Conclusion: The study of environmental inuences has not kept pace with the developments in studying genetic inuences in ADHD. (fMRI) studies in adults with ADHD and pharmacological fMRI studies investigating the effect of single doses of methylphenidate and atomoxetine on task-related brain activity. Method: This review is based on a systematic literature search and research of our group in Cambridge. Results: There is converging evidence from structural and functional neuroimaging supporting the model of neurodevelopmental decits in fronto-striatal networks modulated by dopamine (and noradrenaline). Conclusion: More and better replicated ndings are needed in order to replace speculative interpretations by consolidated evidence.

Friday, 27 May 2011, 11.0012.30 PS-02 Update on neurobiology of ADHD

PS-02-01 Genetic contribution to the development of ADHD: Current state of the art B. Franke* * Nijmegen, The Netherlands Objective: ADHD is highly heritable in children and adults. ADHD has a multifactorial etiology, in which both genetic and environmental factors contribute to disease risk. In most cases, the individual genetic factors are common in the population and have only a small effect size, suggesting that hundreds of genetic variants contribute to disease in the individual patient. Recent evidence also implicates rare variants of larger effect size as disease cause in a yet unknown percentage of patients. Method: In my presentation, I will review the current knowledge of ADHD genetics, with a focus on the persistence of the disorder along the lifespan and on the utility of intermediate phenotypes for the characterization of the effects of genetic risk factors as well as for gene-nding purposes. Results: Candidate gene-based and genome-wide genetic studies have identied a small number of genes involved in ADHD. Using bioinformatics, it has been possible to identify neurite outgrowth as an important biological process in ADHD etiology. First results of studies on adult ADHD suggest that different alleles of a gene may contribute to ADHD in children and adults, and that not all genes for ADHD in childhood also predispose to adult ADHD. Recent work by our group shows that structural and functional neuroimaging is highly suited to unravel the biological pathways from gene to disease in ADHD, and that structural neuroimaging phenotypes are useful intermediate phenotypes in the search for novel ADHD risk genes. Conclusion: The eld of ADHD genetics is rapidly evolving an many new insights into the etiology of this disorder can be expected to come from such research. Large collaborative genome-wide analyses of both common and rare genetic variants continue to be a very important tool in this research, as the data currently available do not yet afford optimal power for gene nding.

PS-02-03 Neurophysiology of ADHD T. Banaschewski* * Mannheim, Germany Objective: The millisecond time resolution of electrophysiology provides a noninvasive method to monitor neural activation patterns associated with a wide variety of brain states and processes in real time. Spatial resolution has increased considerably through source imaging and combined EEG-fMRI. In addition, real time feedback of neural activity has found increasing therapeutic applications in neurofeedback and brain computer onterfaces. Specic brain functions underlying attention, inhibition, or response control can be separated with adequate ERP tasks and EEG/ERP studies can reveal both psychophysiological precursors and correlates of behavioural impairment. Method: Recent electrophysiological research on response inhibition, working memory, motivation, reward and emotion processing in ADHD and the inuence of medication is reviewed. Results: Event-related potentials indicating attentional orienting, preparation and response control revealed multiple attention and regulation problems rather than isolated inhibition decits in ADHD and help disentangling the pathophysiological background of the comorbidity with oppositional deant disorder/conduct disorder. Abnormal brain activity related to performance monitoring and error detection has been found in children, adolescents and adults with ADHD. Familial effects on deviant EEG/ERP parameters indicate that theses parameters could be considered as putative endophenotypes. Recent studies of resting-state functional connectivity indicate that altered spontaneous very low frequency brain activity may interfere with higher cognitive functions. Conclusion: Over the past decade, EEG/ERP research has contributed substantially to our understanding of altered brain processes and functions underlying ADHD. Although decient response inhibition has been proposed as the core decit in ADHD, electrophysiological studies show that ADHD cannot be fully explained by an inhibitionspecic decit. EEG/ERP and multimodal imaging studies are promising tools for multilevel investigations of etiological pathways into ADHD, and neurophysiological markers become increasingly important as targets for treatment.

PS-02-02 Imaging brain structure and function in ADHD U. Muller* * Cambridge, United Kingdom Objective: Neuroimaging research has increased our understanding of neurobiological mechanisms underlying clinical symptoms of ADHD and their response to treatment with stimulants and other pharmacological interventions. In my presentation I will review structural MRI studies in adults with ADHD, radioligand studies with PET and SPECT imaging of the dopamine system, functional MRI

Saturday, 28 May 2011, 08.3010.30 PS-03 Course, differential diagnosis and co-morbidity of ADHD
PS-03-01 ADHD and Borderline personality disorders A. Fossati, Italy


81 PS-03-02 ADHD and autism C. Freitag* * Frankfurt, Germany Objective: ADHD and Autism Spectrum Disorders show considerably phenotypic overlap. Recent studies in twins reported shared and disorder specic genetic and environmental risk factors. Shared biological and psychosocial risk factors and features have rarely been assessed. Method: The present talk will give an overview on studies on ADHD and Autism Spectrum Disorders, present new data, and will discuss areas of clinical importance and research needs. Results: There is a scarcity of studies comparing both childhood onset disorders on the phenotypic, neuropsychological, neurobiological and genetic level. Most studies were performed on neuropsychological measures. Conclusion: The clinical overlap but also the differential diagnosis of ADHD and Autism Spectrum Disorders needs to be studied further, and specic treatment studies are mandatory. Justice System. UK prison studies have indicated a rate of 43% in youths and 24% in male adults screening positive for a childhood history, 14% of whom had persisting symptoms. Those with persisting symptoms had a signicantly younger onset of offending and higher rate of recidivism. ADHD was the most important predictor of violent offending, even above substance misuse. They accounted for 8-fold more critical incidents than other prisoners. Critical incidents have also been associated with personality disordered patients screening positive for ADHD and detained under the Mental Health Act. It is the mood instability associated with ADHD that most likely increases the risk of critical incidents within institutional settings and these behavioural problems might therefore be expected to respond to treatments that reduce levels of ADHD symptoms. With this in mind, the treatment needs of ADHD offenders will be considered and data on the effectiveness of the revised R&R2 offending behaviour programme for ADHD youths and adults will be presented.

Sunday, 29 May 2011, 08.3010.30 PS-04 Update on treatment of ADHD in childhood, adolescence and adults
PS-04-01 Optimizing individually tailored pharmacotherapy in children and adolescents D. Coghill* * Scotland, United Kingdom Objective: To describe the evidence supporting individually tailoring medication treatments for ADHD and suggesting practical clinical approaches to putting the evidence into practice. Method: Review the evidence presented in recent systematic reviews of pharmacotherapy for ADHD and clinical practice guidelines and the various options for putting this evidence into practice within routine clinical settings. Results: Current evidence supports the notion that whilst remission is an achievable goal for many individuals with ADHD many clinicians appear to be satised with some improvement rather than optimised treatment. Studies of stimulant medications suggest that it is difcult to predict who will and wont respond to treatment and for those that do it is not possible to predict what dose will result in the best response. Similarly it is not possible to predict who will and will not suffer adverse effects with ADHD medications. The results of the MTA study suggest several approaches to treatment that may help optimise treatment. Accurate titration is important but is only the rst stage of treatment and it is equally important to remain focused during the continuing care phase. Conclusion: It is possible to develop and implement clinical protocols that aim to optimise pharmacological treatments for ADHD within routine clinical settings. Focussing on ADHD care pathways rather than ADHD teams may be a helpful way forward for some services and may aid transition between services.

PS-03-03 ADHD and decient emotional regulation S. Faraone* * Syracuse, USA Objective: A growing body of research suggests that decient emotional self-regulation (DESR) is prevalent and morbid among patients with ADHD. The diagnostic and prognostic utility of DESR symptoms is complicated by the occurrence of emotional symptoms in disorders that are comorbid with ADHD such as oppositional deant disorder and mood disorders. Thus, we sought to clarify the independent contribution of ADHD to DESR and the clinical implications of DESR using family study methodology. Method: Two independent studies are presented: a family study of ADHD youth and a family study of ADHD adults. For the study of youth, subjects were 197 children with and 224 without ADHD and 128 siblings We dened DESR if a child had an aggregate cut-off score of [ 180 but less than 210 on the Anxiety/Depression, Aggression, and Attention scales of the Child Behavior Checklist. For the adult study, 206 Adults with ADHD or ADHD NOS (late onset) and 123 Adults without ADHD. We assessed DESR with items from Barkleys Current Behavior Scale. All subjects and family members in both studies were comprehensively assessed with structured diagnostic interviews and a wide range of functional measures. Results: The results were essentially the same for the child and adult studies. DESR predicted increased levels of impairment and psychiatric comorbidity and the association of ADHD with DESR was independent of psychiatric comorbidity. DESR was independent of psychometric measures of neuropsychological dysfunction. The familial transmission of DESR suggests it may be a familial subtype of ADHD and is not a familial expression of other Axis I DSM-IV disorders, or of non-familial environmental factors. Conclusion: DESR is a familially transmitted emotional component of ADHD that is independent of ADHDs known comorbidities with other psychiatric disorders and neuropsychological dysfunction.

PS-04-02 ADHD through the life cycle PS-03-04 ADHD and antisocial behaviour M. Weiss* S. Young* * London, United Kingdom Objective: Research suggests there is a disproportionately high concentration of individuals with ADHD involved with the Criminal * Vancouver, Canada Objective: To identify developmental challenges found at each stage of the life cycle and demonstrate how patients can be assisted with negotiating each of these transitions.


82 Method: Symptoms are recurring patterns which dene diagnosis, however, we need to look beyond core symptoms to functioning, adaptive life skills, executive function, and quality of life to understand why there are consistent patterns that characterize each stage of the life cycle. Results: Preschoolers are often most hyperactive and impulsive, and therefore will require increased supervision. Latency places new demands for attention as the child has to do homework and requires forced effort to attend to what they nd boring as well as organizational skills. Despite these difculties many latency aged children with ADHD will have a positive illusory bias. Educational adaptations can allow academic performance to approach actual potential for achievement. Adolescence demands delayed gratication, the capacity to hold consequences in mind, a desire for peer acceptance, and even greater demands for efciency, self care, and ability to prioritize and set long term goals. Quality of life of ADHD in adolescents with ADHD may actually decline, and high risk behaviors become more common. Adults with ADHD often carry scars in self esteem from childhood, and will over the years develop insight and coping strategies that can be worked with in group or individual therapy. Conclusion: When ADHD is viewed longitudinally with multiple dimensions of outcome it becomes evident that while medication is valuable in remediating core symptoms, development can only be understood by also looking at multiple dimensions of outcome. Pills do not build skills. Treatment is by necessity multimodal and includes ongoing support and follow up. The result of this type of care is a patient who is able to compensate for their ADHD to achieve their full potential and a good quality of life. are targeted, the specic mechanisms involved, and the contribution of learned control over specic brain functions and states to the clinical outcome are less clear. Method: The review will cover recent evidence regarding the neurophysiological rationale for, and the specic and nonspecic mechanisms of neurofeedback treatment in ADHD. Selected papers, reviews and metaanalyses are examined for strengths and limitations of the approach. Results: There are sizeable, sustained and partly specic effects of neurofeedback treatment compared to partly matched control treatments, but nonspecic effects are still not sufciently addressed, and comparisons to genuine placebo treatments are largely lacking. Conclusion: The discussion will focus on the importance of specic treatment effects. It will cover the relative merits of different suitable controlled designs including placebo control, the advances and clarications expected from ongoing trials, and important areas for future research. The sizeable clinical effects of neurofeedback treatment consist of both specic and nonspecic contributions. This warrants intense further research to understand both elements, to improve the specic efcacy of neurofeedback, and to optimize training schedules.

Sunday, 29 May 2011, 11.0013.00 PS-05 Persistence of ADHD: Brain imaging, genetics and treatment
PS-05-01 Brain correlates of adult outcome in children with ADHD

PS-04-03 What do we know about psychotherapeutic treatment in adult ADHD? A. Philipsen* * Freiburg, Germany Objective: Adult ADHD is a serious risk factor for co-occuring disorders and negative psychosocial consequences. Given this background, in addition to psychopharmacological treatment there is a need for effective psychotherapeutic treatment options for adults with ADHD. Results: Previous trials on psychotherapeutic concepts were based on cognitive behavioural and/or dialectical behavioural approaches and showed signicant effects and benets for the patients. Targets of psychotherapeutic interventions are coping with the core symptoms, associated problems, comorbidities, but also probable consequences like low self esteem and interpersonal problems. Improvements of ADHD symptomatology and associated symptoms (e.g. depression, anxiety) have been reported after psychotherapeutic treatment. There is preliminary evidence for a signicantly greater benet of a combination therapy with medication and psychotherapy. The group setting per se and support by other participants is regarded as strongly helpful. Conclusion: In the lecture an overview of evaluated individual and group therapy programs in adult ADHD is given and conclusions derived from available data are discussed.

F. X. Castellanos*, E. Proal, P. Reiss, R. Klein, S. Mannuzza, J. Lerch, Y. He, A. Zijdenbos, C. Kelly, M. Milham * New York, USA Objective: Volumetric studies have reported relatively decreased cortical thickness and gray matter volumes in adults with ADHD whose childhood status was retrospectively recalled. We present the rst prospective study combining cortical thickness and voxel-based morphometry (VBM) in adults diagnosed with ADHD in childhood. In adults who had Combined Type ADHD in childhood, we sought to 1) test whether they exhibit cortical thinning and decreased gray matter density in regions hypothesized related to ADHD, and 2) test whether anatomic differences are associated with current ADHD diagnosis, including persistence versus remission. Method: Cross-sectional analysis embedded in a 33-year prospective follow-up at mean age 41. Participants were ADHD probands from a cohort of 207 6-12 year old Caucasian boys; male comparison subjects (n=178) had been free of ADHD in childhood. We obtained MRI scans in 59 probands and 80 comparisons (28% and 45% of original samples, respectively). Results: Cortex was signicantly thinner and less dense in ADHD probands than comparisons in the dorsal attentional network and limbic areas (FDR\0.05, corrected). Additionally, gray matter density was signicantly decreased in probands in right caudate, right thalamus and bilateral cerebellar hemispheres. Probands with persistent ADHD (n=17) did not differ signicantly from remitters (n=26) at FDR\0.05. At uncorrected p\0.05, remitters had thicker cortex relative to those with persistent ADHD in medial occipital cortex, insula, parahippocampus, and prefrontal regions. Conclusion: We observed anatomic gray matter reductions in adults with childhood ADHD, regardless of current diagnosis. The most affected regions underpin top-down control of attention and regulation of emotion and motivation. Exploratory analyses suggest that amelioration and diagnostic remission may result from compensatory

PS-04-04 Efcacy of neurofeedback training D. Brandeis*, R. Drechsler * Zurich, Switzerland Objective: A number of recent controlled studies have established sizeable and sustained therapeutic effects of neurofeedback training in children with ADHD. However, the neurophysiological decits which


83 maturation of prefrontal regions and cerebellar-thalamo-striatal circuitry. develop ADHD (OR= 2.46, 95% CI 1.63-3.70, p = 5.09 9 10-6). Additionally, the LPHN3-11q interaction depicts signicantly better the effect that the LPHN3 susceptibility variant has on both, the response to ADHD stimulant medication and brain metabolism. PS-05-04 Novel treatments for ADHD H. Abikoff* * New York, USA Objective: Difculties in organization, time management, and planning (OTMP) are prominent features of Attention Decit Hyperactivity Disorder (ADHD) and impact functioning as early as 3rd grade. We posited that these difculties reect organizational skills decits. An Organizational Skills Training (OST) intervention was found effective in a pilot study. To evaluate OSTs efcacy, we conducted a randomized controlled trial that included a wait-list (WL) control and a performance-based contingency-management intervention (Parents and Teachers Helping Kids get organized; PATHKO), which precluded skills-training and targeted and rewarded OTMP end-point behaviors. Method: The trial, done in the U.S. at New York University and Duke University Medical Center, randomly assigned 3rd-5th grade boys and girls with ADHD and OTMP decits to OST, PATHKO, or WL. Each treatment involved 20 one-hour twice-weekly clinic sessions. OST involved working primarily with the child, whereas PATHKO sessions occurred primarily with the parent. Outcome domains included OTMP functioning, academic functioning, homework behaviors, and family relations. Results: 180 children entered the study. Completions rates were high (OST = 96%, PATHKO = 92%, WL = 100%). Extensive evidence of efcacy was obtained for both interventions, with most signicance levels at p \ .0001, and effect sizes ranging from .63 to 2.80. Almost two-thirds of the children in each treatment group no longer met entry criteria for OTMP decits vs. 6% of controls (p \ .0001). OST was superior to PATHKO on parent ratings of organizational functioning (p \ .001) and family conict (p \ .05). On all other outcomes, OST and PATHKO were comparable. Parents and teachers were satised with both treatments. Conclusion: Robust treatment effects were obtained for childrens organizational functioning at home and school and on other key functional domains. The skills-based and performance-based treatments show promise of broad clinical applicability with elementary school-aged children with ADHD and OTMP decits.

PS-05-02 Using structural neuroimaging to understand clinical outcome in ADHD P. Shaw*, W. Sharp, M. Malek, J. Rapoport * Bethesda, USA Objective: To delineate the neuroanatomic correlates of variable clinical outcome in Attention Decit Hyperactivity Disorder. Method: Setting: US Federal Research Institute. Subjects: Observational study of 145 children with DSM-IVR dened combined type ADHD (mean age at study entry 11.2 years) were followed longitudinally, with repeated neuroanatomic imaging on a 1.5T GR scanner and clinical assessments into adolescence (mean age at last assessment 17.2, SD 2.5 years). Comparison was made with age, sex and IQ matched typically developing youth with no DSM-IV diagnoses. Linear mixed model regression was used to delineate the developmental trajectories of the cerebral cortex, cerebellum and hippocampus/amygdala and basal ganglia. Results: ADHD which remitted by adolescence was associated with a signicant convergence towards the trajectories of typical development in the cerebral cortex and cerebellum. By contrast, persisting ADHD with full persistence was associated with progressive divergence from typical trajectories. Subjects with partial remission showed an intermediate pattern. Conclusion: Variable clinical outcome of ADHD in adolescences is accompanied by distinct neurodevelopmental trajectories. Improving symptomatology is reected or perhaps driven by a convergence towards typical trajectories, whereas clinical persistence is accompanied by progressive neurodevelopmental deviation.

PS-05-03 Attention Decit Hyperactivity Disorder: From Understanding Genetics to Treatment M. Muenke* * Bethesda, MD, USA Objective: Attention Decit Hyperactivity Disorder (ADHD) is the most common behavioral disorder of childhood with a high heritability. Using pedigrees from a genetic isolate we previously described linkage and association to a handful of loci (4q, 5q, 8q, 11q, and 17p) (Arcos-Burgos et al., AJHG 75:998, 2004). Recently, we identied LPHN3, a novel ADHD susceptibility gene in 4q: we showed that a common variant in LPHN3 confers susceptibility to ADHD and predicts effectiveness of stimulant medication (Arcos-Burgos et al., Mol Psych 15:1053, 2010). Here we explore the interaction between this and additional ADHD-associated loci. Method: We screened for potential interactions between ADHDlinked loci, conditioned on the LPHN3 associated SNPs, and used case-control and family-based association test (FBAT) designs. Results: We found a signicant correlation between 4q and 11q (p\1 9 10-8). Furthermore, we detected interacting effects with a haplotype in 11q (p\5 9 10-6). This haplotype encompasses the gene for neural cell adhesion molecule 1 (NCAM1) that has a fundamental role in neural development, and it is adjacent to the dopamine receptor D2 (DRD2), a gene previously associated with ADHD. Using three additional ADHD datasets, that previously showed association of ADHD to LPHN3, the LPHN3-11q interaction was replicated by formal meta-analysis. Conclusion: The effect of the LPHN3-11q interaction represents a two-fold increase from the original risk conferred by LPHN3 to

Saturday, 28 May 2011, 11.0012.30 PCD-01 The psychostimulant is not dangerous for the patients
PCD-01-01 Proponent L. Greenhill* * New York, USA Abstract not received

PCD-01-02 Opponent K. W. Lange* * Regensburg, Germany


84 Abstract: Methylphenidate is the most frequently prescribed stimulant drug in the treatment of attention decit disorder and has been the focus of much controversy, since a number of harmful methylphenidate-related effects have been observed. In most cases, the side effects are mild but some can be life-threatening. Methylphenidate has been reported to cause sudden death in children and teenagers, especially in subjects with heart defects or serious heart problems. Exposure to methylphenidate and amphetamines salts appears to have similar risks for cardiac emergencies. The ever increasing prescription of methylphenidate has led to non-medical and illicit use (such as cognitive neuroenhancement and brain doping) which is likely to cause a variety of consequences including addiction, negative reactions and medical complications. Method: We performed a literature review and analysis of published and unpublished family and twin studies of ADHD in adults. Results: We found that ADHD tends to aggregate in families and that there are signicant familial associations between parent and offspring ADHD. However not all studies show signicant parent-offspring associations for ADHD. For twin studies we nd that heritability estimates drop from around 70-80% during childhood and adolescence to around 30-40% during adulthood. However these ndings are rater dependent, with higher estimates of heritability and parent-offspring associations for ADHD derived from informant data than with selfratings. Since twin studies of ADHD symptoms in adults have all used self-rating scales, we cannot exclude the possibility that the observed decline in heritability represents a rater effect. Furthermore, bivariate genetic correlations between inattention and hyperactivity-impulsivity remain stable across the lifespan. We further show preliminary evidence that self-ratings are confounded by adult onset ADHD symptoms that show no familial association with childhood onset ADHD. Conclusion: Heritability estimates are lower in adults than during childhood or adolescence, but this may be accounted by rater effects and the onset of ADHD symptoms during adulthood that are aetiogically distinct from childhood onset ADHD. The underlying genetic architecture of ADHD remains stable throughout the lifespan. Further work is needed to clarify the causal inuences on ADHD in adults.

Thursday, 26 May 2011, 13.0014.30 HT-01 IMpACT symposium on adult ADHD

HT-01-01 Brachiating along the developmental trajectory on the persistence of intermediate ADHD phenotypes B. Franke* * Nijmegen, The Netherlands Objective: The genetics of adult ADHD is still largely uninvestigated and only few genes for severe form of the disorder have been identied. Investigation of intermediate phenotypes may help provide novel candidate genes for further testing. Method: In my group, we use intermediate phenotype approaches at the level of ADHD symptom severity, neuropsychological functioning and functional/structural neuroimaging for the identication of novel genes involved in adult ADHD. In addition, we use these intermediates for the characterization of the biological pathways along which these genes increase ADHD risk. Results: As for gene-to-disease pathway mapping I will present (among others) our ndings on the NOS1 Ex1f VNTR, suggesting that this risk factor for ADHD actually exerts its effect on disease risk by acting on impulsivity, a hallmark of ADHD. This is observed both, at the level of neuropsychological performance and of striatal brain activity during an reward anticipation task. As for gene-nding using intermediate phenotypes, I will show evidence of the usefulness of population-based adult ADHD symptom scores, as these have marked effects on brain structure, in this case total brain volume, similar to effects observed in patients with ADHD. Using the intermediate phenotype of adult total brain volume in a genome-wide association study, we have identied novel candidates for further study in adult ADHD. Conclusion: Intermediate phenotypes are useful for gene-nding in adult ADHD as well as for mapping of the mechanisms by which genetic ADHD risk factors increase disease risk.

HT-01-03 You can always blame your mother: How maternal genotype contributes to offspring ADHD J. Haavik*, S. Johansson, A. Halmy, J. McKinney, I. winge, P. Knappskog * Bergen, Norway Objective: Animal research and human studies have identied multiple signalling molecules that are involved in embryonic brain development and that deciency of these factors may lead to longterm adverse effects on brain development and function. One such signalling molecule is serotonin that is a classical neurotransmitter and recently has been shown to be a humoral trophic factor essential for embryonic development. Method: Adult outpatients with ADHD, their family members and random controls were recruited all across Norway. To determine whether genetically determined deciency of serotonin or other maternal growth factors is associated with symptoms of ADHD or related neuropsychiatric disorders in offspring, we performed targeted resequencing of the gene involved in serotonin biosynthesis in peripheral tissues (TPH1) in 741 individuals, as well whole exome sequencing in a subgroup of 12 pedigrees. We identied eight pedigrees with TPH1 mutations carriers. Information about psychiatric diagnoses and symptoms were obtained from all participants and 419 additional controls. All mutant TPH1 variants were expressed in E. coli and human cell lines, puried and subjected to systematic biochemical characterization. Results: Of the seven different TPH1 coding variants that were detected in 38 persons, six variants had signicantly decreased stability or activity in vitro compared to wild type enzyme. Offspring of mothers carrying TPH1 mutations reported much higher ADHD scores than controls, or offspring of fathers with the corresponding TPH1 mutations (p \ 0.001). Exome sequencing revealed several additional candidate genes and mutations that similarly could be involved in embryonic brain development. Conclusion: An impaired maternal serotonin production may have profound long-term behavioural effects on their offspring, independent of the childrens own TPH1 genotypes. Exome sequencing in large pedigrees, combined with high-throughput functional characterization of candidate genes is a promising technology to obtain new insights into pathogenic mechanisms of complex disorders, including the effects of maternal genotypes on offspring behaviour.

HT-01-02 Measuring the heritability of adult ADHD P. Asherson*, A. Merwood, H. Larsson *London, United Kingdom Objective: ADHD tends to aggregate in families and is known to be a highly heritable phenotype during childhood and adolescence. Yet population twin studies of ADHD symptoms in adults nd much lower estimates of heritability; around half the heritability estimated during the childhood and adolescent years. Here we review family and twin studies of ADHD in adults to investigate the potential reasons for the decline in heritability estimates throughout the lifespan.


85 HT-01-04 Expanding the phenotype - shared risk genes for bipolar disorder and adult ADHD A. Reif* * Wurzburg, Germany Objective: Several GWAS on bipolar disorder (BPD) suggested novel risk genes. However, only few of them were followed up and the specicity of these genes is elusive. On the other hand, linkage analyses implicated the 9q22 region in Attention Decit Hyperactivity Disorder (ADHD). This locus contains the brain-expressed GTP-binding RASlike 2 gene (DIRAS2). There is accumulating evidence for neurobiological overlap with of ADHD with BPD, with a high percentage of adult ADHD patients also suffering from BPD and vice versa. Method: To address these specicity of the risk genes implicated in the studies mentioned above, we genotyped ANK3, CACNA1C, DGKH, and EGFR, which were signicantly associated with BPD in previous GWAS, in a sample of 380 BPD patients. Replicated SNPs were then followed up in patients suffering from unipolar depression (UPD, n=387) or adult ADHD (n=535). Furthermore, we conducted an association study with respect to DIRAS2 in 600 patients suffering from adult ADHD. Replication samples consisted of 1035 adult ADHD and 336 BPD patients. Results: While we could not conrm association of ANK3, CACNA1C and EGFR with BPD, 6 SNPs in DGKH were associated with disease, two of them surviving correction for multiple testing. All of them were associated with UPD or aADHD. Furthermore, a haplotype was associated with all disorders. Four DIRAS2 SNPs and two haplotype blocks showed evidence of association with ADHD. In the replication samples, we obtained a consistent effect of rs1412005 and a risk haplotype. Meta-analysis resulted in a signicant common OR of 1.12 for rs1412005 and conrmed association with the risk haplotype (OR=1.45, p=0.0003). rs1412005 also increased risk towards BPD. Conclusion: We demonstrate an association of DGKH and DIRAS2 with BPD and ADHD by applying two-stage designs. The considerable dimensional overlap between them thus might be partially explained on the molecular level by genetic variation in these risk genes. 2001). With SPM8b one-sample t-tests will be performed to determine activations within groups using the individual contrast images anticipation of gain[anticipation of no-gain and anticipation of loss[ anticipation of no-loss. ANOVA for dependent measures will be used to compare these contrasts between drug-nave and medicated patients. Analyzes will explore BOLD signals in controls relative to ADHD. Results: Preliminary: Independent of medication status, 8 patients showed higher activation in anterior and posterior cingulate, ventral striatum, insula as well as hippocampus during anticipation of loss. During anticipation of gain patients showed signicant activation in the ACC, brain stem, cerebellum and premotor cortex. MPH-intake was associated with lower effect sizes during positive and negative reward conditions. Results comparing ADHD patients and healthy controls will be presented. Conclusion: Preliminary results suggest ventral striatal brain activation during the anticipation of gain as well as loss in children with ADHD, independent of medication status. MPH-intake seems to be correlated with lower activations in reward related structures.

HT-02-02 Reward processing in male adults with childhood ADHD a comparison between drug-nave and methylphenidatetreated subjects M. S. Stoy*, L. Schlochtermeier, F. Scxhlagenhauf, U. Lehmkuhl, M. Huss, A. Heinz, A. Strohle * Berlin, Germany Objective: We examined reward processing in adulthood depending on treatment with Methylphenidate (MPH) in subjects with Attention Decit Hyperactivity Disorder (ADHD) during childhood. Method: 11 males with childhood-ADHD treated with MPH, 12 drug-nave males with childhood-ADHD and 12 controls matched by age, handedness and smoking behavior were investigated drug-free in a functional magnetic resonance imaging study using a monetary incentive delay task. As regions of interest we choose the ventral striatum (VS) during anticipation and the orbitofrontal cortex (OFC) during outcome. Results: Our ANOVA did not reveal any signicant effect of group during the anticipation and outcome of gain. Controls, drug-nave and treated subjects did not signicantly differ in their activations in the VS and OFC. Interestingly, whole-brain analyses revealed a decreased activation in the insula in response to loss-outcome in drug nave subjects in comparison to controls and treated subjects. In contrast, subjects with MPH treatment did not show signicant differences compared to controls. Brain activation in the insula correlated signicantly positive with harm avoidance. Conclusion: Our ndings indicate normalizations in the reward system independently of MPH-pretreatment in subjects previously diagnosed with childhood-ADHD. Differences between treated and drug-nave ADHD subjects underpin the need of prospective studies on long-term effects of psychostimulant treatment.

Thursday, 26 May 2011, 13.0014.30 HT-02 Reward processing in children and adults with ADHD
HT-02-01 Reward processing in children with Attention Decit Hyperactivity Disorder - a comparison between drug-naive and methylphenidate-treaded subjects and healthy controls V. Jucksch*, A. Beck, H. Salbach-Andrae, A. Strohle, U. Lehmkuhl * Berlin, Germany Objective: Neuroimaging studies have postulated dysfunctions in the mesolimbic reward system in patients with ADHD (Strohle et al., 2008; Scheres et al., 2010). While performing a monetary incentive delay task (MID; Knutson et al., 2001), patients with ADHD showed reduced ventral striatal activation during reward anticipation. Methylphenidate (MPH) acutely modulates neural activity during response inhibition tasks within PFC and striatum (Rubia et al., 2009). Therefore we examine: 1) brain activity and reward processing in healthy children compared to those with ADHD, and 2) the neural basis of symptom improvement in ADHD after treatment with MPH. Method: 15 children with ADHD and 15 controls were enrolled. Each participant underwent two fMRI sessions, while ADHD patients were drug-nave and after they had received MPH for at least 4 weeks. During each fMRI session, participants performed a MID task (Knutson et al.

HT-02-03 A reward task for simultaneous EEG-fMRIneuroimaging: Pilot results for a study with ADHD children I. Wolf*, M. Plichta, S. Rechtsteiner, S. Hohmann, C. Diener, P. Meyer, M. Zangl, M. Ruf, C. Niemeyer, D. Gass, S. Heike, D. Mier, P. Kirsch, H. Flor, A. Meyer-Lindenberg, T. Banaschewski, M. Holtmann, D. Brandeis * Germany Objective: Simultaneous recording of fMRI (functional magnetic resonance imaging) and EEG (electro encephalogram) is increasingly used


86 to study cognitive and motivational states in basic and clinical neuroscience. We now use this combined measurement technique to learn more about the human reward system involving several neural substrates forming a complex brain network. Simultaneous recordings require modications of the original fMRI reward to improve signal to noise ratio for EEG. One aim of the present study was thus to nd out whether the fMRI core results would prove robust in the modied paradigm, while resolving potential technical problems which may occur when combining both methods in challenging motivational paradigms. Method: Based on previous work of Kirsch et al. (2003) we modied a reward anticipation task for the use with EEG (requiring a button press after a visual cue), which is known to reliably activate ventral striatal brain structures. EEG data and fMRI images were simultaneously acquired in a 3T MRI Siemens TIM Trio scanner from 20 healthy participants (20 to 26 years) using an event related design. Money gained of the reward task was paid after the fMRI-Session. Results: We found a stronger BOLD signal in the ventral striatum during anticipation of reward. The robust activation of the brain reward system in our modied monetary incentive task conrms that neither simultaneous fMRI-EEG, nor the corresponding task modications diminished sensitivity in detecting ventral striatal BOLD-responses. The analyses revealed meaningful ERPs with signicant differences between both conditions (win money/no money) developing during early (\1s) as well as late ([1s) stages of reward anticipation. Conclusion: Showing that simultaneous combination of both methods produced good data quality concerning electrophysiology and hemodynamic response future work will concentrate on data fusion of both techniques to fully utilize the complementary information brought by EEG to fMRI and vice versa. HT-02-04 Altered reward processing in ADHD: Information from fMRI and NIRS A. Fallgatter*, M. M. Plichta, S. Heinzel, A.-C. Ehlis * Tubingen, Germany Objective: The reward system is considered a relevant part of the brain network disturbed in ADHD. Delay discounting is a particular form of reward processing related to impulsivity and is operationalized as the preference for smaller-but-sooner over later-but-larger rewards. Delay discounting can be measured with intertemporal choice paradigms. Moreover, neural structures involved in delay discounting (e.g. the ventral-striatum and the orbitofrontal cortex) are highly innervated by dopaminergic neurons. Method: We employed the functional imaging methods Near-Infrared Spectroscopy (NIRS) and functional Magnetic Resonance Imaging (fMRI) in order to measure brain function during intertemporal choice paradigms in groups of healthy subjects and patients with ADHD. Behavioral measures of impulsivity were employed. Dopaminergic neurotransmission was assessed by a genetic polymorphism (Val158Met) in the gene of the catechol-O-methyltransferase, which has been shown to alter the dopamine bioavailability. Results: NIRS measurements in healthy subjects indicated a dopamine-related increase of function from low (low DA level) to partial (intermediate DA level) and full (high DA level) reward delay sensitivity within the orbitofrontal cortex. Furthermore, DAbioavailability was shown to moderate the association of neural reward delay sensitivity and impulsivity: reward delay sensitivity in the orbitofrontal cortex was strongly correlated with impulsivity at intermediate dopamine levels, but not at low or high dopamine levels where impulsivity was related to delay-independent activation of the orbitofrontal cortex. Functional MRI investigations suggested a hyporesponsiveness of the ventral striatal reward system in patients with ADHD as compared to healthy controls for both immediate and delayed rewards. In contrast, delayed rewards evoked hyperactivation in the dorsal caudate nucleus and the amygdala of ADHD patients. Conclusion: These data support the conception of a close link between delay discounting, brain activation and dopaminergic neurotransmission. In particular, the results implicate that studies on neural correlates of delay discounting should account for the dopamine bioavailability.

Thursday, 26 May 2011, 13.0014.30 HT-03 Progress in understanding and treatment of ADHD - a neurobiological perspective
HT-03-01 Neuronal inhibition and its modulation by TMS neurotherapeutic perspectives for ADHD S. Bender* * Dresden, Germany Objective: The inhibition of unwanted movements is a core problem in Attention Decit Hyperactivity Disorder (ADHD). Transcranial magnetic stimulation (TMS) is a compelling method to assess and inuence inhibition in the brain. What can TMS tell us about inhibitory decits in ADHD? Can these decits be ameliorated by a TMS intervention (repetitive TMS)? Method: We assessed an inhibitory component of the EEG-response to TMS in 8-14-year-old ADHD children and whether a TMS intervention would inuence this inhibition marker (N100). Results: We found a reduced N100 in ADHD children. During a 1-Hz TMS intervention, there was a signicant further decrease and no normalization of this inhibitory EEG-response. There were no signicant effects on hyperactive behaviour with this TMS-protocol. Conclusion: The EEG-response to TMS reveals inhibition decits in ADHD and is an excellent marker to monitor TMS-intervention effects - because TMS protocols must be optimized in order to ameliorate behavioural symptoms.

HT-03-02 Candidate genes in ADHD the importance to elucidate differential functional effects T. Renner*, C. Roser, A.-C. Ehlis, T. Hahn, J. Christian, T. Nguyen, M. Gerlach, A. Fallgatter, A. Warnke, K.-P. Lesch * Wurzburg, Germany Objective: Altered neurotransmission plays a major role in the pathophysiology of ADHD. Molecular genetic approaches aim to reveal new candidates and their specic impact on functional levels. In a differential approach we aimed to elucidate the potential role of KCNJ6, a gene involved in monoaminergic neurotransmission, in the pathophysiology of ADHD, especially in cognitive functions and reward processes. Method: ssociation between KCNJ6 and ADHD was investigated in a family based sample (n=111) and an adult case-control sample (n=450/426). Further, the inuence of rs7275707 on brain activation of ADHD patients (n=183) and healthy controls (n=118) during a continuous performance test (EEG) and in healthy probands (n=53) during reward conditions (fMRI) was assessed. Results: Association was found in the family-based design, but not in the adult case-control sample. A specic effect of rs7275707 on brain activation in ADHD patients and a general inuence on reward related activation was detected.


87 Conclusion: Though association with the general ADHD phenotype was not conrmed, our results indicate a specic inuence of KCNJ6 on brain activation in ADHD and a role as general modulator in reward processes. impairments in vigilance/sustained attention and working memory. Impairments of these functions appear therefore to be the most reliable neuropsychological markers of ADHD. However, meta-analyses have shown that a considerable number of studies failed to nd these differences between patients with ADHD and healthy individuals. Furthermore, effect sizes indicated only small to moderate differences between patients with ADHD and healthy participants. Conclusion: Although there is convincing evidence of cognitive dysfunctioning in ADHD, there is no clear, valid and reliable neuropsychological test prole sensitive or specic for ADHD. Individuals with ADHD have unique proles of neuropsychological functioning, with some patients showing impairments in one function and other patients displaying decits in another function. On group level, patients may differ from healthy participants with regard to cognitive functioning. However, there is no neuropsychological marker that is distinctive regarding the individual diagnosis of ADHD. HT-04-02 Olfaction in ADHD and comorbid disorders M. Romanos*, M. Schecklmann, M. Gerlach * Munchen, Germany Objective: Various neuropsychiatric disorders such as ADHD are associated with specic alterations in olfactory function. Dopaminergic dysfunction is suggestive to underlie these observations. Olfaction may be a phenotypic marker for neurobiological alterations related to specic neuropsychiatric disorders. Method: Here we summarize recent clinical and functional imaging investigations on olfaction in ADHD and associated neuropsychiatric disorders. Results: Alterations in olfactory function are widely prevalent in neuropsychiatric disorders, although distinct domains and aspects of olfaction are differentially affected in the respective disorders. Modulation of neurotransmission by central nervous medication inuences olfactory function. Increased olfactory sensitivity seems to be specic for childhood ADHD. Conclusion: We suggest increased olfactory sensitivity as promising state marker of ADHD that is modulated by stimulant medication and normalizes during temporal development of the disorder. Olfactory function may be a useful biomarker for diagnosis, differential diagnosis and treatment monitoring of ADHD.

HT-03-03 Neural correlates of processing emotional stimuli in children and adolescents with ADHD: An fMRI study on serotonergic modulation F. Zepf*, B. Herpertz-Dahlmann, T. Gaber, K. Helmbold, S. Bubenzer, D. Baurmann * Aachen, Germany Objective: Children and adolescents with ADHD often show covarying problems in affective regulation. The neurotransmitter serotonin (5-HT) has been linked to affective and emotional processes, with evidence coming from human studies involving adults and pharmacological studies using the administration of SSRIs. However, studies in children and adolescents are scarce, and it is not known how an acute central nervous decit in 5-HT synthesis affects affective and emotional processes in adolescents with ADHD. The present study investigated the effects of an acutely diminished central nervous 5-HT synthesis in combination with functional magnetic resonance imaging (fMRI) in order to study the neural correlates of processing emotional stimuli in adolescents with ADHD. Method: Male patients with ADHD aged 9-17 years received the rapid tryptophan depletion-test (RTD) Moja-De in a double-blind within-subject crossover-design. They participated on two days in the investigation, with the two testing days spaced 7 days apart. On one day they received the RTD-test Moja-De within an amino acid drink lacking tryptophan (TRP), the physiological precursor amino acid of 5-HT, thus leading to a diminished central nervous 5-HT synthesis. On a second day they received a TRP balanced amino acid mixture as a control condition. Under depletion/the control condition the participants had to do an emotional word-face matching task in an fMRI environment (Siemens Trio, 3T) in a rapid event-related task design. Results: We will show imaging data on the serotonergic modulation of brain regions involved while the subjects performed the emotional word-face matching paradigm. Conclusion: Implications for neurocircuitries involved in affective and emotional processing will be discussed.

Thursday, 26 May 2011, 14.3016.00 HT-04 Biomarker candidates for the diagnosis, longterm course and therapeutic management of ADHD
HT-04-01 Neuropsychological assessment O. Tucha* * Groningen, The Netherlands Objective: While neuropsychological measures are no biomarkers stricto sensu, they nevertheless full some of the criteria of classical biomarkers such as the objective measurement of processes that have the potential to indicate the presence of a pathology, physiological alteration, decit or psychological condition. This presentation aims to give an overview of cognitive decits of patients with Attention Decit Hyperactivity Disorder (ADHD) and to evaluate the use of neuropsychological assessment in the diagnosis of ADHD. Results: Decits in all domains of cognitive functioning have been reported in children and adults with ADHD. However, these ndings are inconsistent across studies. The most robust ndings are

HT-04-03 Transcranial brain sonography in children and adults with hyperkinetic movement disorders J. Buchmann* * Rostock, Germany Abstract: Transcranial (TBS) sonography, measuring the echogenicity in distinct brain regions, provides a simple and secure approach, very suitably for children. Alterations in the echogenicity of the basal ganglia are discussed as a possible pathophysiological substrate in movement disorders (Becker 1995, Walter 2002). Furthermore, it is assumed that pediatric neuropsychiatric disorders with hyperkinetic movements like ADHD could be pathophysiologically linked to malfunctions of distinct target brain regions, e.g. basal ganglia (caudate nucleaus - CN) or the echogenic size of the substantia nigra (SN) (Krauel et al. 2010, Romanos 2010). Less is known about other pediatric neuropsychiatric movement disorders. We investigated tic/tourette children and found correlations (preliminary results) between echogenic size/echogenicity of CN and SN with motorcortical excitability, both related to the YGTSS score. The contribution provides a brief overview of evidence in transcranial brain sonography in pediatric neuropsychiatric disorders and introduces selected results of its own.


88 HT-04-04 Biomarker research mRNA and protein expression analyses R. Taurines*, M. Romanos, M. Schecklmann, T. Renner, E. Grunblatt, S. Walitza, J. Thome, A. Warnke, M. Gerlach * Wurzburg, Germany Objective: In the absence of objective clinical characteristics, the identication of peripheral biomarkers in neuropsychiatric disorders is highly relevant for the diagnostic process and an individualized therapy. In our studies we analyzed mRNA-expression of candidate genes (BDNF, DRD4, DRD5, TPH1) in peripheral tissue of patients with Attention Decit Hyperactivity Disorder (ADHD) and autism spectrum disorders (ASD) searching for possible molecular markers for these disorders. BDNF expression was additionally assessed on the protein level. Method: Serum and mRNA was obtained from children and adolescents with ADHD and ASD ( comorbid ADHD), diagnosed according to ICD10 criteria, as well as healthy controls. mRNA expression was determined via quantitative realtime PCR, serum BDNF concentrations via ELISA. Results: From the realtime PCR, DRD4-mRNA levels differed signicantly with lower transcript levels in ADHD and ASD children (75% comorbid with ADHD) compared to healthy controls. ASD patients revealed a decreased DRD5 mRNA expression in comparison to the two other groups and a lower BDNF mRNA expression compared to controls. Decreased BDNF expression in ASD patients was conrmed on the protein level. Conclusion: Alterations in mRNA and protein expression patterns in peripheral tissue are potential biomarkers which might in the future facilitate an early diagnosis and differential diagnosis of ADHD and ASD. Sensitivity and specicity of these possible markers have to be determined in future studies in larger cohorts and patients with further neuropsychiatric disorders. HT-05-02 The European network adult ADHD P. Asherson*, S. J. Kooij * London, United Kingdom Objective: The European Network Adult ADHD (ENAA) was established as a network of psychiatrists and psychologists, experienced in clinical management and research of adults with ADHD (A-ADHD). Method: ENAA was established in 2003 and included 40 professionals from 18 countries across Europe. Results: ENAA successfully established an international network of experts. The group has been particularly concerned that due to the lack of recognition and use of appropriate treatments, many adults with ADHD are misdiagnosed and prevented from receiving effective treatments; leading to unnecessary suffering for individuals and their families. To address this issue ENAA published a European consensus statement on diagnosis and treatment of A-ADHD (Kooij et al., 2010). The statement was reviewed and agreed by ENAA members following three meeting between 2003 and 2009 and review of the published literature. ENAA also serves to support local initiatives. For example, Asherson and colleagues established the UK Adult ADHD Network ( UKAAN has developed training courses for the diagnosis and treatment of A-ADHD; and has organised meetings and expert workshops on the delivery of clinical services, ADHD in the criminal justice system, ADHD and addiction, ADHD and occupational health and the role of neuropsychology. UKAAN will also host the rst ENAA conference for ADHD across the lifespan (London, September 21. 22), which focuses on aetiology, clinical course, diagnosis and treatment of ADHD in the adult years; and will be preceded by a workshop for ENAA and other professionals involved in national and international clinical and research initiatives for A-ADHD. Conclusion: A-ADHD remains a condition that is not adequately recognised or treated in many European countries. ENAA provides essential support for the development of clinical practice and research for A-ADHD, leading to improvements in the treatment of this common and often severe mental health disorder. Conclusion: CADDRA has set a model now being replicated, The creation of such networks will raise awareness of ADHD, allow for access to care through family practice, provide ongoing education of physicians, and continue systematic lobbying for ADHD to be recognized as one of the leading mental health conditions requiring care.

Thursday, 26 May 2011, 14.3016.00 HT-05 Networking the adult networks

HT-05-01 CADDRA, the Canadian network M. Weiss*, A. Vincent * Vancouver, Canada Objective: The objective of CADDRA was to network the experts in ADHD from across the country to 1. advocate for ADHD in medical education 2. create a national ADHD continuing education program 3. generate a world class national ADHD conference so that local clinicians would be exposed to the cutting edge of new research, and 4. to create user friendly practice guidelines to establish a uniform minimal standard of care. Method: The symposium will review the logistics of how the organization was created so it can be duplicated in other countries. We will present our successes in collaborating with patient advocacy groups, and for reimbursement of medication. We will review the format, role, and structure of the third edition of the guidelines and the use or our website for publication of the guidelines and to create a membership. Results: Physicians representing both languages, all provinces, and all specialties organized the executive board. CADDRA is now incorporated as a non prot organization with bylaw that insure its ongoing structures for the future. Our national, annual conferences have been well attended with presentations by world class speakers so as thus inform local clinicians of the cutting edge of new research and methods of practice. Unique aspects of our practice guidelines is that they are both printed and web based, they are continuously updated, and they include an ADHD toolkit that makes it possible for a general practitioner to assess and treat ADHD, with free rating scales appropriate to all ages.

HT-05-03 The Latin American network E. Barragan* * Mexico, Mexico Objective: To explain the objetives and impacts in the adult networking in latinamerica Method: We analyze the diagnosis of adult ADHD in LA using the LatinAmerican survey for ADHD, the major comorbilities in our region and the rst lines of treatment. Results: We proposed to used a regionalized screenig tool adapted to our necesities, as well, to the rst line treatments fo adults in latinamerican treatment guides. In these, we concluded that methyphenidate and atomoxetine in combination with a cognitive therapy are the best choice of treatment. Conclusion: In LA, ADHD in adults its not well recognized. We need to improve diffusion and have a more educational labor with people dedicated to Adult mental health. The treatment in adults have a good efcacy and its well tolerated.


89 HT-05-04 APSARD, the USA network A. Rostain* * Philadelphia, PA, USA Abstract not received they did not present with signicant antisocial comportment in childhood. When ages 18, 25 and 41, they and 178 boys without ADHD were blindly assessed. The developmental sequence leading to substance abuse will be presented. Results: Through adulthood, at age 41, the greatest risk factor for substance abuse and dependence is Antisocial Personality Disorder which originated de novo during adolescence. Conclusion: Among children with ADHD who did not have conduct disorders when diagnosed, substance abuse and dependence follows a clear developmental pattern. Abuse of drugs appears mediated by the development of antisocial disorders.

Thursday, 26 May 2011, 14.3016.00 HT-06 International Collaboration on ADHD and substance abuse (ICASA,
HT-06-01 ADHD and substance abuse: Clinical and pharmacological perspectives W. van den Brink* * The Netherlands Abstract not received

HT-06-04 ADHD and substance abuse: Challenges for harm minimisation S. Kaye* * Sydney, Australia Objective: The harms associated with substance use disorders (SUD) are well documented and have a wide impact, particularly on physical, psychological and social functioning. SUD are associated with poorer physical and psychological health, increased criminal activity, increased risk of violent offending and victimisation, and a range of risk-taking behaviours. Risk behaviours that are particular features of SUD include harmful routes of drug administration (e.g. injecting), blood-borne virus risk behaviours (e.g. needle-sharing; unsafe sex practices), and high-risk driving behaviours (e.g. speeding; dangerous driving; driving under the inuence of alcohol/drugs). Psychiatric comorbidity is highly prevalent among those with SUD, who have higher rates of mood, anxiety and personality disorders than the general population. Depending on the nature of the comorbid disorder, this can result in a range of complications for the course and treatment of SUD. In the case of comorbid ADHD, the vulnerability to those harms already inherent in the use of alcohol and other drugs is likely to be increased. Those with ADHD may be at greater risk of SUD-related harm due to the inattention, carelessness, and impulsive behaviour that are associated with ADHD. In addition to various treatment interventions targeted toward the cessation or reduction of substance abuse, public health strategies designed to reduce the harm associated with SUD have been developed and implemented in many countries. The presence of comorbid ADHD, however, poses particular challenges to the implementation and effectiveness of these strategies. Difculties with reading, attention and information processing may reduce the effectiveness of educational programs and information resources, whilst impulsivity may affect compliance with harm minimisation protocols and recommendations. This presentation will entail a discussion of these, and other, implications of comorbid ADHD for SUD harm minimisation.

HT-06-02 ADHD and substance abuse: A genetic perspective J. A. Ramos-Quiroga* * Barcelona, Spain Objective: Cocaine is the second most used illegal drug in Europe. The transition from use to dependence involves both genetic and environmental factors. Genetic variation in neurotransmitter systems is involved in the susceptibility to cocaine dependence and ADHD. We examined the possible contribution to cocaine dependence of 15 genes involved in the cellular machinery that controls neurotransmitter release: genes encoding proteins of the SNARE complex (STX1A, SNAP25, VAMP1 and VAMP2), fusion control elements (SYT, SYT2, CPLX1, CPLX2, CPLX3 and CPLX4) and regulatory elements (STXBP1, SYP, SNPH, NSF, and RAB3A). Method: We genotyped 121 SNPs, selected according to genetic coverage criteria, in 360 cocaine-dependent patients and 360 controls from Spain Results: Single and multiple-marker analyses revealed a strong association between cocaine dependence and the NSF gene, encoding the N -ethylmaleimide-sensitive factor (P _ 5.1e-04, OR _ 2.44 (1.45 4.00) and P _ 0.001, OR _ 1.82 (1.28 2.59), respectively). The presence and absence of psychotic symptoms were also studied. Interestingly, when we considered the time between initial consumption and the onset of cocaine dependence, we observed that the association was mainly restricted to the group of patients that rapidly developed drug dependence (_ 2 years; P _ 2.98e-06, OR _ 1.33 (1.20 1.47)). Conclusion: Our data show preliminary evidence that NSF may predispose not only to cocaine dependence, but also to an early onset of the dependence.

Thursday, 26 May 2011, 14.3016.00 HT-07 Structural, functional and neurochemical correlates of adult ADHD: Do they differ from childhood?
HT-07-01 Structural correlates of adult ADHD: Do they differ from childhood ADHD? K. Konrad* * Aachen, Germany Objective: Unlike in other psychiatric disorders, the majority of neuroimaging studies on structural brain abnormalities in ADHD has included children and adolescents. However, more recently a number

HT-06-03 ADHD and substance abuse: A longitudinal perspective R. G. Klein* * New York, USA Objective: The objective is to elucidate the developmental trajectory from childhood ADHD to substance abuse through adulthood. Method: A cohort of 207 boys were systematically diagnosed with ADHD when they were between 6 and 12 (Mean, 8). Importantly,


90 of studies addressed structural correlates of ADHD in adults including analyses of both grey and white matter development across the lifespan. Method: We will summarize anatomical ndings on between-group differences comparing ADHD and control subjects across all age groups. Different imaging techniques (MRI, DTI) as well as different methods of data analyses (VBM, Cortical thinning, ROI volumetry, etc.) will be briey introduced. Where possible, data from voxel-wise meta-analyses will be presented. Results: Across studies results demonstrate rather widespread grey matter (GM) abnormalities in structural brain development with regional GM increases and decreases as well as white matter decreases. Effect sizes were largest for GM reductions in prefrontal cortex. However, across age groups anatomical brain differences seem to be relatively consistent within the development and non-progressive with respect to GM differences. Findings for WM differences were more preliminary due to the small number of DTI studies. Conclusion: Stable anatomical brain differences in subjects with ADHD across the life-span in particular in regions of the brain that are involved in attention and executive control support the concept that ADHD is a biological disorder. Possible reasons for heterogenous ndings (such as methodological differences, effects of comorbidity and treatment, multiple etiological pathways, endophenotypes, and age-dependent compensatory processes) will be discussed. Objective: Brain imaging studies revealed dysfunctions during several cognitive processes in patients with ADHD. Diverse cognitive and emotional processes are considered as biological markers of altered brain function in ADHD. Method: Based on their superior time resolution, electrophysiological methods like Event-Related Potentials (ERPs) are adequate for the measurement of fast occuring brain functions. Near-Infrared Spectroscopy (NIRS) is superior to other methods of neuroimaging with regard to an ecological setting allowing even tasks requiring verbal responses. Functional Magnetic Resonance Imaging (fMRI) is the method of choice when spatial localization of brain processes is in the focus of interest. We employed ERP, NIRS and fMRI during different cognitive and emotional tasks in healthy subjects as well as in patients with ADHD. Results: Results indicate a dysfunction of the medial prefrontal cortex comprising the anterior cingulate cortex (ERP), the lateral prefornatl cortex (NIRS) and striatum and amygdale (fMRI) in ADHD patients. Recent studies showed a signicant inuence of variants of dopaminergic as well as serotonergic genes on such measures of brain function (imaging genetics). Conclusion: These results exemplify the advantages of a multimodal neurophysiological assessment with different neuroimaging methods. Moreover, the imaging genetics approach extends the information delivered by neuroimaging methods. Future studies will show whether such multimodal neuroimaging approaches will help to improve diagnostic procedures and treatment decisions in ADHD.

HT-07-02 Neurochemical ndings using MR spectroscopy. Similarities and differences in childhood and adult ADHD E. Perlov* * Freiburg im Breisgau, Germany Objective: Neurobiological research has implicated the striatum and basal ganglia as crucial in the pathophysiology of ADHD. These regions are dense connected with the cortex of the frontal brain, in particular with the anterior cingulated cortex (ACC) and some structures of cerebellum. That is a well known fact that the ACC is crucially involved in the regulation of impulse control and emotional regulation. Latest theoretical conceptualizations of the cerebellum as core site of the brain to model motor, affective and cognitive behaviour performed by M. Ito and J. Schmahmann puts weight to the assumption that it might also play a key role in ADHD pathophysiology. Method: In our recent studies we found signicantly increased glutamate-glutamine (Glx) to creatine (Cre) ratios in the left cerebellar hemisphere and decreased ratios of this metabolite in the right ACC using the method of Magnet Resonance Spectroscopy (MRS). In our review and metaanalysis of MRS studies in ADHD we found alterations in choline compounds. Our new study investigates the metabolic disturbances in ACC and cerebellum in adult ADHD in more then 100 patients. The preliminary ndings of this study would be present. Conclusion: The discussion about possible implications of the neurochemical alterations in different brain regions in ADHD is the main issue of the talk. Concerning the cerebellar alterations, this is the rst evidence for alterations in neurochemistry in ADHD. This relate well to recent hypotheses that the cerebellum might control mental activities by internal models.

HT-07-04 Fear acquisition and extinction in adult ADHD: A simultaneous conditioning & fMRI study. Is there a specic pattern of dysfunctional emotional learning in ADHD across the life span? L. Tebartz van Elst*, S. Maier, E. Perlov, O. Tuescher * Freiburg, Germany Objective: Recently there is an increase of awarness towards emotional decits in Attention Decit Hyperactivity Disorder (ADHD). In the present study we aimed to assess whether ADHD patients show abnormalities already at a basic level of explicit and implicit emotion processing. Method: To implement this we conducted a classical fear conditioning (FC) paradigm, as well as a so called instructed fear (IF) study where subjects acquired a fear adaptive response by being told an aversive stimulus might occur when viewing a neutral image. 17 adult ADHD patients and healthy control subjects were studied in an experiment of classical fear conditioning and 13 further adult patients and 17 healthy controls were instructed which visual stimulus might be paired with an aversive electrodermal stimulation (threat condition). In both studies we recorded skin conductance responses (SCR) and functional imaging data (fMRI) in the experimental trials. Results: In the FC study, which aimed to induce fear mainly implicitly, we found no differences between groups. In patients and controls the SCR was signicantly higher for the CS? as compared to the CS- condition, while there was no signicant difference in SCR between groups. In the IF study, which aimed to induce fear cognitively or explicitly, controls showed a very similar activity pattern as described in earlier studies using the same paradigm. As in the FC study skin conductance measurements did not show any signicant group differences and both groups reported they expected an aversive stimulus during the threat condition. In the group comparison contrasting the threat to the safe condition revealed a diminished BOLD response towards the threat condition in the fear expression network in ADHD patients, namely in the dorsal anterior cingulate cortex (dACC) and the bilateral anterior insula.

HT-07-03 Multimodal functional brain imaging in ADHD: Do we have reliable markers of ADHD dysfunction? A. Fallgatter*, A.-C. Ehlis * Tubingen, Germany


91 Conclusion: The implications of these ndings with respect to emotional information processing in adult ADHD will be discussed. their gains over 6 and 12 months. Improvements in investigator-rated inattentive symptoms from baseline to post-treatment predicted better functioning on the LIFE-RIFT at post-treatment (p = .017) but did not predict impairment scores at 6- or 12-month follow-up. Conclusion: Among adults with persistent ADHD symptoms treated with medication, the use of cognitive-behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms which were maintained at 12 months.

Friday, 27 May 2011, 16.0017.30 HT-08 Next steps towards empirically supported psychosocial treatments for adult ADHD
HT-08-01 Treatment of adults with ADHD: CBT only versus medication and CBT L. Hechtman* * Montreal, Canada Objective: To evaluate the relative efcacy of CBT only versus medication and CBT combined for adults with ADHD. Method: Sixty-six adults who met DSM IV criteria for ADHD via Connors Adult ADHD Diagnostic Interview (CAARSD) and who had no current comorbidities that required treatment were randomly assigned to receive either a 12-week group CBT program or medication with CBT combined. The CBT program, with 6-10 subjects per group, addressed organizational and time management skills, anger management and relationships, as well as self esteem and cognitive restructuring issues. Individual coaching calls three times a week were also part of this program. Outcome evaluations included ADHD symptoms and the areas outlined above which were targeted in the CBT program. Results: Generally most subjects completed the 12-week CBT program and all groups beneted from the interventions. However, the combined group seemed to benet most as they were able to make the most use of the CBT program and generalized it best. Conclusion: Adults with ADHD may require both medication and CBT for optimal outcome.

HT-08-03 DBT-based treatment in adult ADHD A. Philipsen*, E. Graf, S. Matthies, M. Colla, C. Jacob, E. Sobanski, B. Alm, M. Roesler, B. Kis, M. Huss, M. Berger * Freiburg, Germany Objective: Adult ADHD is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences. Given this background, instead of or in addition to psychopharmacological treatment, there is a need for effective psychotherapeutic treatment options for adults with ADHD. Method: Due to overlapping clinical features in adult ADHD and borderline personality disorder (BPD) (e.g. emotion dysregulation, impulse control, low self esteem, disturbed interpersonal relationships, Philipsen et al. 2008, 2009) our treatment is mainly based on the principles of dialectical behavioral treatment (DBT, Linehan, 1993). Cognitive behavioral treatment strategies are mainly integrated to modify maladaptive thoughts which interfere with the therapy (homeworks, acquirement of new skills). The structured program is applied in weekly session to adult ADHD outpatients in a group setting. The several topics are presented to the patients in a treatment workbook (Hesslinger et al. 2004). Results: As shown in our pilot study and feasibility multicenter study (Hesslinger et al. 2002, Philipsen et al. 2007), the DBT-based program with 13 weekly sessions resulted in good outcomes. ADHD severity, depression and personal health status were signicantly improved. Patients regarded the program topics behavioural analyses, mindfulness and emotion regulation as the most helpful. As in our initial pilot study, patients in the multicenter study rated the group setting as highly effective. However, so far, randomized placebo-controlled studies comparing the effects of medical management, specic psychotherapy, and the combination of both are still lacking. Therefore, the University of Freiburg, Germany, has initiated a multicenter trial at seven university sites which is funded by the German Federal Ministry of Research and Education (01GV0606, ISRCTN54096201). Conclusion: In the lecture preliminary data of the interim analysis will be presented.

HT-08-02 Comparison of CBT to relaxation with educational support for residual ADHD in adults S. Sprich*, S. Safren, M. Mimiaga, C. Surmann, L. Knouse, M. Groves, M. Otto * Boston, USA Objective: To test cognitive-behavioral therapy (CBT) for ADHD in adults treated with medication and clinically signicant symptoms. Method: 86 medicated adults with clinically signicant ADHD were randomly assigned to receive either CBT or an attention-matched comparison treatment, relaxation with educational support (RES). All participants received 12 individual sessions of either CBT or RES. The primary outcome measures were ADHD symptoms rated by a blinded assessor (ADHD rating scale and Clinical Global Impression Scale (CGI)) at baseline, post-treatment and 6- and 12-month followup. The secondary outcome measures were self-report and investigator report of ADHD symptoms and scores on the Range of Impaired Functioning Tool (LIFE-RIFT). Results: CBT achieved lower post-treatment scores on both the CGI (magnitude -0.0531; 95% condence interval (CI), -1.01 to -0.05; p =.03) and the ADHD rating scale (magnitude -4.631; 95% CI, -8.30 to -0.963, p =.02) compared with RES. Throughout treatment, selfreported symptoms were also signicantly more improved for CBT (beta=-.041; 95% CI, -0.64 to -0.17; p \.001), and there were more treatment responders in CBT for both the CGI (53% vs. 23%; odds ratio (OR), 3.80; 95% CI, 1.50 to 9.59; p =.01) and the ADHD rating scale (67% vs. 33%; OR 4.29; 95% CI, 1.74 to 10.58; p =.002). Responders and partial responders in the CBT condition maintained

HT-08-04 Cognitive-behavioral treatment for adult ADHD: Targeting executive dysfunction M. Solanto*, D. Marks, J. Wasserstein, K. Mitchell, H. Abikoff, J. M. J. Alvir, M. Kofman * New York, USA Objective: The authors examined the efcacy of a 12-week manualized group cognitive-behavioral intervention designed to enhance time-management, organization, and planning in adults with AD/HD. Method: Eighty-eight clinically referred adults who met DSM-IV criteria for ADHD based on clinical and structured diagnostic inter` views and standardized questionnaires were stratied vis-a-vis ADHD medication use and otherwise randomly assigned to receive ADHDspecic cognitive-behavioral therapy (CBT) or supportive


92 psychotherapy in a group modality. The CBT developed for this intervention employs cognitive-behavioral principles and methods to impart skills and strategies in time-management, organization, and planning, and target depressogenic and anxiogenic cognitions that undermine effective self-management. The Support group controlled for non-specic aspects of treatment by providing support while avoiding discussion of cognitive-behavioral strategies. Therapeutic response was assessed by an independent (blind) evaluator via structured interview pre- and post-treatment, as well as by self-report and collateral informant behavioral ratings. Results: General linear modeling analyses, comparing change from baseline between treatments, revealed statistically signicant effects for independent evaluator, self-report, and collateral ratings of DSMIV inattentive symptoms. Employing dichotomous indices of therapeutic response, a signicantly greater proportion of MCT vs. Support group members demonstrated improvement. Logistic regression examining group differences in operationally dened response (controlling for baseline ADHD severity) revealed a robust effect of Treatment Group (odds ratio=5.41; 95%CI=1.77). Conclusion: CBT (vs. Support) yielded signicantly greater improvements in dimensional and categorical estimates of ADHD severity, supporting its efcacy as a viable psychosocial intervention. three studies we measured the reactivity towards pleasant, neutral and unpleasant pictures and assessed the affect-modulated startle reex and electrodermal responses to indicate valence and arousal perception in children and adults. In a fourth study, we obtained psychometric alexithymia scores. The fth study measured the emotional reactivity assessed with the startle reex towards stimuli which have been conditioned to different delay periods to measure delay aversion in adults. The last study assessed whether incentives and methylphenidate have an impact on attentional control in children using an attention modulated prepulse startle facilitation paradigm. Results: The studies indicated that ADHD adults with the combined type are marked by a reduced reactivity towards pleasant stimuli, and the hyperactive-impulsive type towards pleasant and unpleasant stimuli, while the inattentive subtype reacted comparably to controls. Children with ADHD combined type were marked by reduced arousal reactions towards the emotional stimuli. Methylphenidate normalized emotional dysfunctions in both, ADHD adults and children. In adults with ADHD, hyperactive-impulsive but not inattentive symptoms were associated with elevated alexithymia scores. ADHD adults also showed an aversive reactivity towards delay associated cues, while cues indicating no delay were perceived as pleasant. With respect to attentional control, we found that methylphenidate and incentives both reduced attentional control decits in children with ADHD. Conclusion: Results point to emotional-motivational decits especially in ADHD patients with hyperactive-impulsive symptoms which seem to be normalized by methylphenidate. Motivational factors improve the cognitive performance of children with ADHD.

Friday, 27 May 2011, 16.0017.30 HT-09 KFO 125 ADHD

HT-09-01 Familial investigations in ADHD T. Renner*, M. Romanos, C. Jacob, T. Nguyen, C. Freitag, J. Meyer, H. Schafer, M. Gerlach, K.-P. Lesch, A. Warnke * Wurzburg, Germany Objective: High hereditability underlines the importance of family based approaches in ADHD studies. Clinical and genetic data of the Wurzburg Clinical Research Program ADHD KFO (125) are presented. Method: Clinical modiers were investigated in a sample of ADHD families (n=280). Additionally a sample of multigenerational families was investigated by genome-wide linkage analysis. Results: New genetic loci were indicated by the multigenerational pedigrees linkage analysis. A high rate of comorbidities was detected in the ADHD families. Preliminary data on clinical modiers of ADHD is reported. Conclusion: Linkage analysis detected several genomic loci, indicating new candidate genes. A developmental course of comorbidities in ADHD is suggested. Pathophysiological overlaps between ADHD and comorbities will be elucidated in further studies.

HT-09-03 Imaging genetics in ADHD - neurophysiological endophenotypes A.-C. Ehlis*, T. Dresler, S. Heinzel, T. Renner, K.-P. Lesch, A. Fallgatter * Tubingen, Germany Objective: ADHD is one of the most common psychiatric disorders in childhood, which in many cases persists into adulthood. Several etiological factors have been discussed, with genetic factors playing a pivotal role. In order to identify not only potential risk genes for ADHD, but also the specic mechanisms by which genetic variants might contribute to the disease, candidate polymorphisms need to be related to specic behavioral, cognitive or neurophysiological phenotypes. These so-called endophenotypes are considered to be more directly connected to the relevant underlying psycho- or neuropathology and thereby etiological factors than the clinical diagnoses themselves. Promising endophenotypes for ADHD include executive functions such as inhibitory control, working memory and higher order controlled motor functioning. Scientic approaches attempting to connect neural correlates of these endophenotypes to genetic risk variants have been subsumed under the topic of imaging genetics or genomic imaging. Method: The present talk will give an overview of the genomic imaging ndings obtained in the KFO 125 sample of adult ADHD patients. Specically, over the past years, we have examined processes of response inhibition and prefrontal response control in adult ADHD patients as well as healthy control participants in order to relate neurophysiological markers to potential risk polymorphisms of the disease. Results: We report several interactions between diagnostic categories and genetic subgroups, including a few gene-gene interactions, specically focussing on polymorphisms affecting dopaminergic (DAT1, DRD4, COMT) and serotonergic (TPH2, 5-HTTLPR) neurotransmission. The results indicate an impact of ADHD risk genes on neurophysiological measures of prefrontal functioning with partly differential effects in both diagnostic groups (ADHD patients vs. healthy controls).

HT-09-02 Emotional-motivational decits in ADHD A. Conzelmann*, R. Mucha, C. P. Jacob, P. Weyers, A. J. Fallgatter, M. Romanos, A. Warnke, K.-P. Lesch, P. Pauli * Wurzburg, Germany Objective: We wanted to investigate whether emotional-motivational reactivity of ADHD patients is disturbed in terms of subjective and psychophysiological reactions, whether methylphenidate has an impact on emotional-motivational reactivity and whether motivational factors improve cognitive dysfunctions in ADHD patients. Method: We assessed samples of adults and children with and without ADHD. Some patient groups were medicated with methylphenidate. In


93 Conclusion: We conclude that studies on endophenotypes in ADHD are valuable research strategies suited to further elucidate the mechanisms by which genetic risk factors might contribute to the eventual clinical phenotype of the disease. other core symptoms of ADHD, indicating that mood instability might also represent a core symptom of ADHD. Method: Using a sample 50 untreated adults with ADHD and 50 controls, we investigate the correlation between ADHD and mood instability and the co-variation of these two sets of symptoms over time. Results: Our preliminary analyses are promising in showing very high correlations, in the order of 0.8, between both inattentive and hyperactive-impulsive symptoms and mood instability. Further, we have validated our ndings using rating scales with real time experience sampling in which we measure the variability in mood symptoms measure over the working week. Conclusion: We conclude that ADHD and mood instability symptoms in adults are closely linked. Further work is needed to delineate whether the close relationship arises from shared aetiological factors. Initial analyses using the sample presented here will investigate the co-variation during the treatment response with stimulants or other medications for ADHD. Further work is aimed to clarify whether the problems with regulation of emotional responses and mood states seen in ADHD arise from the same underlying processes that lead to impaired regulation of attention and impulse control.

HT-09-04 Genome-wide screening approaches: Towards identication of pathogenetic mechanisms K.-P. Lesch* * Wurzburg, Germany Abstract: Although the substantial heritability of Attention Decit Hyperactivity Disorder (ADHD) is documented in numerous family, twin and adoption studies, with estimates up to 80%, linkage scans followed up by positional ne-mapping, genome-wide association (GWA), and copy number variation (CNV) studies have linked only a few putative risk genes to ADHD. Comparison between population and family-based studies shows little concordance, since loci linked to increased ADHDrisk are often characterized by pedigree-specicity. The origins of common and rare risk alleles are based on population growth and migrations. The oldest alleles are common in all populations worldwide, and account for90% of the variability in allele frequencies. Rapid population growth has led to the appearance of vast numbers of new risk alleles, each individually rare and specic to one population or even to one family. Theserisk genes code for proteins involved in proliferation, migration, and specication of neurons (NPAS3, NRXN1, LPHN3), neurite outgrowth and axonal guidance (e.g., CDH13, ASTN2), intracellular signal transduction (e.g., DIRAS2, NOS1, CTNNA2), and regulators of cellular energy balance (e.g., NPY, SLC2A3). Moreover, it is becoming increasingly evident that epigenetic processestranslating environmental stimuli into changes in expression of established and novel candidate genes play a pivotal role in establishing long-lasting changes in brain function related to ADHD.Work in progress now focusses on the elucidation of the role of these new candidates in the pathogenesis of ADHD using neuronal cell models, genetically modied animals, such as mouse and zebrash as well as neuropsychological and imaging paradigms in humans. Preliminary evidence from these studies suggests that several pathogenetic pathways converge on ADHD-associated dysregulation of monoaminergic signalling.

HT-10-02 Emotional symptoms in children and adolescents with ADHD T. Banaschewski* * Mannheim, Germany Objective: ADHD is often associated with symptoms of emotional lability (EL), such as irritability, hot temper, low frustration tolerance, and sudden unpredictable shifts towards negative emotions such as anger, dysphoria and sadness. EL has been consistently noted in the changing denitions of the ADHD construct and its diagnosis and is currently considered an associated feature of the disorder. However, it is still unclear how EL and ADHD are interconnected. Method: 1186 children with ADHD-combined type and 1827 siblings (aged 6-18 years) were assessed for symptoms of EL, ADHD, associated psychopathology and comorbid psychiatric disorders with a structured diagnostic interview as well as parent and teacher ratings of psychopathology. Analyses of variance, regression analyses, v2-tests or loglinear models were applied. Results: Age, hyperactive-impulsive, oppositional, and emotional symptoms accounted for 30% of EL variance; hyperactive-impulsive symptoms did not account for EL variance when coexisting oppositional and emotional problems were taken into account, but oppositional symptoms explained 12% of EL variance specically. Severity of EL in probands increased the severity of EL in siblings, but not the prevalence rates of ADHD or ODD. EL and ADHD does not co-segregate within families. Conclusion: EL is a frequent clinical problem in children with ADHD. It is associated with increased severity of ADHD core symptoms and more symptoms of comorbid psychopathology, primarily symptoms of oppositional deant disorder, but also affective symptoms, and substance abuse. EL in ADHD seems to be more closely related to ODD than to ADHD core symptoms, and is only partly explainable by the severity of ADHD core symptoms and associated psychopathology. Although EL symptoms are transmitted within families, EL in children with ADHD does not increase the risk of ADHD and ODD in their siblings.

Friday, 27 May 2011, 16.0017.30 HT-10 Emotional symptoms in ADHD: Part of the disorder?
HT-10-01 Mood variability in adults with ADHD P. Asherson*, C. Skirrow, J. Kuntsi, G. McLoughlin * London, United Kingdom Objective: ADHD is a neurodevelopmental disorder that persists into adulthood in two-thirds of cases. Current denitions of ADHD focus on three core domains of inattention, overactivity and impulsivity, yet it is widely recognised that there is a wider range of co-occurring psychopathology. Among the most prevalent of these is mood instability, characterized by shifts in mood from highs to lows, frustration, and chronic irritability. Mood instability may often be the main presenting symptom of ADHD and may also be one of the more impairing features of the disorder. Importantly, it has been noted that treatment for ADHD with stimulants or atomoxetine often results in improvements in mood instability symptoms in the same timescale as

HT-10-03 The concept of emotional symptoms as dened by the Utah criteria of ADHD F. Reimherr*, M. K. Marchant, J. L. Olsen, R. J. Robison * Salt Lake City (UT), USA


94 Abstract: Previous studies have documented that many patients with Attention Decit Hyperactivity Disorder (ADHD) have signicant emotional symptoms. Such symptoms are part of the Utah Criteria for the diagnosis of ADHD in adults and are assessed by the WenderReimherr Adult Attention Decit Disorder Scale (WRAADDS). Following previously published criteria, scores showing an average of moderate impairment or worse on the WRAADDS emotional factor items assessing temper, mood lability, and emotional overreactivity were used to categorize patients with emotional dysregulation. These symptoms help to characterize the more complex presentation of adults with ADHD. Data from 2 highly positive placebo-controlled, crossover studies examining methylphenidate were combined (N = 136). 72% met criteria for emotional dysregulation. These patients were more likely to have combined-type ADHD, more oppositional deant symptoms, higher ADHD ratings, worse social adjustment, higher personality disorder ratings, and a trend toward more substance abuse. Both groups responded to methylphenidate. Emotional symptoms in subjects with emotional dysregulation also showed a very signicant response (effect size = 0.83). A large portion of adults with ADHD in this sample showed symptoms of emotional dysregulation. These results including high levels of the emotional dysregulation in the sample, association of emotional dysregulation with more severe, complex symptoms at baseline and signicant treatment response of emotional dysregulation symptoms to methylphenidate] support including emotional dysregulation as a core feature of more severe adult ADHD. Adults with ADHD and emotional dysregulation should be viewed as a distinct subgroup.

Friday, 27 May 2011, 16.0017.30 HT-11 International ADHD treatment guidelines for childhood, adolescence and adulthood
HT-11-01 Guidelines in Francophone and Eastern European countries B. Millet* * Rennes, France Abstract: Many controversies exist in France regarding diagnosis and treatment of ADHD. Even though the realty of the disorder is now considered for children and young adults, the clinical picture in adult remains blurred and needs clarication with other disorders especially bipolar disorders. The prevalence of ADHD in France would range from 3.5% to 5.6% for youth and from 4 to 5% into adulthood. Adults with ADHD seem to have high rates of comorbid Axis I and II disorders Treatment as in other countries is based on psychotherapeutical approaches especially behavioral and cognitive therapy at rs line and pharmaceutical treatments with psychostimulants, and to a lesser extent antidepressants. A synthesis of the literature by French authors will be provided during this session.

HT-11-02 Guidelines in Mediterranean and Latin countries, Asia and Africa J. A. Ramos-Quiroga* * Barcelona, Spain

HT-10-04 Different psychopathological dimensions in adult ADHD R.-D. Stieglitz*, M. Rosler * Basel, Switzerland Objective: The diagnosis of Attention Decit Hyperactivity Disorder (ADHD), as described in DSM-IV, requires on the psychopathological level 6 or more symptoms of inattention and/or 6 or more symptoms of hyperactivity/impulsivity. Based on these syndromes 3 diagnostic subtypes were identied (ADHD-combined type, ADHD-predominantly inattentive type, ADHD predominantly hyperactive-impulsive type). The DSM-IV symptoms and the subtypes were originally developed for the use in child psychiatry. The question remains whether the DSM-IV criteria are adequate to characterize adult ADHD. Several authors (e.g. Wender) propose that the picture of the disorder is more differentiated in adults than in children. One issue, which is often discussed, concerns the signicance of emotional dysregulation. Emotional dysregulation is not only a potential further aspect of ADHD in adults but also a problem to distinguish ADHD from other psychiatric disorders (e.g. borderline personality disorder). A further aspect of the psychopathology of adult ADHD is disorganization. This domain of symptoms is related to disturbances of executive functioning, which is reported to be impaired in ADHD. Method: This is a review of the literature regarding the different symptom domains of adult ADHD. In addition the authors report on their own investigations in this eld of research including more than 1.000 persons suffering from ADHD. Results: Beside the classical psychopathology of adult ADHD (inattention, hyperactivity, impulsivity) emotional dysregulation and disorganization are frequently part of the clinical picture. The factor structure of this model of adult ADHD will be discussed. Conclusion: Symptoms of emotional dysregulation and disorganization seem to be intrinsic factors of the psychopathology of adult ADHD. The diagnostic criteria for the use in adults should incorporate those symptoms.

Objective: To review the recommendations of the available Guidelines for ADHD across life span of these geographic areas. Method: Systematic qualitative revision of the published guidelines for ADHD. Results: At these geographic areas there are guidelines that can be useful to improve the management of ADHD. Methylphenidate are the most recommended rst line drug and atomoxetine is the second. Conclusion: Methylphenidate is the rst line agent and atomoxetine can be the rst option depending of the clinical characteristics of the patient. There is a need for guidelines for adults with ADHD.

HT-11-03 Guidelines in Nordic and German-speaking countries R. Wandschneider* * Rostock, Germany Objective: The health care systems in Nordic and German-speaking countries stand for a high level of quality but are also characterised by a multitude of different scopes, emphases and approaches. This is reected in a plethora of different ADHD guidelines. The aim of our study was to research and compare the available national and international guidelines in these regions. Method: Therapeutic guidelines of different origin national and international medical associations, health care providers, governmental bodies as well as summaries of product characteristics (SPCs) were analyzed and compared with regard to their congruences and dissimilarities. Results: We discovered both a large number of different guidelines as well as a signicant inhomogeneity between them. Conclusion: It would be desirable if more unifying, consensual and independent guidelines could be produced. This would increase general acceptability, protect diagnostic and therapeutic freedom and be in the best interest of our patients and their families.


95 HT-11-04 ADHD guidelines in Anglophone countries J. Thome* * Rostock, Germany Objective: Several guidelines for the diagnosis and treatment of ADHD both in childhood and adulthood have been published in the English-speaking world. This paper aims at presenting the main aspects of some selected guidelines and to compare them with each other for similarities and differences. Method: The following guidelines were selected: the CADDRA Canadian ADHD Practice Guidelines, the UK NICE guideline, the Australian Guidelines on ADHD and the US ACAAP/APA guidelines. Results: While there are many similarities between the different guidelines, there still remain several differences, especially regarding the different age groups (i.e. child/adolescent and adult) and the relevance of pharmacological and non-pharmacological treatment strategies. Conclusion: Further convergence of the different guidelines based on scientic and clinical evidence would be desirable, as well as continuous updating in order to integrate newly available research results. Nevertheless, national specics such as the organisation of health care and service delivery must be considered. Ultimately, the global exchange of information and ideas should lead to an improved and reliable standard in diagnosing and treating patients suffering from ADHD. Objective: Attention Decit Hyperactivity Disorder (ADHD) is one of the most common child psychiatric disorders. Previous studies have reported a blunted cortisol response to challenging situations and a decreased cortisol awakening response (CAR) in children with ADHD. As ADHD often is comorbid with oppositional deant disorder (ODD), conduct disorder (CD), or anxiety disorder (AnxD), and changes in hypothalamic-pituitary-adrenal (HPA) axis activity have also been reported for these disorders, the present study aimed to compare the CAR in children with ADHD with and without comorbid disorders. Method: Data on the CAR were obtained in 128 children with ADHD (aged 6-13 years) and in 96 control children (aged 6-12 years). Results: Children with ADHD?ODD showed an attenuated CAR (area under the curve, AUC) compared to children with ADHD without ODD/CD and control children. Conclusion: Findings point towards either disinhibition or pervasive underarousal in children with ADHD?ODD, and seem to be specic for children with ADHD?ODD, as the attenuated CAR-AUC was not observed in children with ADHD without comorbid disorders or children with ADHD?CD or ADHD?AnxD. In addition, current adverse parenting conditions, family conicts, and acute life events were associated with mean increase in CAR, emphasizing the role of psychosocial risk factors in mediating HPA axis activity in children with ADHD.

HT-12-03 Genome-wide association analysis of conduct disorder in an ADHD background

Friday, 27 May 2011, 16.0017.30 HT-12 ADHD and conduct disorder from childhood to adulthood
HT-12-01 Co-morbid disorders of childhood ADHD M. Romanos*, T. Renner, R. Taurines * Munchen, Germany Objective: Comorbid disorders in ADHD are highly prevalent yet variable throughout life thus resulting in substantial difculties in regard to clinical diagnosis, scientic categorization, and etiological conceptualization. Method: Referring to conduct disorder as example theoretical models of comorbidity are discussed. Recent clinical and epidemiological approaches to elucidate the complexity of comorbidity in ADHD are presented. Results: The phenotypic complexity and temporal characteristics of co-morbidity mirror the heterogeneous multifactorial aetiology of ADHD. Recent data suggest that both psychiatric and non-psychiatric co-morbidity need to be considered. Conclusion: Heterogeneity of ADHD impedes rather aetiologically based clinical classication systems of ADHD. Future research on ADHD with improved approaches to account for co-morbid disorders will hopefully result in enhanced concepts for clinical differentiation.

R. Anney* * Dublin, Ireland Objective: Individuals with Attention Decit Hyperactivity Disorder show high co-morbidity with a wide range of psychiatric disorders including oppositional deant disorder (ODD), conduct disorder (CD), anxiety disorder, depression, substance abuse and pervasive developmental disorder (PDD). Family studies suggest that ADHD?CD represents a specic subtype of the ADHD disorder with familial risk factors only partly overlapping with those of ADHD alone. As part of a series of exploratory analyses of the GAIN-ADHD sample we attempted to identify markers and genes important in the development of conduct problems in this European cohort. Method: Over 900 affected proband-parent trios from the International Multicenter ADHD Genetics (IMAGE) project were initially selected for the GWAS scan. Four broad phenotypic measures of conduct problems (CP) for the ADHD probands were described. First a categorical measure of CP was dened using DSM IV criteria of CD. Three additional quantitative measures of CP were dened using the Parent Account of Childhood Symptoms (PACS), the Long Version of the Conners Parent Rating Scale (CPRS-R:L) and a combination of the two. Logistic and linear regression for the categorical and quantitative traits respectively were performed using PLINK v1.07. Associations were adjusted for gender and population metrics. Results: None of the analyses found markers showing genome-wide statistical signicance. Eleven loci that show modest association signal (P\10e-6) were observed across the four analyses. Conclusion: Determination of whether these ndings represent the identication of putative risk variants and genes requires additional replication in an independent study. We discuss these ndings in the context of association enrichment, putative candidate genes and their implications to our understanding of the etiology of ADHD?CP. This work is part of an ongoing collaboration for the International Multicentre ADHD Genetics project.

HT-12-02 Cortisol awakening response in children with ADHD with and without oppositional deant disorder or conduct disorder C. Freitag*, S. Hanig, H. Palmason, J. Meyer, S. Wust, C. Seitz * Frankfurt, Germany


96 HT-12-04 Co-occuring problems of early onset persistent, childhood limited, and adolescent onset conduct problem youth E. Barker* * United Kingdom Abstract not received HT-13-04 Effects of omega 3/6 dietary supplements in ADHD M. Johnson* * Goteborg, Sweden Objective: Review of studies with omega 3/6 fatty acids in the treatment of Attention Decit Hyperactivity Disorder (ADHD) in children and adolescents. Method: Comparison of results from randomized placebo-controlled trials including our own recent study of Omega 3/6 fatty acid treatment for 6 months in 75 children and adolescents with clinically diagnosed ADHD Results: Studies show varying but signicant improvements. Our own study indicated that treatment responders tended to have ADHD inattentive subtype and comorbid neurodevelopmental disorders. Conclusion: A subgroup of children and adolescents with ADHD, characterized by inattention and associated neurodevelopmental disorders, treated with Omega 3/6 fatty acids, responded with meaningful reduction of ADHD symptoms.

Saturday, 28 May 2011, 16.0017.30 HT-13 Non-pharmacologic interventions for the treatment of ADHD
HT-13-01 Dietry interventions on ADHD J. Buitelaar* * Nijmegen, The Netherlands Abstract not received

Saturday, 28 May 2011, 16.0017.30 HT-14 Impact of ADHD on the risk for delinquent behaviour
HT-14-01 Adult ADHD and pathological gambling W. Retz*, J. Ringling, M. Vogelgesang, M. Rosler * Homburg, Germany

HT-13-02 Effects of family based interventions M. Dopfner* * Koln, Germany Abstract not received

HT-13-03 Effects of school based intervention M. Danckaerts* * Belgium Objective: The objective of this contribution is to provide an overview of the different types of school-based interventions aimed at improving ADHD and its concomitant functional impairment within the school environment. Method: A systematic search of the literature has been undertaken to identify relevant meta-analytic and review papers, as well as studies reporting effect sizes on outcomes such as ADHD-related behaviour, compliance with school-based rules and homework and/or academic performance. Both behavioural interventions and interventions aiming at manipulating academic instruction and material have been searched for. Results: A wide variety of different interventions for children with ADHD is described in the school setting. However, for most of these, no controlled studies exist. Mainly contingency based management interventions have been studied more thoroughly, but often in intensive programs and special school settings, limiting the relevance to naturalistic classroom situations. Effect sized reported are typically in the same range as for parent training and smaller than for medication. Conclusion: Behavioural interventions both at home and in the school are deemed important in the treatment of ADHD according to current European Guidelines. A wide variety of interventions is described in the literature, but high quality studies in representative school environments are still lacking. Nevertheless creative ideas and interesting programs are identied, which hopefully can be studied more rigorously in the near future in order to evaluate their potential for improving outcome in children with ADHD.

Objective: Pathological gambling (PG) refers to the uncontrollable impulse to gamble, irrespective of the interference the behavior has on the individuals life. It often results in nancial problems; disrupted relationships, and criminal behavior. PG is frequently associated with psychiatric axis-I and II disorders. Also ADHD is related to PG and delinquent behavior. Method: Thus, we performed a study with 161 PG patients to explore the relationship between PG, ADHD and delinquency. All individuals were diagnosed for axis-I and personality disorders according to ICD10. For the diagnostic process of PG and ADHD also standardized instruments were used. Results: In the study population we found an ADHD lifetime prevalence of 29.2%, 24.2% fullled the DSM-IV criteria for the full ADHD syndrome. In PG patients with ADHD a higher prevalence of further psychiatric disorders was found as compared to PG patients without ADHD. These included substance use disorders and personality disorders. Moreover, higher ratings on the SCL-90 hostility scale were found. PG patients reported more lifetime convictions, a lower age of rst conviction, and there was a trend for more violent offences than in PG patients without ADHD. Conclusion: ADHD seems to be a risk factor for the development of pathological gambling and there is evidence that lifetime and persisting ADHD modulates the risk for delinquent behavior in adult pathological gamblers.

HT-14-02 Impact of ADHD on behavior disorders in prison inmates G. Gudjonsson* * London, United Kingdom


97 Objective: Recent research has focused on identifying factors that predict critical incidents and behavioural disturbance in institutional settings. The ndings from three different studies are reviewed and presented. These include adolescents in a secure unit facility, adults with a primary diagnosis of Personality Disorder detained in secure unit services, and prisoners serving sentences for a variety of offences. In all three studies, participants were assessed for ADHD symptoms. The studies showed that ADHD was a signicant predictor of behavioural disturbance/critical incidents within each institution, and it was found that ADHD symptoms predicted behavioural disturbance/critical incidents above and beyond that of Conduct Disorder in adolescents and Personality Disorder traits in adults. The ndings point to the unique contribution of ADHD symptoms as a risk factor for behavioural disturbance/critical incidents within correctional institutions. Objective: The majority of the adults with ADHD have chronic difculty to go to bed on time. This leads to a shorter sleep duration and daytime sleepiness that may aggravate the inattention problems of ADHD. This sleep pattern is also known as a delayed sleepphase, and the patients as eveningtypes. The other way round, eveningtypes have been associated with impulsiveness. Method: Review of the literature in child and adult ADHD regarding sleep, and presentation of research in 40 adults on sleeppatterns using questionnaires, measurements of Dim Light Melatonin Onset and actigraphy, compared to controls. Results: The adults with ADHD display a chronic delayed sleep phase pattern in about 80%. Dim Light Melatonin Onset is signicantly delayed in those with sleep onset problems compared to those without, and to normal controls. In addition, the activity pattern as shown by actigraphy is delayed as well. Conclusion: In this presentation the impact of this sleep pattern in adults with ADHD on mood (i.e. seasonal affective disorder), eating habits (like timing of meals and binge eating), activity patterns (like nightshift work and light at night) and health in general, i.e. obesity and cancer will be discussed. Reference: van Veen MM, Kooij JJS, Boonstra AM, Gordijn MCM, van Someren EJW. Delayed Circadian Rhythm in Adults with Attention Decit Hyperactivity Disorder and Chronic Sleep-Onset Insomnia. Biol Psych 2010,67(11):1091-6.

HT-14-03 ADHD modulates the risk for reactive violence M. Rosler*, W. Retz * Homburg, Germany Objective: The prevalence of ADHD in offender populations is increased. But the risk to develop criminality is mainly caused by comorbid conduct disorder and not by ADHD. We conducted a study on different offender populations to answer the question whether ADHD may have a modulating effect on the type of violent offences. Method: We performed a case control study with violent and nonviolent offenders. The violent offenders were classied according to the typology as dened by the rules of the penal code. Furthermore the violent offences were devided according to the concept of proactive and reactive violence. Results: When we compared non-violent and violent offenders with regard to the prevalence of ADHD we found no differences between the two groups. The analysis of the prevalence of ADHD in different violent offender groups (sexual violence, murder, assault, etc.) revealed again no differences. When we grouped the persons according to the reactive/proactive model we found a massive overrepresentation of individuals with ADHD among the reactive violence group. Conclusion: We favour the hypothesis that ADHD has a modulating effect on the type of violent offences. There is a signicant preponderance of offenders with ADHD among the group of reactive violent offences.

HT-15-02 Impact of ADHD medication on circadian rhythms and clock gene expression A. Coogan*, A. Baird, S. OKeeffe, M. Barrot, J. Thome * Ireland Objective: The aim of this study was to examine the effects of methylphenidate and atomoxetine on circadian clock gene product expression in the mouse brain, as well as examining the effects on behavioural circadian rhythms. Method: We examined the effect of 7 days treatment with methylphenidate (2.5 mg/kg, i.p.), atomoxetine (3 mg/kg, i.p.) or saline on PER1, PER2, CLOCK and c-Fos expression, by means of semiquantitative immunohistochemistry in a number of regions of the mouse brain, including the master suprachiasmatic nucleus circadian clock. We also examined the effects of acute treatment with atomoxetine (3 mg/kg), under varying photic conditions and at different points in the circadian cycle, on behavioural circadian rhythms in mice, as well as on PER2, CLOCK, BMAL1 and c-Fos expression in the mouse brain. Results: Chronic treatments with methylphenidate or atomoxetine altered diurnal patterns of expression of clock gene products in a number of hypothalamic, basal ganglia, cortical and subcortical regions. Regions affected include the suprachiasmatic nucleus, the hippocampus and the striatum. In another set of experiments it was found that acute treatments with atomoxetine altered behavioural circadian rhythms in mice in a phase-dependent manner. We found that atomoxetine treatment during the circadian day against a photic background of constant light produced a phase-delay of *3 h, whilst treatments during the night phase did not elicit signicant alteration. Atomoxetine treatment also altered expression of clock gene products in the master circadian suprachiasmatic clock. The effects of atomoxteine were mimicked by treatment with another nor-adrenaline reuptake inhibitor reboxetine, and were blocked by pre-treatment with the alpha-receptor antagonist prazosin. Conclusion: We conclude that these preclinical studies indicate strong evidence that medication used in the management of ADHD can exert profound effects on the circadian timing system

HT-14-04 Does childhood treatment of ADHD decline the risk for adult antisocial behaviour H. Soderstrom* (invited) * Sweden Abstract not received

Saturday, 28 May 2011, 16.0017.30 HT-15 Circadian rhythmicity in ADHD patients through life time
HT-15-01 Changes of circadian behaviour in ADHD patients S. Kooij* * Den Haag, The Netherlands


98 HT-15-03 Insomnia and morning/evening preference among ADHD patients compared to healthy individuals and other patients with psychiatric disorders B. I. Voinescu*, A. Szentagotai, A. Dobrean * Cluj-Napoca, Romania Objective: Our previous research revealed that chronic insomnia was found in up to 16% of the volunteered healthy individuals and in more than half of the psychiatric patients included in the study (suffering from depression and/or alcoholic abuse/dependence); eveningness was far more frequently found among depressed and alcoholic patients, too. Based on the data in literature, we concluded that subjective sleep complaints were usual ndings in adults diagnosed with ADHD as they experienced daytime sleepiness more often and reported more sleep problems than controls. Non-medicated patients showed associations with self-reported shorter sleep duration, lower sleep efciency, and lower overall sleep quality. Adult ADHD patients also appeared to be more evening oriented. With these in mind and with almost no adult ADHD diagnosis conrmed in Romania, we started a pilot study trying to see whether chronic insomniacs were masking undiagnosed adult ADHD patients. We are using several sleep scales and the Barkley Adult ADHD Rating ScaleIV, as well as combined actigraphic and ambulatory EEG monitoring. Preliminary results are to be presented. improves cognitive functions by modulating task related deactivations (TRDs) in a dened network know as the default mode network (DMN). The effects of atomoxetine (ATX), which has similar afnity for the noradrenaline transporter, but minimal afnity for the dopamine transporter, on these networks is only beginning to be understood. The aim of this study was to use pattern recognition to characterise the differential effects of these drugs in healthy volunteers on brain function. Method: Fifteen healthy male volunteers were scanned after administration of MPH (30mg), ATX (60mg) or placebo on three separate occasions in a latin-square study design. We used continuous arterial spin labelling (cASL) to quantify regional cerebral blood ow (rCBF) and a rewarded working memory (WM) task during BOLD fMRI scanning. Imaging data were preprocessed in SPM5. We used multivariate pattern recognition to characterise the effects of MPH, ATX and placebo using sparse multinomial logistic regression for rCBF and Gaussian process classiers for the working memory task. Results: MPH and ATX rCBF maps could be discriminated accurately (100% and 93% respectively) with a network of changes including increased rCBF in nodes of the DMN, the striatum and substantia nigra (MPH), and decreased rCBF in the brain stem and thalamus (ATX). During rewarded trials both drugs attenuated WM networks and enhanced TRDs in regions consistent with the DMN. Conclusion: Baseline effects of MPH and ATX can be detected in distinct patterns associated with each drug using cASL, although only MPH showed effects in DMN areas. During the WM task both MPH and ATX showing prominent effects during rewarded trials in both task activated and deactivated networks. Thus, interactions between drug effects and motivational state are relevant in dening the functional effects of MPH and ATX, which extended beyond the DMN.

HT-15-04 CLOCK genes polymorphisms and alterations of CLOCK gene expression in ADHD patients J. Thome* * Rostock, Germany Objective: A disturbed circadian rhythm is a typical clinical feature in patients with ADHD. The aim of this study was to establish whether this clinical phenomenology is associated with changes on the molecular level, i.e. with alterations of the expression of so-called CLOCK genes. Method: Buccal swabs were collected from patients and controls in order to obtain cells from which RNA was extracted. Using RT-PCR, expression levels of PER1, PER2 and BMAL1 were quantied at several time points during a 24h period. Results: The rhythmicity of the BMAL1 expression pattern was signicantly changed in patients. Conclusion: To our knowledge, this is the rst study showing a signicant alteration in the expression pattern of CLOCK genes in adult ADHD patients. This could be one of the cellular and molecular mechanisms underlying the changes in circadian rhythmicity observed in clinical practice.

HT-16-02 Head to head comparison of single dose effects of methylphenidate and atomoxetine in fMRI of ADHD children K. Rubia*, A. Cubillo, A. Smith, N. Barret, V. Giampietro * London, United Kingdom Objective: The stimulant drug methylphenidate (MPH) and the nonstimulant drug atomoxetine (ATX) are widely used for ADHD treatment, but their differential effects on ADHD brain function are not known. MPH normalise frontal, striatal and cerebellar brain activation in ADHD children during inhibition, sustained attention and time discrimination (Rubia et al., 2009a,b,2011). However, to our knowledge, no fMRI study has investigated the effects of an acute dose of ATX on brain activation in ADHD, or compared its effects with those of MPH. Method: 20 medication-nave children with ADHD performed 4 tasks in fMRI (3T) after a single clinical dose of MPH, ATX or placebo, in a double-blind, randomized crossover design: a Stop task, a time discrimination task (TD) a parametrically modied sustained attention task (SAT) contrasted with sensorimotor timing, and a visual N-back working memory (WM) task. Repeated-measures ANOVAs were conducted on brain activation and performance with drug condition (MPH, ATX, placebo) as within-subjects factor. Results: Preliminary results (17 patients) show that MPH compared to placebo and ATX improved time estimation, both drugs improved reaction times and response variability in the SAT, but had not effect on WM or Stop task performance. During the Stop task, only ATX enhanced activation in the inferior prefrontal cortex during inhibition, while MPH had drug-specic upregulation effects on striatum and SMA during response execution. During the SAT, ATX and placebo

Saturday, 28 May 2011, 16.0017.30 HT-16 Pharmacoimaging in ADHD

HT-16-01 M. A. Mehta*, A. Marquand, S. de Simoni, O. ODaly, F. Zelaya, S. Williams * London, United Kingdom Objective: Studies in ADHD suggest that methylphenidate (MPH)


99 showed larger activation than MPH in the temporo-parietal junction during sustained attention, while MPH enhanced activation in this region during sensorimotor timing. During the TD, MPH enhanced anterior cingulate activation compared to placebo and ATX. During the WM task, ATX showed a drug-specic upregulating effect compared to both placebo and MPH on cerebellar and superior temporal activation. Conclusion: The ndings show that ATX and MPH have dissociated and task-dependent drug-specic effects on the brain activation of ADHD children. Objective: To characterize motor cortex inhibition as a biomarker of ADHD diagnosis, symptom severity, and medication response. Method: We have used single and paired pulse Transcranial Magnetic Stimulation (TMS) in our laboratory to study short interval cortical inhbition (SICI) as it relates to ADHD and Tourette Syndrome. The relationship between SICI, a quantitative measure, and ADHD symptom severity as well as acute and chronic treatments have been evaluated. In addition, we present pilot data related to dopamine transporter polymorphisms, and to acute and chronic treatment with methylphenidate and atomoxetine. Results: SICI is reduced by approximately 40% in 8-12 year old ADHD children. This reduction generally correlates (r = .5; p \ .01) with ADHD symptom severity in children with both ADHD and Tourette Syndrome. Medication effects are complex but generally acute treatment, particularly with psychostimulants, tends to normalize SICI in ADHD children. Conclusion: SICI in motor cortex appears to be a biomarker of ADHD symptoms in childhood.

HT-16-03 Head to head comparison of 6 weeks treatment effects of methylphenidate and atomoxetine in fMRI of ADHD children J. Newcorn*, K. Schulz, A.-C. Bedard, J. Fan * New York, USA Objective: The increasing number of FDA-approved stimulant and non-stimulant medications for Attention Decit Hyperactivity Disorder (ADHD) raises important questions about the mechanisms by which different medication classes exert their therapeutic effects. We used event-related functional magnetic resonance imaging (fMRI) to compare the relationship between symptomatic improvement and changes in neural activity produced by six to eight weeks of treatment with methylphenidate versus atomoxetine in youth with ADHD. Method: Youth (n = 16 per group; mean age 11.4 2.8 years; 26 males) were scanned at baseline and after treatment while performing a go/nogo task. Mean medication doses were 55 17 mg for methylphenidate and 1.3 0.5 mg/kg for atomoxetine. The neural origins of the symptomatic improvement were investigated with a general linear model (GLM) analysis that combined within-subjects modeling of pre- versus post-treatment effects and between-group comparisons of these treatment effects. Results: Both medications produced substantial improvement in ADHD symptoms and go/nogo indices, with no signicant differences between the two treatments. Treatment with atomoxetine was associated with signicantly greater increases in activation than methylphenidate in frontostriatal regions. Conversely, there were signicant reductions in medial superior frontal and left posterior cingulate activation with methylphenidate. Symptomatic improvement was related to common activation in medial prefrontal cortex (mPFC), and divergent patterns of activation in right inferior frontal gyrus, left anterior cingulate cortex, left caudate nucleus, bilateral precuneus and right posterior cingulate. Conclusion: Acute treatment with methylphenidate and atomoxetine produced clinical improvement via both common and unique mechanisms, with distinctions seen in several regions within the task positive frontostriatal and task negative cingulate-precuneus networks. These ndings offer a window into the neurophysiological basis of common and unique mechanisms of response to stimulant and non-stimulant treatments, which constitutes an important rst step in matching treatments to individual patients with ADHD.

Friday, 27 May 2011, 16.0017.30 YS-01 Young Scientist Award Session I

YS-01-01 Different executive function proles in children and adolescents with subtypes of ADHD E. W. Skogli*, M. G. ie * Lillehammer, Norway Objective: Subjects with different subtypes of Attention Decit Hyperactivity Disorder (ADHD) often have impaired executive functioning (EF). In terms of the degree and type of impairments, however, the ndings are inconsistent. Research to date has focused mainly on performance-based EF, whereas studies dealing with emotional regulation and EF in naturalistic settings have been largely absent. In the current study, EF in different subtypes of ADHD were measured both with traditionally performance-based tests, an experimental decision making task designed to study the integration of emotion and neurocognition, and a behaviour/symptom checklist of EF. Method: Subjects with ADHD-C (n=36, 23 males), ADHD-I (N=46, 22 males) and healthy controls (N=50, 32 males) between 8 and 17 years referred to Child and Adolescent Mental Health Centres were included. None of the subjects were medicated with stimulants. The neuropsychological test battery included measures of inhibition, working memory, planning, cognitive exibility and verbal uency, as well as a measure of decision making and a behaviour/symptom checklist of EF (Behavior Rating Inventory of Executive Function/ BRIEF). Results: The ADHD-C group showed signicantly impaired scores on the BRIEF (the Inhibition scale and the Behavioural Regulation Index-BRIEF), compared to the ADHD-I group and healthy controls. In contrast, the ADHD-I group showed impaired EF on the performance based measures (impaired cognitive exibility and inhibition) relative to the healthy control group. None of the ADHD subjects showed impairments on the decision making test. Conclusion: A behaviour rating scale measuring EF in a naturalistic setting was more sensitive in detecting impairments in EF in subjects with ADHD-C. In contrast, performance based measures were better at detecting EF decits in the ADHD-I group.

HT-16-04 TMS-evoked motor cortex inhibition as a biomarker of ADHD severity and effects of methylphenidate and atomoxetine D. L. Gilbert* * USA


100 YS-01-02 Attention Decit Hyperactivity Disorder symptoms and environmental adversity in a prospective population study of preschoolers E. Paliokosta*, E. Emerson, E. Simonoff * London, United Kingdom Objective: A number of environmental factors have been associated with ADHD during school years. Although both prospective and retrospective studies suggest that ADHD symptoms in preschool children are associated with a later diagnosis of ADHD, little is known about factors affecting their presentation in preschoolers. This study aims to identify risk factors for ADHD symptoms at the age of three years using data from the UK Millennium Cohort Study (MCS). Method: A nationally representative birth cohort of 13,040 children followed up at 9 months and 3 years was included. The hyperactivity subscale of the parent version of Strengths and Difculties Questionnaire (SDQ) 3-4 was used to dene categorically ADHD caseness. Information about socio-economic position (SEP) (income; social housing; low income state benet; material hardship; maternal education; social capital), maternal characteristics (poor health or disability, self-esteem, self-efcacy and depression), parental style and child characteristics (birth weight, pre-maturity, temperament, early developmental concerns, sensory problems and epilepsy) was collected at 9 months and 3 years and were recoded for the purpose of the analysis as categorical variables indicating presence or absence of a factor. Results: Multiple logistic regression analyses revealed an independent effect on ADHD caseness of the following variables: 1) SEP: material hardship and area deprivation (OR=1.43); low maternal educational attainments (OR=1.58) and single parenthood (OR=1.27); 2) maternal characteristics: lower self-efcacy (OR=1.26); lower selfesteem (OR=1.33); higher depression (OR=1.34); and lower attachment (OR=1.21) and 3) child characteristics: male sex (OR=1.61); concerns about speech delay (OR=1.79); epilepsy (OR=1.52); hearing problems (OR=1.86); vision problems (OR=1.51); temperamental fussiness (OR=1.27) and low regularity (OR=1.15). Signicant interactions between material hardship, maternal and child variables were detected. Children with all risk factors present were 7-fold more likely to meet ADHD caseness threshold compared to children with no risk factor present. Conclusion: Our study supports the signicant contribution of early environmental factors on ADHD symptoms in preschoolers. YS-01-04 EEG parameters during working memory task and response inhibition differentiate between medicated and medication naive children and adolescents with ADHD J. Geissler*, M. Romanos, A. Fallgatter, A. Warnke, K.-P. Lesch * Wurzburg, Germany Objective: Neuropsychological proles in Attention Decit Hyperactivity Disorder are very heterogeneous, with a considerable number of patients not displaying decits in laboratory tasks despite severe symptomatology in real life. We investigated topographical and eventrelated electrophysiological parameters in combination with behavioural output during tasks designed to measure working memory as well as response inhibition to get a clearer picture of the core problems and propose ADHD endophenotypes that might facilitate diagnosis. Method: The sample comprised 74 ADHD patients ( 10.12 years) and 30 healthy controls. Patients were further divided into subgroups: under stimulant medication (N=31), medication naive (N=18) and medication discontinued three days prior to the study (N=25). A 21-channel EEG was recorded during a working memory task with varying load (1-back and 2-back) and a Continuous Performance Test (CPT) to assess response inhibition. NoGo-Anteriorization as main electrophysiological marker for inhibition describes a shift in the centroid of the brain-electric eld from parietal towards prefrontal areas whenever prepared responses are suppressed. Results: Frontocentral N2 was delayed in medication naive compared to medicated subjects, p = .007 and correlated positively with false alarms for medication naive subjects (p = .032) and mean RT for medicated patients (p = .017). On a performance level, discontinuation of medication corresponded with more errors of omission and commission compared to medicated patients. Although there was no difference in error rates during the CPT, NoGo-Anteriorization as indicator of prefrontal functioning differentiated between those on medication and those who had discontinued it, p = .036. Conclusion: Error rates showed limited discriminative power, while EEG parameters could identify patients suffering from ADHD without medication. Psychostimulants not only reduced errors, but also normalized brain activity during tasks. As this is part of a longitudinal study, it will be interesting to see the development of these putative endophenotypes for ADHD and to identify subgroup specic combinations. Psychopathy and ADHD shared an impulsive factor. There was no other clearly dened shared factor to be found. Conclusion: Findings on the PCA suggest that ADHD and psychopathy are unrelated on a symptomatic level, with the exception of impulsivity.

YS-01-03 Symptoms of ADHD and psychopathy in perpetrators A factor-analytic approach S. Boureghda*, W. Retz, M. Rosler * Saarbrucken, Germany Objective: The current study attempts to further uncover the relationship between ADHD and psychopathy in perpetrators by investigating the possibility of underlying co-morbid factors of ADHD and psychopathy using standardized instruments. Additionally, the impacts of childhood ADHD symptoms on PCL scores were assessed. Method: Principal component analyses (PCA) were performed on ADHD-SR self-rating questionnaires and on the PCL-SV, which was rated for 314 criminal offenders. Additional correlation analyses and chi-square tests were performed on scores of the two questionnaires and self reported childhood ADHD symptoms. Results: The severity of ADHD and psychopathy scores were found to be associated. Single item scores of psychopathy were also found to be associated with self-reported childhood ADHD symptoms.

Saturday, 28 May 2011, 16.0017.30 YS-02 Young Scientist Award Session II

YS-02-01 Non-shared environmental effects of birth weight on ADHD symptoms persist into early adolescence. A 10-year longitudinal twin study C. Greven*, A. Ronald, R. Plomin, A. Rodriguez * London, United Kingdom Objective: Markers of poor fetal development, especially low birth weight, have been associated with Attention Decit Hyperactivity


101 Disorder (ADHD). However, genetic factors may underlie this association, as the same genes may be involved in low birth weight as well as ADHD. This study examines whether birth weight is associated with ADHD symptoms using a monozygotic (MZ) twin differences design to isolate non-shared environmental inuences from genetic and shared environmental factors. Method: ADHD symptoms in up to 5200 MZ twins from the U.K. population-representative Twins Early Development Study were rated by parents (ages: 2, 3, 4, 7, 8, 9, 12 years) and teachers (ages: 7, 9, 12 years). Twin birth weight was obtained via parent report when the twins were 18-24 months old. Results: Birth weight and ADHD symptoms were negatively associated. Within MZ pair comparisons revealed that the lighter twin in a pair had, on average, more ADHD symptoms than the heavier co-twin, suggesting that the association between birth weight and ADHD symptoms was non-shared environmentally mediated. Neither gestational age, gender nor socio-economic status moderated this non-shared environmental association. Effect sizes were generally stronger for more discordant twins and for parent than teacher rated ADHD symptoms. Although effect sizes were small, the magnitude of the association was consistent over a 10-year period spanning ages 2 to 12 years. Conclusion: Results suggest that poor fetal development, as evidenced by lower birth weight in relation to the co-twin, is a nonshared environmental risk factor for ADHD symptoms, with inuences that persistent into early adolescence. YS-02-03 Differences in functional connectivity patterns during response inhibition in drug naive children with ADHD H. Slama*, I. Massat, M. Kavec, S. Linotte, A. Mary, D. Baleriaux, T. Metens, P. Peigneux * Brussels, Belgium Objective: The present study aimed at identifying and comparing the regional brain activity and functional connectivity patterns associated with response inhibition, in prepubertal children with Attention Decit Hyperactivity Disorder (ADHD) and healthy controls, selected with stringent criteria minimizing potential confounds. Indeed, while neuroimaging studies have substantially contributed to better understand neural mechanisms underlying response inhibition in ADHD, it remains poorly understood in children. Moreover, high rates of co-morbidity, ongoing medications and behavioural differences in performance may be considered as potential confounds in neuroimaging studies in ADHD, each of these parameters having the potential to impact independently on patterns of cerebral activity involved in inhibition. Method: Eighteen never medicated children with ADHD combined type (8-12 years) and fourteen matched healthy participants completed fMRI (3T) studies while performing a Stop-Signal task measuring withholding of a triggered motor response. The design (Rubia, Smith, Brammer, et al. Am J Psychiatry 2005; 162:10671075), which manipulated task parameters to force each subject to fail on 50% of trials, ensured that subjects worked at the edge of their own inhibitory performance, controlling for intersubject and intergroup performance discrepancies and allowing for investigation of differences in brain activation related to inhibition and inhibition failure. Data were analysed using SPM8b. Results: Children with ADHD exhibit increased inhibition-related activation in a widespread cortico-subcortical network encompassing the right inferior frontal gyrus, the bilateral caudate nucleus (pcorr=0.022 in right caudate) and lentiform nucleus. Differential functional connectivity in ADHD compared to healthy participants is revealed between right caudate nucleus and a large network of subcortical and cortical regions: left postcentral gyrus, left inferior frontal gyrus, left superior frontal gyrus, left middle frontal gyrus, right precuneus and left anterior cingulate. Conclusion: Our ndings yield novel evidence for a core functional neuroanatomical network subtending response inhibition-related processes in ADHD children that may participate to the pathophysiology and the expression of clinical symptoms in this disorder.

YS-02-02 Interactions between self-regulation and aspects of parenting in predicting symptoms of Attention Decit Hyperactivity Disorder A. Lordos*, K. Fanti * Nicosia, Cyprus Objective: The purpose of this study was to explore the association between self-regulation and aspects of parenting in predicting Attention Decit Hyperactivity Disorder (ADHD). Method: A Greek Cypriot community sample of 1755 school age children and both of their parents completed questionnaires which included measures of ADHD symptoms, parental involvement, positive parenting, parental stress, and self regulation. Separate hierarchical regressions were conducted for the father and mother data sets, with ADHD symptoms as the dependent variable. The rst block of predictors included age and gender, the second block included the parenting variables, while self-regulation was entered in the model as the third block. Two-way and three-way interaction terms were inserted into the model as the 4th and 5th blocks. Results: Among boys, an interaction effect was found between maternal stress and maternal involvement, suggesting that maternal involvement is a protective factor at low levels of maternal stress but a risk factor at high levels of maternal stress. Additionally, an interaction effect was found between parental stress and positive parenting, suggesting that parental stress is a particularly acute risk factor for ADHD symptoms when positive parenting is absent. Among girls, an interaction effect was found between self regulation and maternal involvement, suggesting that maternal involvement is only protective against ADHD symptoms in girls with high self regulation, while it has no such impact on girls with low self regulation. Conclusion: This study highlights the complex interaction between self-regulation and aspects of parenting in explaining symptoms of ADHD. Further elucidation and validation of these interaction effects could contribute to a better understanding of the role of parenting in ADHD, with signicant implications for clinical practice.


102 YS-02-04 Association between dopamine--hydroxylase gene and Attention Decit Hyperactivity Disorder in Han Chinese boys N. Ji*, L. Liu, H.-m. Li, Z.-h. Li, Q.-j. Qian, L. Yang, Y.-f. Wang * Beijing, Peoples Republic of China Objective: ADHD is a highly heterogeneous disease, and appears its motor and cognitive symptoms are mediated differently. Different genetic factors may operate for males and females. Genetic polymorphisms of DBH gene may lead to altered NE neurotransmission. Our aim was to investigate the association of ADHD and polymorphisms in the DBH gene in Han Chinese ADHD boys. Method: A total of 1075 male ADHD trios were included. The diagnosis of ADHD and its subtypes as well as evaluation of comorbidities were ascertained as per the criteria of DSM-IV. 8 SNPs (rs1076150, rs1611115, rs1108580, rs2873804, rs1548364, rs2519154, rs2073837, rs129882) of DBH gene were genotyped implementing TaqManTM real-time PCR genotyping technique. TDT was employed for statistical analyses; permutation tests were used to evaluate gene-wide statistical signicance. Results: After permutation we found:1) In all ADHD trios (n=1075), A allele of rs2073837 showed over-transmission (P=0.0492); C allele of rs129882 showed a trend of over-transmission (P=0.0606). 2) In ADHD-C trios (n=497), A allele of rs2073837 (P=0.0192) were overtransmitted. 3) In ADHD comorbid oppositional deant disorder trios (n=331), A allele of rs2073837 (P=0.0090) and C allele of rs129882 (P=0.0020) were over-transmitted. Conclusion: Our results supported that DBH gene may be implicated in the pathophysiology of ADHD. Especially, strong association was found between the rs129882, rs2073837 polymorphisms and male ADHD comorbid ODD. Rs1611115 didnt show any associations as we investigated before in Chinese samples, which may due to the enlarged sample size. Withdrawal and Competence scores. Oppositional deant disorder/ conduct disorder comorbidity was more common in ADHD C. There were no differences in terms of anxiety/depression, parental symptoms, neuropsychological measures, and treatment response. Conclusion: Our results showed that previous differences reported between ADHD subtypes were also valid in this Turkish sample. There were similarities and differences between the subtypes, indicating that more detailed analysis, using other methods such as neuroimaging and genetics, can be helpful to have a better understanding of ADHD.

P-01-02 Comparison between parental SNAP-IV, teachers SNAP-IV and T.O.V.A. in regards to attention and impulsivity in children with ADHD V. Hercigonja-Novkovic*, D. Kocijan-Hercigonja * Zagreb, Croatia Objective: Objectives are: establish the co-relation between parental and teachers SNAP-IV in diagnostic procedures of ADHD 2. to establish co-relation between parental and teachers SNAP-IV and objective measure of attention and impulsivity; obtained in clinical setting - T.O.V.A. Method: Sample is 40 school aged children (age 7-10), of both genders, referred to clinic for ADHD diagnosis. Parents will ll in the SNAP-IV form and the same SNAP-IV will be lled in by childrens teachers. Then the comparison will be made. Children will be given the test of variables of attention in our clinical setting-T.O.V.A., and the results on variables of attention and impulsivity will be compared to those on SNAP-IV from both parents and teachers. Results: Results will show that test of variables of attention more accurately measures attention and impulsivity in children with ADHD. Results will show that teachers SNAP-IV form is more objective and similar to clinical results than parental SNAP-IV. Conclusion: SNAP-IV is good and relevant part of diagnostic procedure, but one must take into account the subjectivity of it, especially of the parental SNAP-IV.

Friday, 27 May 2011, 14.3016.00 P-01 Diagnosis: Children and adolescents I

P-01-01 Attention Decit Hyperactivity subtypes: Comorbidity, treatment response and parental characteristics O. Oner*, P. Oner, E. Cop, K. Munir * Ankara, Turkey Objective: To investigate the differences between Attention Decit Hyperactivity Disorder (ADHD) Combined (C) and predominantly inattentive (PI) subtypes in terms of social competency, emotional and behavioral problems, comorbidities, parental psychopathology, socioeconomic status (SES), cognitive measures, and treatment response in a clinical sample from Turkey. Method: ADHD and comorbid disorders were diagnosed with semistructured interview in 537 children and adolescents. Child Behavior Checklist (CBCL), Teacher Report Form (TRF), Conners Parent and Teacher Rating Scales (CPRS-CTRS) were obtained from the teachers and parents. Parental symptoms were evaluated with Adult Self Rating (ASR). Trail Making Test-A and B and Weschler Intelligence Scale for Children-Revised (WISC-R) were used to measure neuropsychological performance. One-month treatment response was dened as 25% or more decrease in pre-treatment CPRS and CTRS Total scores. p\.0018 were dened as statistically signicant. Results: ADHD PI subjects were more likely to be older, female, and from higher SES. ADHD C subjects had higher CBCL and TRF Aggression, Delinquency and Social Problems scores and lower

P-01-03 Validity of the DSM-IV factor structure of ADHD in young adults D. Baeyens*, L. Van Dyck, M. Danckaerts * Antwerp, Belgium Objective: DSM conceptualization of ADHD portrays inattention (IA) and hyperactivity/impulsivity (H/I) as two separate dimensions. The criteria in DSM-IV were empirically derived from clinically referred children and adolescents. We set out to determine whether the current factor structure is applicable to young adults (16-25 years old) with and without ADHD. Method: Parent and self reports (4-point Likert scale) on DSM-IV ADHD symptoms were obtained for 1716 (718M/998F) young adults from a Flemish community-based sample of which 252 had clincical scores on the Adult ADHD Rating Scale (Kooij & Buitelaar, 2005). Conrmatory (CFA) and exploratory (EFA) factor analysis were used to examine the data structure. Results: CFA for parent and self-report data revealed that single (IA/ H/I), two (IA?H/I) or three-factor (IA?H?I) models did not meet the minimum thresholds for goodness-of-t. For both informants data t the three-factor model better than a single- or two-factor model. Overall, parent ratings t the model better than self-reports. EFA indicates that data from self ratings support a ve-factor structure


103 (active IA, passive IA, H, I and emotional restlessness) whereas parent ratings reveal the current DSM dimensions IA and H/I. Conclusion: CFA indicates that the current conceptualisation of ADHD is not supported by data on young adults: neither a single nor a two- or three-factor model of ADHD meets the criteria for goodnessof-t. Of these models, ADHD symptoms in young adults are best described by a three-factor model. This nding highlights that the current DSM taxonomy of ADHD is specically focusing on a childhood population and does not fully account for the more complex nature of adult ADHD. Further evidence for this was found in EFA on self report data which suggests that more differentiation, even into ve factors, is needed. As parent reports rather support the current DSM two-factor structure, implications for the informant agreement will be critically discussed. Method: Patient records of the preceding 12 months at a child psychiatric unit in Cyprus were investigated to identify cases where at least one of the three related symptom categories inattentiveness, hyperactivity or impulsivity was included in the initial referral note. 53 cases were identied (47 boys) with a mean age of 9.77 years (range 4 to 17 years) for inclusion in the study. For these cases, oneway ANOVA was conducted with type of ADHD-like presenting symptoms - Hyperactive/Impulsive (N=24), Inattentive (N=9), or Combined (N=20) as the factor and with the nal diagnoses as dependent variables. Results: Among the overall sample, 29 patients (55%) were ultimately diagnosed with ADHD, 17 patients (32%) with Learning Difculties, 10 patients (19%) were deemed to be abused, 7 patients (13%) were diagnosed with Autism Spectrum Disorder, 6 patients (11%) with Conduct Disorder and 6 patients (11%) with Anxiety Disorder. By cluster of symptom type, Anxiety Disorder was significantly predicted (p\0.05) by the presence of only inattentive symptoms, while Conduct Disorder was signicantly predicted (p\0.05) by the presence of only hyperactive/impulsive symptoms. Conclusion: This study highlights the importance of exploring alternative potential diagnoses in children and adolescents referred for ADHD assessment, without rushing to accept ADHD-like symptoms at face value. Learning Difculties, Abuse, or Autism are particularly likely possibilities. Despite limitations in statistical power, this study suggests that an investigation of possible alternative diagnoses on the basis of specic ADHD-like presenting symptom clusters might be a promising avenue for research and clinical practice.

P-01-04 An experiential qualitative diagnosis instrument for self-image in ADHD children G. Cucu-Ciuhan* * Pitesti, Romania Objective: The objective of the study was to create and validate some qualitative experiential diagnostic techniques of the self-image in ADHD children. Method: There were two phases involved: the creation of the experiential diagnostic techniques and the development and validation of the video records check list for the self-image.Two classic projective techniques (Draw a person test and Tree test) were transformed in dynamic experiential exercises.The study involved 10 children, 5 with ADHD and 5 normal.The video records check list for the self-image was developed using the group of experts method. Results: The value of the Spearman Rho correlation coefcient indicated a medium to strong correlation (Spearman Rho=0,5, a=0,000) between the raters evaluations. The value of the Alpha Cronbach coefcient indicated a strong internal consistency (.914). To evaluate the discriminate validity we used the independent samples T test. The T test reveled a signicant difference between the ADHD group and the control group for the total score of the video records check list for the self-image (t=2,294, sig=0,029). Conclusion: The video records check list for the self-image has good reliability and good content and discriminate validity and can be used for qualitative diagnosis of the self-image in ADHD children.

P-01-07 The strength-based interview of behaviors, parent edition: Inter-rater reliability and factor structure P. Robaey*, R. Schachar, N. Forget-Dubois, G. Dionne, M. Boivin * Ottawa, Canada Objective: A symptom-based rating then creates a highly skewed and truncated distribution of scores in the normal population, because it only rates normality as an absence of symptom The objective of the study was to test the distribution, the inter-rater reliability, and to examine the factor structure of a strength-based interview for ADHD The Strength-based Interview of Behaviors, Parent edition (SIB-PE) was developed and tested from a previous clinical instrument, the Parent Interview for Child Symptoms (PICS). Method: The SIB-PE rates each symptom/strength on a scale from -3 to ?3. We obtained data on 298 twins (age: 100 months). 55 interviews were randomly selected to be videotaped and coded twice independently in order to assess inter-rater reliability Results: The SIB-PE scores were normally distributed for ADHD combined scores, but also for Inattention and Hyperactivity/Impulsiveness scores. The modes of all distributions were centered on zero. Kappas values increased with the number of symptoms and reached 1 for a total of 5 symptoms (ADHD Hyperactive/Impulsive subtype) to 6 symptoms (ADHD Inattentive and Combined subtypes), which gives great condence in the diagnostic inter-rater reliability using the current diagnosis thresholds. An exploratory factor analysis of the scores yielded four factors: one hyperactivity/impulsiveness factor and three attention factors that seemed to match Posners attention networks: executive, alert and orienting. Conclusion: A strength-based interview may thus constitute a useful tool for genetic studies by increasing the range of rating of ADHDrelated behaviors, for reliably diagnose ADHD and provide subtypes that may be closer to attention physiological brain systems.

P-01-05 When appearances can deceive: Final diagnoses of children and adolescents presenting with inattentive, hyperactive or impulsive symptoms in an out-patient child psychiatric unit. E. Lordou*, A. Lordos, C. Lazarou, A. Lazarou, P. Mama, A. Paradeisioti * Nicosia, Cyprus Objective: The purpose of this study was to investigate the extent to which presenting symptoms of inattentiveness, hyperactivity or impulsivity, actually map out to Attention Decit Hyperactivity Disorder (ADHD) once the clinical assessment process has been completed; and if not, to explore whether distinct clusters of ADHDlike symptoms differentially predict alternative diagnoses.


104 P-01-10 The comparison between children with Attention Decit Hyperactivity Disorder with their parents in integrated visual and auditory test results R. Rostami*, M. Bidadian, J. Zarei * Tehran, Iran Objective: The purpose of this study was the comparison between children with Attention Decit Hyperactivity Disorder (ADHD) with their parents in integrated visual and auditory (IVA) continuous performance test (CPT) results. The hypothesis in this study was that the parents of children whom were diagnosed as with Attention Decit Hyperactivity Disorder had themselves this disorder in their childhood. Method: This study was performed between November 2010 and January 2011. This study was retrospective design. Participants of this research included 60 adults, 20 male and 40 female who were the parents of children whom were diagnosed as ADHD from Atieh group. Participants were between 25-50 years old and completed the IVA test. Their children completed this test before their treatment. For analyzing the data correlation was used. Results: Results showed that there is a signicant relationship between results of IVA test for parents and their children. Conclusion: The ndings of this research suggest that most of the parents having children with ADHD have inattentive symptoms. Most parents are categorized into predominantly inattentive subtype. These results are discussed in regard to the results of follow-up studies of those diagnosed with ADHD which indicate signicant continuation, impairment and persistence into adulthood that has a number of negative consequences in economic, occupational, social, academic, marital and parenting domains. Most adults with ADHD are not recognized and remain untreated or treated for other comorbid mental disorders. The problems discussed above indicate the importance of an exact method such as IVA for the diagnosis of ADHD. were no differences between both groups regarding age and educational level. However, we found a signicant difference in anxiety scores measured by STAI (p\0.05), children with ADHD having higher scores than their siblings. Depressive scores on CDI did not differentiate between ADHD probands and sibs. Conclusion: Our results suggest that ADHD is associated with anxiety, even if there is no formal diagnosis of Anxiety Disorder. This association may not be related to psychosocial factors or family environment, although other alternative explanations are possible and are being investigated. Although previous studies have demonstrated higher anxiety levels in parents of children with ADHD, which might be associated to the burden of an ADHD offspring, the present study suggests that siblings without the disorder do not have higher anxiety levels.

P-02-02 The risk of overweight and obesity in boys with Attention Decit Hyperactivity Disorder T. Hanc*, A. Slopien, T. Wolanczyk * Poznan, Poland Objective: Comparison of the prevalence of overweight and obesity among boys with Attention Decit Hyperactivity Disorder (ADHD) and the general population (GP) 2) identifying factors associated with risk of obesity in boys with ADHD. Method: The study sample consisted of 71 boys with a conrmed diagnosis of ADHD, between 6-17 years of age. The study was a cross-sectional and included measurement of height and weight and questionnaire survey. was calculated. Excess weight and obesity were diagnosed using Body Mass Index (BMI) and the WHO standards. Nonparametric Kruskal-Wallis test, chi2 method and Mann-Whitney test were used in statistical analysis. The signicance level was set at p\0.05. Results: Comparison of mean standardized values of height (z=0.12), weight (z=0.18) and BMI (z=0.22) of boys with ADHD and GP (n=18828, 7-17 years) showed no difference. The prevalence of overweight did not differ between the sample (14.08%) and GP (15.52%). However, a statistically signicant difference was found between the incidence of obesity (ADHD: 7.04%, GP:2.67%). The risk of overweight/obesity in our sample was related to birth weight above 4500g (high birth weight - HBW). BMI of boys with HBW (z=1.75) was signicantly higher than boys with a birth weight between 2501-4500g (normal birth weight - NBW, z=0.26). The incidence of overweight/obesity was also higher (4-fold) in boys with HBW than NBW. The level of BMI and risk of overweight and obesity were no signicantly inuenced by severity of ADHD symptoms, comorbid disorders and prior treatment. Conclusion: The risk of obesity were more than 2.5 times higher in boys with ADHD than in the general population of Polish boys. The predisposing factor for excessive body weight in this group is high birth weight. This may suggest a common genetic basis of ADHD and obesity, but also may indicate the crucial role of dietary habits prevailing in the family. High birth weight in the general population is also a risk factor for obesity later in life. Therefore, in subsequent studies it should be investigated whether the increased risk of obesity in boys with ADHD is not associated with a higher incidence of high birth weight in this group.

Friday, 27 May 2011, 14.3016.00 P-02 Co-morbidity: Children and adolescents I

P-02-01 Anxiety symptomatology in ADHD children A comparison study between probands and their siblings D. Segenreich*, R. Suwwan, J. Sergeant, P. Mattos, D. Fortes, J. Torres, L. Novo * Rio de Janeiro, Brazil Objective: A higher prevalence of Anxiety Disorders is well documented in ADHD children living in culturally and economically heterogeneous parts of Brazil. However, anxiety levels which do not reach DSM IV cutoff for formal diagnosis notwithstanding their relevance in clinical practice has not been studied in Brazil. The aim of this study was to perform a comparison of anxiety levels between children with ADHD and their siblings without ADHD. Method: Fifty ADHD probands and thirty four siblings (n=84) were evaluated for ADHD, depressive and anxiety levels, and also psychiatric comorbidity. ADHD and comorbid disorders were assessed with the semi-structured interviews (K-SADS and P-Chips, respectively) by trained psychiatrists in both ADHD probands and their sibs. They were also evaluated with Child Depressive Inventory (CDI), Stait-Trait Anxiety Inventory (STAI) for children. Probands and siblings who presented with a full mood or anxiety DSM-IV disorder were excluded from the study in order not to inate the symptom count for subthreshold cases. Results: Seventeen probands and ten siblings were excluded from the original sample because of present mood or anxiety disorder. There

P-02-03 Game addiction and ADHD in early elementary age children S.-C. Kim*, I.-W. Chung, S.-W. Park, H. Yoo, S.-C. Cho * Goyang, Republic of Korea


105 Objective: The purpose of this study was to survey the relationship between early elementary age childrens game addiction and ADHD, and to investigate the associated psychopathology and parent-child relationship problems. Method: The study included 2481 boys and girls, with an age between 6 to 8 (rst-graders with mean age years old), collected from elementary schools in Paju city, South Korea, in 2010. Primary caregivers were required to complete Korean ADHD Rating Scale (K-ARS) as screening tool. Those whose K-ARS scores exceeded 19 point were required to perform Korean Child Behavior Checklist (K-CBCL). To conrm the diagnosis, the ADHD section of the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was performed by a experienced child psychiatrist. Thirty-six children who were screened by K-ARS and K-CBCL completed the Childrens Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAI-C). Their primary caregivers also completed the Internet Game Addiction Scale for Children and the Parent-Child Communication Scale. Correlation, chi-square test and logistic regression analysis were conducted to investigate the associated psychopathology of game addiction and ADHD. Results: Signicant difference in game addiction score was observed between ADHD group and non-ADHD group. There was also signicant difference in the frequency of problematic game user and non-problematic game user according to ADHD diagnosis. Logistic regression showed that diagnosis of ADHD and male gender increased the odds of problematic game use. Childrens depression, anxiety, and parent-child communication showed no association with the development of game addiction score in this age-group. Conclusion: This study shows that ADHD is highly related to problematic game use in early elementary age children. (ANOVA: Metalinguistic _ F (2,29)= 15.86, p B .05; Verbal uency _ F (2,29)= 6.19, p B .05) and one executive function component (ANOVA: Shifting and working memory _ F (2,29)= 14.22, p B .05). Participants in Cluster 1 manifested sufcient language competence and shifting working memory than participants in cluster two who manifested vulnerability in shifting working and metalinguistic component. Participants in cluster 3 showed impairment in inhibitory attention control and verbal uency. Conclusion: ADHD children present different language organizations/or impairment at various levels of severity and language complexity components. On the basis of the language organization characteristics or impairment correspond different clinical proles and different severity EF impairment.

P-02-05 Does the clinical prole of children with Attention Decit Hyperactivity Disorder with comorbid mood disorder differ from those without comorbid mood disorder? P. Palaniappan*, S. Seshadri, S. Srinath, S. Girimaji * Bangalore, India Objective: Though there are many studies on ADHD (Attention Decit Hyperactivity Disorder) and co-morbid mood disorder, only few studies have analyzed clinical prole of ADHD children who later develop mood disorder. Hence we studied the factors in ADHD subjects (children and adolescents) who later develop mood disorder and assessed the global functioning in ADHD subjects with and without comorbid mood disorder. Method: Subjects aged 6 to 16 years were screened for diagnosis of ADHD using DSM IV TR criteria at index consultation (N=60) with informed consent. Comorbidities were diagnosed using K-SADS PL and then subjects were grouped as those with (N=14) and without (N=27) co-morbid mood disorder (Unipolar depressive disorder and Bipolar affective disorder). Severity of ADHD and Global functioning were assessed by Conners Parents 10 item abbreviated index and Children Global Assessment scale (CGAS) respectively and the results were compared using independent t test. Results: Age range of subjects with and without co-morbid mood disorder was 1016 years and 6-9 years respectively. When compared to subjects without co-morbidity, subjects with co-morbid mood disorders showed signicant family history of mood disorder (p=0.07) and higher parental discord (p=0.04). No statistically signicant difference was found in gender, Temperament and Upbringing pattern. First episode of all subjects with co-morbid bipolar affective disorder (N=8) was hypomania. None of the subjects with mania suffered from pervasive irritable mood and rapid cycling subtype. Subjects with comorbid bipolar affective disorder had Conduct disorder (37%), Obsessive compulsive disorder (37%) and Substance use disorder (25%), whereas subjects with co-morbid unipolar depression had Oppositional deant disorder (33%). Subjects with co-morbid mood disorder scored poor on global functioning (p=0.04). Conclusion: ADHD children with family history of mood disorder and signicant parental discord have higher risk of developing mood disorder later in life.

P-02-04 Neuropsychological proles in ADHD preschoolers: Relation between executive functions and language competences M. G. Melegari*, M. Innocenzi, A. Costa, L. Canzano, F. Baccarin, F. Martines, S. LaPietra, A. Marano * Roma, Italy Objective: The present study investigates the relation between executive functioning (FE) and language-processing in a sample of ADHD preschoolers. Clinical implications of the different neuropsychological proles are discussed to explore the controversy hypothesis of co-morbidity between the two impairments (Riccio, Hynd, Cohen, Hall, & Molt, 1994). Method: Sample: 31 preschooler ADHD, 64.5% with a history of speech-language impairment (whose 41.9% treated by child neurologists). Assessment (using standardized test): EF measures=planning, attention, Shift inhibitory control and Working memory; Language measures= receptive and expressive lexical and phonological competences; narrative competence categorial and phonemic uency.Statistical analyses Descriptive and correlation analysis between measures, Exploratory factor analyses (EFA) and Cluster analyses were conducted. Results: Correlation analysis showed moderate coefcient values between language and EF variables (r=B.30). EFA identied a consistent factorial solution on language components (3 factors; explained variance 72.32%): Phonological and Lexical; Metalinguistic; Verbal uency; and another consistent factorial solution regarding to executive functions (2 factors, explained variance 60.76%): attention-planning; shifting - working memory. A threecluster solution was selected: Clusters had different patterns. Cluster analysis on factorial scores showed signicant difference between the three clusters regarding to language complexity components

P-02-06 Comorbid Attention Decit Hyperactivity Disorder in a sample of Brazilian children with Attention Decit Hyperactivity Disorders (ADHD) S. M. M Palma*, S. Rizzutti, L. F. Coelho, S. A. Oncalla, D. L. F. Barbosa, R. Barbosa, M. C. Miranda, O. F. A. Bueno, M. Muszkat


106 * Sao Paulo, Brazil Objective: This study evaluated the clinical aspects related to ADHD and its comorbidities. Method: Evaluation of 250 children aged 7 to 14 years enrolled in NANI/UNIFESP complaining of difculties in attention and/or hyperactivity, by a multidisciplinary team and application of extensive battery of neuropsychological tests: DSM-IV criteria, Continuous Performance Test (CPT), ve subtestes from Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Results: 116 children (88 M and 28 F) fullled the criteria for ADHD, among which 45 were of the inattentive type, 59 of combined type and 12 were hyperactive/impulsive. DSM-IV 48 cases (41,5%) had complained of comorbidities, being that 23 (20%) with anxiety disorders, 14 (12%) with oppositional deant disorder, 3 (2,5%) with conduct disorder, 5 (4,5%) with bipolar disorder and 3 (9%) met criteria for major depression (9%). Conclusion: Attention Decit Hyperactivity Disorder (ADHD) is a highly prevalent disorder among school age1. Children and it is now recognized as an important condition because of its poor outcome and strong association with comorbidities2. These patients need more attention and personalized treatment strategies. The impact of comorbidities may modify the therapy, rehabilitation strategies and prognosis. rstly, to establish psycholinguistic approach to cross-cultural research of children with ADHD, and secondly, to compare peculiarities of speech and language activities of American and Ukrainian children with ADHD of the age 8-10 years. The core of psycholinguistic approach is psychology of meaning. Method: The typology of meaning was proposed for speech and language activity research. Three types of meaning were used: lexical, sentential, discourse. The lexical meaning was represented by the associative meaning (free associative experiment after J. Deese), connotative meaning (semantic differential after Ch. Osgood).The sentential meaning comprises of propositional analysis. The discourse meaning was studied by frame analysis of story-telling. The study groups consisted of 24 Ukrainian children and 22 American children (mean age 10 years). The method of free associative experiment is used for revealing the associative word-meaning, which characterizes speech and language competence. The method of semantic deferential allows revealing emotional attitude to neutral notions, which shows the emotional liability of the person in communication. The propositional analysis is based on theory Fillmore (1968) and characterizes the thinking process. The frame analysis (Zasyekina, 2006) for discourse meaning allows revealing cohesion and coherence of the story and reects social-pragmatic skills and feeling of the context in communication. Data analyses were carried out using SPSS. T-tests were used to examine differences between two groups. Results: The great discrepancy in different types of meaning was not established. The main differences are observed in connotative meaning, which has higher indices in Ukrainian group than in American one. Conclusion: The culture is not specic feature for children with ADHD as age and gender are. It gives a great opportunity for international contribution to ADHD treatment.

P-02-07 A clinical study of phenomenology and comorbidity of ADHD in Indian children A. Vaithiyam*, K. Devendran * Madurai, India Objective: To discuss the phenomenology and co morbidities of pediatric BPD. Method: 60 subjects (6-16 years) attending child guidance clinic at Ram Psychiatry Hospital & Institute who fullled DSM-IV-TR 2000criteria for BPD were assessed using K-SADS-PL, child mania rating scale (CMRS), child depression rating scale (CDRS) ADHDRS and C-GAS. Results: All the subjects were diagnosed as BPD- I. Their mean chronological age was 13.6 ? 1.7 years and the mean age at onset of BPD was 12.5 ? 1.9 years. The commonest symptoms in mania were increased goal directed activities, distractibility (100% each), elation (100%), and grandiosity (96.6). Irritability and rapid mood swing were reported by parents in 73% and 40% subjects respectively. Psychotic symptoms were present in 11.9% of the subjects. 5(8.3%) subjects had chronic course, and one (1.6%) had rapid cycling, 10(16.1%). Two subjects had ADHD (3.2%), and one had ODD (1.6%). Conclusion: Differentiation of co morbid disruptive behavior disorders especially ADHD from BPD is possible with respect to age of onset, quality of the disturbed mood, and the course of each disorder.

P-02-09 Analysis of leiter-r proles in comparing ADHD children with high functioning pervasive developmental disorder not otherwise specied in preschoolers F. Manti*, A. Fabrizi, F. Giovannone * Roma, Italy Objective: The aim of this study was to investigate cognitive proles, emotional and behavior problems between a group of children with Attention Decit Hyperactivity Disorder (ADHD) with a group of children with high-functioning (IQ C 80) pervasive developmental disorder not otherwise specied (PDDNOS). Method: The current study investigate 30 children (15 ADHD and 15 PDDNOS) ranging in age from 48 to 60 months. The diagnosis of children were based on DSM-IV TR criteria and established by three clinicians (two psychiatrists and one language and speech therapist), by several clinical interviews on development and symptoms of children lled out by parents; by observation of children and neuropsychological measures (Leiter-R Test and Child Behavior Checklist 1.5-5). In addition, parents were asked on the developmental history of their children (speech and language development, attention problems, social interaction, sleep, motor functioning and diet). All analyses were carried out by Statistica 8 software. Given the small sample size data were analyzed by independent sample t-test to assess the differences between ADHD group and PDD NOS group. Results: It was found that ADHD group had higher scores on subtests of Leiter-R than PDDNOS group. Subtests Repeated Patterns (p=0,0036), Delayed Recognition (p=0,001), Forward Memory (p=0,02) and Attention Sustained (p=0,000086) discriminated best. Conclusion: This study claried difference in cognitive function and autistic symptom proles between ADHD and PDDNOS children. Often, deductive and inductive cognitive skills were affected by emotional-behavior component. It was concluded that based on

P-02-08 The impact of culture on language and speech competence of children with ADHD L. Zasyekina* * Lutsk, Ukraine Objective: The assessment of speech and language competence from culture perspective is difcult by linguistic variation that impacts on verbal presentation. The two main objectives of the research are,


107 intelligence scores, ADHD and PDDNOS emerged as distinct categories, whereas the combined diagnosis did not. Conclusion: The results of our study reveal a high phenotypical overlap between PDD and ADHD. P-03-02 Family adversity risk factors for ADHD and associated disruptive behaviour disorders in Singapore N. Lim-Ashworth*, Y. P. Ooi, C. G. Lim, D. S. Fung, R. P. Ang * Singapore, Singapore Objective: This study examined whether family adversity predicted disruptive behaviour disorders (DBD) (including ADHD, CD and ODD) when compared to clinically referred children who did not receive a diagnosis. We also explored the associations between family adversity and behavioural and emotional problems as measured by the Child Behaviour Checklist (CBCL). Method: The sample consisted of 178 children aged 9 to 17 seen at an outpatient psychiatric clinic in Singapore. 77 of the children satised the DSM-IV criteria for DBD and the remaining 101 did not receive a clinical diagnosis. Their parents completed a computerised diagnostic interview (C-DISC), a clinical interview and the CBCL. The family adversity index was summed from six items (e.g., low SES, large family size) on the clinical interview; 1 point was given for the presence of each item. Results: Analyses from logistic regression indicated that the family adversity index signicantly predicted DBD, with 3.3% of the variation accounted for by the index (OR = 1.44, Sensitivity = 55%, Specicity = 60%). Correlational analyses suggested that the index was associated with the following CBCL scales: Total Problems, r(176) = .16, Thought Problems, r(176) = .17; Aggressive Behaviour, r(176) = .16, p\.05, and Externalising Behaviour, r(176) = .22, RuleBreaking Behaviour, r(176) = .29, p \ .01. Conclusion: Our ndings suggest that a high family adversity increase the risk of a DBD diagnosis. The presence of adverse familial factors was related with mainly externalising behavioural issues. Identication of at-risk children should be considered, especially from the school and community levels. Interventions aimed at equipping these families with protective resources and reducing the impact of the adversity may be benecial.

P-02-10 Neurological soft signs in children with Attention Decit Hyperactivity Disorder compared to Asperger syndrome E. Dagati*, L. Casarelli, M. Pitzianti, A. Pasini * Ciampino, Italy Objective: Motor dysfunction is not just an additional characteristic of Attention Decit Hyperactivity Disorder (ADHD) and Asperger Syndrome (AS), but underlies some of their core characteristics.In this study we evaluated children with ADHD and AS for neurological examination abnormalities compared with healthy children. Method: 33 drug-naive boys were enrolled: 11 ADHD, 11 AS, and 11 healthy children matched for age, sex, and IQ. Subjects were 8-12 years of age with an IQ[80. Motor function was assessed using the revised Physical and Neurological Assessment of Subtle Signs. Three variables were obtained: total speed of timed movements, total overow, and total dysrhythmia. Effects of age, group, and IQ were assessed. Results: Total speed of timed movements is slower in AS than in ADHD and healthy children, independently of age and IQ. No difference in total overow was found. Total dysrhythmia seemed to differentiate ADHD and AS from controls. Conclusion: Total speed of timed movements differentiated AS children from ADHD and controls, whereas total dysrhythmia was present in both ADHD and AS patients but not in controls. Dysfunction of the fronto-striatal-cerebellar networks related to motor control, reported in boys with ADHD and AS, could be at the base of our ndings.

Friday, 27 May 2011, 14.3016.00 P-03 Co-morbidity: Children and adolescents II

P-03-01 Pervasive developmental disorders (PDD) with Attention Decit Hyperactivity Disorder (ADHD) and chronic multiple tic disorder (CMTD) in children and adolescents M. Igor* * Kyiv, Ukraine Objective: PDD, ADHD, CMTD are neurodevelopment disorders thought to involve frontostriatal brain regions. While from a neurobiological perspective it is possible, and even highly likely, that ADHD and PDD might clinically co-exist, our major diagnostic classication systems (DSM-IV-TR and ICD-10) currently preclude such a dual-diagnosis.This study aims to evaluate neurodevelopment spectrum symptoms in children with, as well as the comparison of tthree PDD subsamples of children with ADHD (PDD?ADHD), without ADHD (PDD-ADHD), with CMTD/ADHD (PDD?CMTD/ ADHD). Method: Participants are 249 children with PDD. Dimensional and categorical aspects of ADHD, PDD, CMTD are evaluated using a diagnostic symptom checklist according to DSM-IV. Results: Of the sample, 84.7% fulll DSM-IV criteria for ADHD, -20.1% for CMTD. The comparison of the PDD?ADHD and the PDD-ADHD samples reveals differences in age and IQ. Correlations of ADHD and PDD show signicant results for symptoms of hyperactivity with impairment in communication and for inattention with stereotyped behavior. Item proles of ADHD symptoms in the PDD?ADHD sample are similar to those in a pure ADHD sample.

P-03-03 ADHD and learning disabilities as factors of school unsuccess M. Inna*, M. Igor, K. Svetlana * Kyiv, Ukraine Objective: The aims of this study was to investigate the prevalence of ADHD, school skills and behavioral disorders and examined academic success of school children with ADHD subtypes, oppositional (ODD) and conduct (CD) disorders. Method: Were examined 646 children: 482 at a secondary school and 164 at a special school for students with learning disabilities (LD). The investigation included: 1) screening of parents through the CSI 4, CBCL and Connors Parent Rating Scale, 2) screening of teachers with scales NICHO Vanderbilt and Connors Teacher Rating Scale. Results: ADHD at the Kievs school children is more common than in Europe and the USA: the 12,2% in secondary school, 27,4% in special school. It was establish gender differences: the accumulation in special school ADHD boys with hyperactivity and impulsivity (ADHD-H/Im) and girls with inattention (ADHD-H/Im). 31,7% children with ADHD had ODD, 39,4% - CD, 31,0% - LD. In children with ADHD-H/Im, along with academic problems, there have been more severe disruptions of school adaptation than in children with ADHD-I and students without ADHD.


108 Conclusion: Special schools provide better conditions for the integration of ADHD children. LD can mimic the symptoms of ADHD. Students with ADHD should always be screened for LD. tolerance, emotion regulation difculties. This group presents a major probability of bipolar disorder diagnostic.

P-03-04 Attachment patterns in Attention Decit Hyperactivity Disorder with and without Severe Mood Dysregulation: Preliminary results C. Paloscia*, C. Rosa, F. Manaresi, R. Alessandrelli, A. Marianecci, A. Pasini * Rome, Italy Objective: Severe mood dysregulation (SMD) is a syndrome characterized by severe, nonepisodic irritability and by hyperarousal symptoms typical of mania but who lack the demarcated periods of elevated or irritable mood specic of bipolar disorder. SMD occurs in about 30% of children and adolescents with Attention Decit Hyperactivity Disorder (ADHD). We compared attachment patterns in ADHD with and without SMD. Method: This study compared 24 boys with ADHD (7-13 years) to 20 boys (7-13 years) with ADHD and SMD. Patients were admitted consecutively to Division of Child Neuropsychiatry of Tor Vergata University and to a child outpatients service. Clinical evaluation of children was performed with the Kiddie Schedule of Affective Disorders (K-SADS) and Conners Rating Scale. All patients were evaluated with Separation Anxiety Test to assess attachment patterns. Results: Signicant differences were found between ADHD and ADHD with SMD. ADHD Children with SMD showed an higher prevalence of insecure and disorganized attachment compared to group without SMD (p\0.001). Conclusion: Attachment patterns could represent an important risk factor to develop severe mood dysregulation in ADHD. Further studies will be needed to clarify the nature of this association.

P-03-06 Attention Decit Hyperactivity Disorder: Co morbidity and multimodal management of children attending community clinic in a patch of Midessex, UK P. Sahare* * Braintree, United Kingdom Objective: This main aim of the study was to nd the subtypes and co morbid conditions associated with ADHD among children and adolescents attending paediatric community clinic settings in a patch of Mid Essex.UK. The second aim was to nd out how is ADHD managed in the community setting. Method: Design: Cross sectional study with retrospective data analysis Place and Duration of study: Children and Adolescent attending community clinic setting in a patch of Midessex, UK from January to February 2010. Retrospective data analysis was done in January 2011. Methods: 4-19 years children and adolescents attending the community clinic in the Braintree and Witham patch of Midessex UK during the above mentioned period. Results: Of the 141 children attending the clinic 23 (16.3%) children had a diagnosis of combined type ADHD and 7 (4.9%) were diagnosed to have inattentive type of ADHD. The common co-morbid conditions associated with ADHD were Oppositional deant behaviour (n=12) (40%), emotional and behavioural difculties (n=5) (16.6%), sleep problems (n=5) (16.6%), learning difculty (n=8) (26.6%), motor coordination difculties (n=5) (16.6%), and anxiety (n=3) (10%). All the parents and teachers of children diagnosed with ADHD were provided behavioural strategies to be implemented at home and school respectively. Out of the 30 children with ADHD/ ADD spectrum 24(80%) children were started on medications (modied release preparation of methylphenidate). Desired response so as to reduce the core symptoms of ADHD was obtained in 20(83.3%) children. 7(23.3%) children were referred to the Child and Adolescent mental health team. 5 (16.6%) children had input from the Occupational therapy team. Melatonin was the drug of choice for children with sleep problems who did not respond to good bed time routines. Only 2(8.3%) children had weight loss as a side effect of medications. Conclusion: The results suggest that in Midessex patch of UK approach to management of ADHD is multimodal with involvement of children, parents, and other health professionals along with medications. Co morbidities are commonly associated with ADHD and hence there is a need to involve other health professionals. Modied release preparations of methylphenidate are effective in managing ADHD.

P-03-05 Bipolar disorder diagnostic among ADHD population use of child Bipolar Questionnaire (CBQ, Papolos, 2006) A.-L. Thoumy*, A. Gaiffas, M. P. Bouvard * Bordeaux, France Objective: An overlap of maniac and hypomaniac symptoms and ADHD symptoms is frequently described, particularly in children and adolescents. The main objective of this study is to evaluate maniac and hypomaniac symptoms presented by children and adolescents with ADHD using categorical, dimensional and temperamental approach. Method: A 12 months prospective study included 35 subjects with ADHD diagnostic, aged 7 to 17 years old. Maniac and hypomaniac symptoms were studied using different approaches: categorical (MINI-KID, ADHD Rating-Scale), dimensional (Child Behavior Checklist, Child Bipolar Questionnaire) and temperamental (Ques tionnaire de Temperament Cyclothymique et Hypersensitif). Results: According to dimensional approach, children and adolescents with ADHD present externalizing symptoms (aggressiveness, irritability, emotion dysregulation). Conclusion: Dimensional approach underlines a similar symptomatology for bipolar disorder (BPD) and ADHD. There is a particular group among this ADHD population, with irritability, poor frustration

P-03-07 Verbal turns difculties in 4-5 years old Saudi males with ADHD W. Al-Dakroury*, N. Hewlett, J. Watson, H. Gardner * Riyadh, Saudi Arabia Objective: This study will investigate the verbal turns difculties in of 4-5 years old males with Attention Decit Hyperactivity Disorder in Jeddah region, Saudi Arabia.


109 Method: The participants were twenty 4-5 year old Saudi boys. Ten were typically developing and ten had a diagnosis of ADHD. All participants were mono lingual and from the Jeddah region of Saudi Arabia. Speech and Language screening and Hearing screening were conducted for all typically developing children. A 30 min sample of speech was collected from each child in conversation with an unfamiliar interlocutor. The protocol for each session was consistent across all participants. A 15 min sample of speech was collected during free play with the mother. All sessions were recorded on DVD using two video cameras. We intend to use this data for an extensive comparison of the pragmatic linguistic abilities of ADHD children and typically developing children. The rst stage of this analysis, reported here, focused on quantitative aspects of verbal output. Results: In the sessions with the unfamiliar interlocutor, the mean number of verbal turns for the ADHD group was 67.1 and for the typically developing children it was 196.9. The difference was signicant (p \ 0.0001). In the sessions with the mother, the mean number of verbal turns for the ADHD group was 47.2 and for the typically developing children it was 123.50. The difference was signicant (p \ 0.0001). In the sessions with the unfamiliar interlocutor, the mean number of words per turn for the ADHD group was 1.73 and for the typically developing children it was 2.74. The difference was signicant (p \ 0.001). In the sessions with the mother, the mean number of words per turn for the ADHD group was 1.954 and for the typically developing children it was 2.78. The difference was signicant (p \ 0.001). Conclusion: ADHD children have a reduced verbal turns, compared to typically developing children of similar age. Of course we have at this stage no means of telling whether the reduced verbal turns is merely a by-product of non-linguistic core behavioral characteristics of this disorder or whether it stems from a core linguistic pragmatic decit which is (or can be) an integral part of the disorder itself. The next stage of our research will involve an analysis of topic initiation and topic maintenance characteristics, within the same data set, with a view to throwing further light on this question. S and ADHD-RS scales). After adjustment for comorbidity, age, gender and symptom severity scores, ADHD patients with a CBCL-DP prole showed a personality pattern characterized by high Emotionality on the EAS questionnaire and low Self-directedness on the JTCI questionnaire. There was a trend toward an association between the CBCL-DP prole and response to methylphenidate (ADHD-RS Response rate: t-test = 1.80; p = 0.07). Subjects without the CBCL-DP prole showed a better response to methylphenidate treatment for most criteria responses (criteria 1: improvement on the ADHD-RS above 50%: chi2 test = 3.97; p\0.05 - criteria 2: improvement on the CGI-S above 50%: chi2 test = 1.43; p \ 0.23 - criteria 3: improvement on the ADHD-RS and CGI-S above 50%: chi2 test = 4.29; p\0.05). No signicant difference was found between subjects with and without CBCL-DP in cognitive functioning. Conclusion: Given the specic clinical characteristics and treatment outcomes of ADHD patients with a CBCL-DP prole, further research is needed to develop appropriate treatment strategies.

P-03-09 Reader proles in ADHD subtypes in 7-10 years old children in Malaga (Spain) M.-J. Diaz*, A. Lora-Espinosa, M. Lopez-Zamora, J. L. Luque-Vilaseca, N. Mendoza * Malaga, Spain Objective: 1) To study the efciency and reading speed in children with ADHD. 2) To study if the ADHD subtypes have different reader proles. 3) To establish how children with different subtypes of ADHD behave at reading. Method: Population: Children 7-8 and 9-10 years-old of Malaga (Spain): 28 and 48 Primary School. Multistage cluster random sampling: 14 schools: 52 classrooms: 1000 children were included. Sample: N=242: 79 children with ADHD (inattentive subtype=35, hyperactive-impulsive subtype=18 and combined subtype=26), 68 children with reading disability (RD) and 95 controls. Measures: academic performance, reading efciency, reading speed, lexical effect and inhibition decits. Method: 1) Questionnaires DSM-IVTR-ADHD for the diagnosis of ADHD; 2) Performance Vanderbilt to parents and teachers; 3) Reading Efciency Test for the diagnosis of reading disability; 4) Ravens Test to remove children with low IQ; and 5) Lexical Decision Task with 3 types of stimuli: words, nonwords and pseudohomophones, this task was programmed with E-Prime Software 1.2. Results: Low performance in reading (p\0.005): inattentive subtype: OR=7.52 (4.69-12.07), hyperactive-impulsive: OR=2.92 (1.48-5.76), combined: OR=7.40 (2.80-19.56). In children 9-10 years old in reading efciency: IA: 20.12 (SD=3.3, p\0.001), HI: 24.25 (SD=6.19, p\0.23), mean controls: 28.12 (SD=6.06). In reading speed: IA: 24 (SD=4.03, p\0.001), HI: 26.75 (SD=6.15, p\0.14), controls: 30.07 (SD=6.03). Reading time of words (p\0.000): IA=2239.47ms, HI=1729.67ms, RD=2431.91ms, controls= 1759.95ms. Reading time of pseudohomophones (p\0.000): IA= 3100.34ms, HI=2337.25ms, RD=2911.26ms, controls=2322.14ms. Conclusion: 1. High risk of low academic performance in children with ADHD (inattentive subtype [OR). 2. Reading efciency task: worst score of children with ADHD. The worst is the inattentive subtype, but better than children with reading disability because there is not phonological decit. 3. Subtype-HI almost the older normally achieving readers. 4. Inattentive and hyperactive-impulsive subtypes are different disorders.

P-03-08 Do ADHD children with a CBCL-Dysregulation prole have specic treatment outcomes, clinical and cognitive features? H. Peyre*, M. Speranza, D. Purper-Ouakil * Paris, France Objective: The CBCL-Dysregulation Prole, CBCL-DP, characterized by elevated scores on the Attention Problems, Aggressive behavior and Anxious/Depressed scales of the Child Behavior Checklist (CBCL) is associated with later severe psychopathology and psychosocial impairment. This study aims to identify the clinical characteristics (clinical severity, comorbidity, temperament and character traits), cognitive prole and treatment outcomes of Attention Decit Hyperactivity Disorder (ADHD) children with a CBCLDP prole. Method: The sample consisted of 173 outpatients (age mean = 10.9; age SD = 2.82; 153 males) with ADHD. A subsample of 136 subjects was reassessed with clinical (CGI-S and ADHD-RS) and neuropsychological tests (Trial Making Test, Stroop test and Continuous Performance Test) after optimal titration of methylphenidate treatment. Results: Subjects with a CBCL-DP prole (24.3% of the sample) showed more comorbidity (mainly oppositional deant disorders and anxiety disorders) and a higher clinical severity (p\0.01 for both CGI-



Friday, 27 May 2011, 14.3016.00 P-04 Co-morbidity: Adults I

P-04-01 Adult Attention Decit Hyperactivity Disorder and obesity: A case-control study M. F. Docet*, A. Larranaga, J. L. Fernandez Sastre, L. F. Perez Mendez, R. V. Garca-Mayor * Vigo, Spain Objective: To determine the rate of Attention Decit Hyperactivity Disorder (ADHD) in obese adult patients in comparison with normal weight adults and its relationship with gender and obesity degree. Method: This case-control study includes 252 obese patients dened by a Body Mass Index (BMI)C30 kg/m2, with a mean age of 49.413.7 years, range 18-79 years, 203 (80.6%) women, and a mean BMI=40.35.9 kg/m2; and 172 normal weight subjects (BMI=18.524.9 kg/m2), with a mean age of 40.213.5 years, range 18-79 years, 124 (72.1%) women. Exclusion criteria: to have cognitive disorders and/or to be unable to perform the Self-Report Scale. Weight, height and BMI were determined in all the participants and they were categorized by their obesity degree. The screening version of the Adult ADHD Self-Report Scale Version-1.1 was administered to all the participants. Those who have four or more checkmarks were diagnosed as having ADHD. The study protocol was approved by the local ethical committee and all the subjects gave their informed consent. Results: Fifty-seven out of 252 (22.6%) obese patients and nine out of 172 (5.2%) normal weight subjects were diagnosed with ADHD (p=0.000; OR=5.3). There were not signicant differences related to gender in both obese and normal weight groups. The proportion of patients having ADHD in I, II and III obesity degrees was 8 out of 43 (18.6%), 24 out of 87 (27.6%), 25 out of 122 (20.5%), respectively, without statistically signicant differences among them (p=0.38). Conclusion: A high rate of ADHD was observed in the obese adult patients. ADHD patients are 5.3 times more likely to suffer from obesity than their non-ADHD counterparts. The impulsive and nonattentional behaviour of ADHD patients, may contribute to the development of abnormal eating behaviours leading to obesity.

P-03-10 Gender differences in internalized and externalized problems of children with ADHD I. Jerkovic*, R. Damjanovic, S. Golubovic * Novi Sad, Serbia Objective: Attention Decit Hyperactivity Disorder (ADHD) is not independent of the childs sex. The study analyzes the extent to which ADHD boys and girls differ in their expression of internalized and externalized problems, as well as in terms of the problems with attention and hyperactivity/impulsivity. Method: The sample consisted of 1079 children of the average age 91.60 months (SD=10.67). Assessors were pre-school teachers in the kindergartens and teachers in early grades of primary school. By using the scale IVJER, it has been determined that 184 children meet the criteria for ADHD (17.0% of the total sample). Out of 184 distinguished children in total, there were 132 boys (71.7%) and 52 girls (28.3%). Results: Based on Chi-square test (Chi-Square=10.072, p\.01), it has been conrmed that girls are relatively more frequently represented in a group of children who have difculties with attention, while boys are more frequently represented in a group that meets the criteria for the mixed type of disorders. When comparing the scores (and not just their afliation to a specic diagnostic subgroup) a difference between boys and girls on the IVJER scale is even more obvious. Boys are underrated both in relation to the scores for attention (t=2.34, p=.02) and in relation to the scores for hyperactivity/impulsivity (t=2.74, p\.01). Afterwards, all distinguished children have been assessed on the ECBI (The Eyberg Child Behaviour Inventory) and SCARED (Screen for Child Anxiety Related Disorders) scales. Conclusion: According to the results of t-test we can conclude that girls with ADHD have shown more indicators of panic disorder (t=3.70, p\.01) and of social anxiety (t=4.09, p\.01) than boys with ADHD, while there is no difference in the manifestation of separation anxiety symptoms, generalized anxiety disorder and school phobia. In terms of externalized problems, there was no difference in this sample.

P-04-02 The inuence of ADHD phenotype on screening for Dyslexia A. Duguid*, U. Muller * Cambridge, United Kingdom Objective: Patients suffering from ADHD often have comorbid neurodevelopmental disorders, including learning disabilities. Accurately diagnosing the co-occurring conditions can be challenging due to overlapping clinical features. This is certainly true for developmental dyslexia: in fact, the similarity in features and high cooccurrence with ADHD has prompted the suggestion of a common aetiology (Eden, 2008). The present study aims to determine if the


111 characteristics of a patients ADHD phenotype can inuence the outcomes of a widely used dyslexia screener in an adult population. Method: All patients were assessed at the Adult ADHD Research Clinic, Cambridge, using a semi-structured clinical interview. 98 consecutive patients (age 18-52 years; 33 female, 65 male) were diagnosed with ADHD according to DSM-IV criteria and included into this study. The 18-question ASRS (Kessler 2005) was used to rate symptom severity and to classify the diagnostic subtype (inattentive or hyperactive). The Revised Adult Dyslexia Checklist (RADC; Vinegrad 1994) was used as a dyslexia screener. This 20-item questionnaire contains 12 specic and 8 non-specic questions relating to dyslexia. Correlations between scores and sub-scores from the ASRS and the dyslexia screener were calculated in order to investigate the hypothesis that attention decits, but not hyperactivity/ impulsivity symptoms, mimic dyslexia symptoms in adults with ADHD. Results: Analysis using Pearsons product-moment correlation coefcients showed there was a positive correlation between the inattentive ASRS score and the non-specic RADC score (r = 0.270, p = 0.007) but not between the hyperactive ASRS score and nonspecic RADC score. Analysis of individual questions in the ASRS identied questions when answered positively predicted positive answers in certain questions in the dyslexia screener. Conclusion: Discovery of an association between inattentive features of ADHD and dyslexia in clinical tests may alter the way clinicians use dyslexia screeners in adult ADHD populations. Specically, identication of questions in the ASRS and dyslexia screener which indicate an overlap in clinical features may guide the interpretation and diagnosis of dyslexia in those adult ADHD patients. For screening purposes in ADHD patients it may be more appropriate to use only the 12 dyslexia-specic questions from the RADC and disregard the non-specic questions. Conclusion: The present cross-sectional study carried out in a treatment seeking SUD population demonstrates high prevalence rates of adult ADHD consistent with other recent estimates of ADHD prevalence in SUD populations. The ASRS can be useful as a screening instrument in this population but a thorough clinical assessment is needed for correct diagnosis. Further analysis will show if this population also displays high co-occurrence with other psychiatric disorders, such as depression. .

P-04-04 The possible role of childhood ADHD in the development of adult heroin dependence C. Barta*, A. Szilagyi, K. Boor, A. Szekely, Z. Demetrovics, J. Csorba, M. Sasvari-Szekely * Budapest, Hungary Objective: Several studies suggested a possible link between substance use disorder and Attention Decit Hyperactivity Disorder (ADHD). The goal of the study was to analyze this link. Method: The ADHD Rating Scale (ADHD-RS) completed by parents is a tool for diagnosing ADHD in childhood. We adapted this questionnaire for a self-report retrospective scale to estimate the presence of childhood ADHD symptoms in adults. This retrospective questionnaire was completed by 121 heroin dependent patients and 85 age- and sex-matched healthy controls. Results: Our results showed strong gender difference in the prevalence of ADHD symptoms, since male subjects obtained higher mean scores on both attention-decit and hyperactivity scales than females in both the control as well as in the heroin dependent population. Besides, the mean scores of both scales were higher in the clinical population as a higher portion of substance abusers reported symptoms of childhood ADHD than controls. Conclusion: These results support the hypothesis that untreated childhood ADHD could be a risk factor for developing substance use disorder.

P-04-03 ADHD in treatment seeking patients with substance use disorders: prevalence and usefulness of the Adult ADHD SelfReport Scale (ASRS) as a screener M. Konstenius*, S. Wallhed, G. van de Glind, W. van den Brink, J. Franck * Stockholm, Sweden Objective: Attention Decit Hyperactivity Disorder (ADHD), with or without conduct disorder, is a risk factor for developing substance use disorders. Prior studies on ADHD in populations with substance use disorders (SUD) have shown prevalence rates between 10% and 30%. Method: This report is part of a larger international cross-sectional study with a two-stage design, consisting of two parts: (1) screening for ADHD with self-rated ADHD-symptoms using the Adult ADHD Self-Report Scale (ASRS), and (2) a diagnostic assessment using the Connors Adult ADHD Diagnostic Interview for DSM-IV (CAADID). At this time, we have recruited 307 consecutive patients at a large publicly funded addiction treatment clinic in Stockholm, Sweden. Of these 307 patients, 146 completed the full diagnostic assessment. Results: Twenty-three percent of the sample met DSM-IV diagnostic criteria for adult ADHD. With regards to SUD, 70% of the sample reported primary alcohol dependence, 22% primary dependence of narcotics such as amphetamines or opioids, and 8% a primary diagnosis of cannabis dependence. ASRS sensitivity was 0.82 (95% CI 0.66-0.91), specicity 0.76 (95% CI 0.68-0.83) with a positive predictive value of 0.50 (95% CI 0.37-0.63) and a negative predictive value of 0.94 (CI 0.87-0.97).

P-04-05 Association of atomoxetine treatment with substance use and abuse in a drug using population with Attention Decit Hyperactivity Disorder I. Petrakis*, G. Dermatis * Limnos, Greece Objective: The basis for this study was the well-established association between ADHD and substance use disorder. The aim was to investigate the effects of atomoxetine on the illicit drug use of opiates, benzodiazepines, cannabis and cocaine in drug dependent individuals attending substitution therapy treatment at the Greek Organisation Against Drugs.The objectives were to compare urine sample results for opioid, cannabis, cocaine and benzodiazepines three months before and three months after the initiation of atomoxetine treatment and to monitor for dosage changes of methadone and buprenorphine after the initiation of atomoxetine. Method: Fourteen patients (9 male and 5 female) completed a 24-week open-label study. Urine drug testing results were monitored for a period of three months before and three months after the initiation of atomoxetine treatment in order to determine any changes in drug use behaviour. Compliance to treatment and changes in methadone or buprenorphine doses were also monitored. Results: No statistically signicant differences were identied between the mean results of the two monitoring periods (pairedsamples t test) for any of the screened drugs of abuse. However, the overall mean urine results for opioids, cocaine and benzodiazepines showed a trend towards reduction after the introduction of


112 atomoxetine. The post-atomoxetine grouped mean urine results for cannabis were found higher than the results prior to initiating the ADHD pharmacotherapy. Supervision of atomoxetine administration showed no added benet when compared to non-supervised administration. No notable changes in methadone or buprenorphine doses were observed throughout the monitoring period. Conclusion: This study investigated the effects of atomoxetine on all four screened drug substances in one of the OKANA drug dependency centres. The ndings of this study suggest that a larger scale randomised placebo-controlled study is needed in order to investigate the efcacy of atomoxetine as adjuvant treatment to opiate substitutes. months we have worked with 2 young people with this complex presentation. Our impression was that compared to other journeys within the care and social care system, these young people with their babies experience a particularly haphazard and chaotic journey through the organisational systems. Method: We have reviewed the literature concerning teenage pregnancy and co-existing mental health disorders, including substance misuse. The study, as a multiple case design, then explores two cases in detail from a systemic perspective. We have described at the individual pathways through the health and social care organisational systems from the young persons experience. We have tracked the treatment pathways of substance misuse treatment and treatment for ADHD through that process. We have also explored the organisational structure and the points at which decisions are made about the care and parenting for the baby. We have assessed the parent-infant relationship using The Care Index and The working Model of the Child Interview. Results: The exploration of the case study data has then generated hypotheses about treatment and treatment outcomes for this group. This study demonstrates that recognition and treatment of ADHD and substance misuse problems during pregnancy adds signicantly to the complexity of this process for young people. Conclusion: The study proposes that stability of treatment, including psychosocial interventions, both before and after birth is likely to improve the establishment of early attachment relationships for young mothers and their babies. The combined risk factors for early parenthood include ADHD, school exclusion, childhood maltreatment and social adversity, which are all factors associated with substance misuse disorders in adolescence. This group requires further study in order to compare treatment interventions and develop services that will promote improved infant outcomes.

P-04-06 ADHD and substance abuse: Could sensation seeking be a moderating factor? A. Burke* * Johannesburke, South Africa Objective: The argument presented in this paper rests on three fundamental issues, i.e.: Research has shown that in adults, symptoms of hyperactivity become less pronounced, and instead inattention and disinhibition become most prominent (Billingsley-Jackson, 2008). Adults with ADHD actively engage in risky behaviours, such as substance abuse and sensation seeking (Huizink, van Lier & Crijnen, 2008; Peters & McMahon, 1996; Triolo, 1999; Wood, Wendor & Reimherr, 1983). Sensation seeking, together with other factors, are signicant predictors of substance abuse Wagner (2000). Many research studies report a linear causal link between ADHD and Substance Use, or a linear causal link between Sensation Seeking and Substance Abuse. The objective of this study is to create a multifactorial model of ADHD and Substance Abuse. Method: The results of various exploratory, quasi-experimental and experimental studies will be integrated into a meta-theoretical model. This research has been done on 50 low sensation seekers, 50 high sensation seekers, 15 ADHD, and 20 non-ADHD adults. These groups have further been subdivided into Substance and non-Substance abusers. The following instruments have been used: Biopac EEG, CANTAB, Zuckerman Sensation Seeking Scale (Form V), Arnet Inventory of Sensation Seeking, ASRS. Multivariate statistical techniques, such as factor Analysis, Multiple regression Analysis and Structural Equation Modeling is used to analyze the data. Results: The results indicate that there is a complex relationship between ADHD and Sensation Seeking, with Sensation Seeking being a moderating factor in the frequency and type of substances that are used by ADHD. The model also suggests that overt and covert effects of a substance may lead to dependence on the substance. Conclusion: The results seem to suggest that treatment of adults with ADHD and a comorbid Substance Abuse problem would have to take various factors into account for a successful outcome.

P-04-08 Internet addiction in male adolescents with untreated ADHD - rst results of an out-patient diagnostic and treatment program in Berlin O. Bilke-Hentsch*, T. Hellenschmidt * Berlin, Germany Objective: Media and Internet addiction seem to emerge as a mental health problem in adolescents with ADHD. Although not yet broadly recognised by addiction research, there exist clinical and neurobiological implications, that Internet addiction resembles classical adolescent addiction patterns such as with marihuana or alcohol. ADHD patients are supposed to be a risk group. Method: As part of either the dependency or of the out-patient psychotherapy programs in a large mental hospital covering inner-city Berlin an out-patient diagnostic and treatment system was established in April 2009 for internet addicted youth. Using ICD-10, operationalised psychodynamic diagnostics (OPD-KJ) and family diagnostic procedures specic patterns of intrapsychic conicts and family developmental stages as well as ADHD features should be detected. Results: From 4-9/2009 we could administer 27 severe male Internet addiction-cases with all signs of clinical dependency, both neuropsychological and somatic, including withdrawal, severe craving and severe mood swings as well as massive social and academic failure. 9 patients showed classical signs of an untreated ADHD such as impulsivity, short attention span and failure in school, apart from their other psychiatric disorders and chronic family conicts. Conclusion: There seems to be a small but severely ill subgroup of intensive internet users that develop social isolation, craving and other features of addiction. Using the clinical diagnosis Internet addiction offering an out-patient approach we must consider severe chronic intrapsychic conicts as well as untreated ADHD and other

P-04-07 Teenage pregnancy, ADHD and co-existing substance misuse disorders; a review and exploration of 2 case studies D. Judge*, S. Gracias * Bristol, United Kingdom Objective: The Young Peoples Specialist Substance Misuse Treatment Service was established in 2000 to work with Adolescents in Bristol with complex drug treatment needs. Over the last 10 years the service has seen a steady increase in presentations of young people at various stages of pregnancy with co-existing substance misuse and a range of mental health disorders including ADHD. During the last 6


113 psychiatric disorders for therapy planning. Obviously intense research as well in epidemiology as in clinical treatment is needed in this worldwide broadening area. the current analysis were the Addiction Severity Index (ASI), ADHD Retrospective Questionnaire, Perceived Stress Scale (PSS), and Methadone Treatment Interview. Results: (1) As a mediate indicator for the severity of addiction, we found signicant differences in physical withdrawal symptoms (Methadone Treatment Interview) between the subgroups of expected and non-expected childhood ADHD using the plausability of childhood hyperactivity as a grouping variable. Patients with expected childhood hyperactivity showed signicantly (p=0,024) higher group mean on the subscale of physical withdrawal symptoms. (2) The main indicator for treatment efcacy was the length of time the patients spent in treatment. The results of linear regression showed that the signicant explanatory variables of the treatment length were perceived stress (Beta=0,349, p=0,004) and the total score of the ADHD Retrospective Questionnaire (Beta= -0,256, p=0,032). Conclusion: Our study may reafrm the importance of early recognition of ADHD for it has a signicant impact on some aspects of addiction severity (such as the physical withdrawal symptoms) and on the treatment efcacy of substance use disorders. We also need to be aware of the different effects of hyperactivity and attention decit subtypes.

P-04-09 The impact of childhood ADHD on the severity of addiction, and on subsequent SUD treatment efcacy M. Kapitany-Foveny*, Z. Demetrovics * Budapest, Hungary Objective: The main goal of the study was to analyze the (1) ADHDs effect on the severity of addiction, and (2) the possible moderating effect of ADHD on the treatment efcacy of substance use disorders.

P-04-10 Substance use disorder with comorbid Attention Decit Hyperactivity Disorder Y.-A. Kaufmann*, J.-G. Bavarel, R. Khan, D. Zullino ` * Geneve, Switzerland Objective: Attention Decit Hyperactivity Disorder (ADHD) affects not only children but persists for up to 4.4% in the general population. One of the most problematic risk factors for untreated children in adolescents and in adulthood is substance use disorder (SUD). Often undiagnosed, however a few studies show, depending on the substance used, 15 to 35% adult SUD patients suffer from ADHD. This study was designed to evaluate the prevalence of ADHD in a French speaking Swiss SUD facility. Method: It consisted of 97 adult participants examined for ADHD. We used in this cross sectional study WHO self-report screening scale for ADHD (ASRS-v1.1). For all subjects with at least 4 positives of 6 items on the ASRS-v1.1 the diagnosis of ADHD in childhood was then conrmed with the Wender Utah rating scale (WURS). Results: First we found that 39% had at least 4 of the 6 items positive in the ASRS-v1.1 test. Among this group of subjects positive for the screening of ADHD no more than 34% suffered from ADHD in their childhood hence excluding false positives by the WURS. Conclusion: The results of this study conrm the high rate of ADHD patients in SUD units mentioned in other studies. Using WURS seems more accurate to conrm the diagnosis of ADHD in SUD patient. However, family interview or the use of the adult Conners scale not yet available in French should provide an even more robust ADHD diagnosis. Thus it will ease decision making for instauring a treatment.

Method: Two samples have been involved in the analysis. The rst sample consisted of 80 heroin dependent patients (55 males and 35 females, mean age = 30,2 years, sd=5,48) participating in the rst Suboxone maintenance treatment trial at six outpatient centers in Hungary. The second sample consisted of 73 heroin dependent patients (52 males and 21 females, mean age= 26,7 years, sd=5) who entered methadone maintenance treatment at the biggest Drug Oupatient Centre in Budapest, Hungary. The applied measures used in

P-04-11 Screening for ADHD among patients with SUD in the MMT Programme in Malaysia: A new avenue for SUD treatment H. Peters* * Kajang, Malaysia Objective: The study aims to explore the prevalence and degree of ADHD related symptoms among patients in the MMT program in Malaysia. The ongoing pilot study wants to illustrate the moderating


114 effect of comorbid ADHD symptoms on SUD to broaden understanding, planning and treatment of addiction. Method: The pilot study screened a sample of 20 patients from the University Hospital UMCAS with the diagnosis of SUD who taking part in the MMT Programme in Kuala Lumpur in Malaysia. Among these patients, the attention prole was evaluated with a translation of the ADHD-LE from Schmidt and al. 2009. Results: A signicantly impaired adaptive functional attention prole was found in over 80% of the clinical group. These outcomes are associated with an early onset of addiction, a long substance dependence, an increased relapse frequency and a higher rate of comorbid psychological problems. Additionally, a signicant part of the sample has an increased number of accidents which are mostly caused by own fault. The age of onset is corresponding with difculties in the functional attention organisation. Conclusion: The results recommend to increase awareness of the status of ADHD as the key initiating factor for SUD. Poor treatment outcomes in the MMT program should be considered alongside the potential moderating impact of untreated ADHD. It is important to look at the individuals developmental relationship between attention decit/hyperactivity symptoms and substance abuse in light of self medication. This could greatly improve treatment outcomes. The ADHD-LE screening is an excellent reliable and economic tool to illustrate the relevance of functional impaired attention among SUD patients. It provides valuable information for clinical decision making in view of administering adjunct treatment of Methylphenidate. were younger, had earlier onset of regular substance use, and had greater likelihood of drug addiction than the non-ADHD cohort. Outcome data do not suggest higher relapse rates in the ADHD cohort.

P-04-13 Association between Attention Decit Hyperactivity Disorder (ADHD) and craving among patients with Alcohol Use Disorders (AUD) A. Seitz*, P. Allemann, H. Klingemann, P. Eggli, Y. Burren, M. Wapp, K. Schlai, S. Stutz, C. Buri, F. Moggi, I. Icasa * Bern, Switzerland Objective: Craving is a crucial concept in diagnosis, etiology and treatment of AUD. Clinical experiences give rise to the suspicion that patients with AUD and ADHD may suffer more from craving than AUD only patients. The purpose of this study is to examine the association between ADHD and craving among patients who enter an inpatient treatment for AUD. Method: In the International ADHD in Substance use disorders Prevalence study (IASP) of the International Collaboration on ADHD and Substance Abuse (ICASA), substance use disorder treatment programs of nine European countries, the USA, South Africa and Australia are collecting data on ADHD and comorbid disorders. In the Swiss IASP study, 400 patients in three inpatient treatment programs were assessed by the Adult ADHD Self-Report Scale (ASRS), the Obsessive Compulsive Drinking Scale (OCDS), the Screening for Substance Use Disorders (SSUD), the Screening for Symptoms of Withdrawal (SSW) and the Brief Symptom Inventory (BSI). AUD patients with and without ADHD were compared on craving, withdrawal and psychiatric symptoms by using chi-squared for categorical data and t-test for continuous data. The association of craving and ADHD as well as the most important withdrawal and psychiatric symptoms were analyzed by hierarchical regression analyses. Results: Patients with adult ADHD showed higher craving and more withdrawal and psychiatric symptoms than patients without ADHD. They also rated withdrawal symptoms as more severe. In the regression model, about 40% of variance in alcohol craving can be explained by ADHD but more strongly by withdrawal symptoms (i.e., anxiety/agitation, sweating and gastrointestinal symptoms) and psychiatric symptoms (i.e., depression, obsessive-compulsive behavior and interpersonal sensitivity). Conclusion: Alcohol craving is more likely related to subjective rating of withdrawal and psychiatric symptoms than to adult ADHD. The validity of the ASRS, however, needs to be further examined by the large data set of the IASP study of ICASA.

P-04-12 ADHD and addictions: Clinical characteristics and outcome in a residential treatment population T. Schneekloth*, A. Rai, D. Hall-Flavin, V. Karpyak, L. Loukianova, J. Geske, J. Biernacka, M. Frye, D. Mrazek * Rochester, Minnesota, USA Objective: ADHD is a highly prevalent childhood disorder with symptoms persisting into adulthood at reported prevalence of 4.4% in United States. The comorbidity of ADHD and Substance Use Disorders (SUDs) has been well established. Several studies of subjects with SUDs suggest that 15-25% of adults referred for treatment have a history or active symptoms of ADHD. ADHD has been associated with earlier onset of SUDs and greater treatment resistance. The aim of this study was to characterize the ADHD cohort in an addiction treatment program and examine the impact of this comorbidity on addiction outcome. Method: This was a retrospective study of 853 patients admitted to residential level addiction treatment between 6/28/2004 and 1/28/ 2011 in Rochester, Minnesota, USA. Approximately 75% of these patients had non-psychotic psychiatric disorders comorbid with SUDs. A clinical database, including discharge diagnoses and followup outcome data, was analyzed utilizing Chi-squared tests for association of ADHD with relapse, drug diagnosis, and pre-admission alcohol use. Differences in distributions of age and consumption measures between patients with and without ADHD were tested using Wilcoxon rank sum scores. Results: Fifty-six of 853 patients (6.6%) had a clinical diagnosis of ADHD. Patients with ADHD were signicantly younger (p\.0001) and began regular use at a younger age (p=0.0004). They were also more likely to have a drug addiction diagnosis (p=0.0001). Pretreatment alcohol consumption patterns and post-treatment relapse rates at 3, 6 and 12 months did not differ signicantly between the groups. Conclusion: This study showed lower than expected incidence of ADHD in an addiction treatment population, an incidence similar to community rates. Consistent with earlier reports, those with ADHD

P-04-14 Validation research of modied Lesch Alcoholic Typology including group of alcohol addicted patients with co morbid ADHD spectrum disorders S. Syrek*, M. Sznabowicz * Borlange, Sweden Objective: Completing classication of alcohol addiction with group of patients with ADHD. Method: The coexistence of ADHD and addiction including alcoholism was being observed and described for more than 40 years. Despite that ADHD spectrum comorbidity has not been taken into consideration in alcohol addiction classications. Lesch Alcoholic Typology (LAT) published in 1988 and used by the authors distinguishes 4 subgroups of patients addicted to alcohol. Out of previous classications it is the only one of clinical use, points out directly


115 etiology of addiction and includes therapeutic instructions that consider comorbidity of mental disorders. In separate article we propose the addendum to the above mentioned classication in order to consider the group of patients with ADHD and modify the diagnostic procedure. Craving in the V-th (ADHD) group appears to cope impulsivity, hyperactivity and attention decits. Alcoholism model is described by Reward Deciency Syndrome. We present revised alcoholic typology and research plan which would verify our thesis about existence of 5 homogenous groups with different addiction etiology and specic treatment. The evaluation will cover verication of diagnostic procedure and distribution of patients in subgroups distinguished with regard to diagnostic questions and clinical scales. Conclusion: Since therapeutic approaches vary signicantly between subgroups of alcohol-dependent patients a proper classication seems to be of high clinical relevance. disorders and ADHD. Those studies on allergic rhinitis and asthma returned inconsistent results, while atopic eczema (AE) had not been adequately accounted for. Method: We here present our recent epidemiological studies on the association between ADHD and AE and outline current investigations to further elucidate the underlying neurobiological mechanisms. Results: ADHD was signicantly associated to AE (odds ratios around 1.5) in two epidemiological cross-sectional and in two epidemiological birth-cohort samples. The association was independent of comorbid atopic disorders, socio-economic factors and various other possible confounders, but possibly modied by early sleep disruption. Even when AE did not persist beyond age 2 years the risk to develop ADHD was signicantly increased at age 10 y. Conclusion: The temporal pattern suggests that AE precedes and may cause or exacerbate ADHD symptoms. Both genetic as well as environmental factors may engender the association. Genetic studies as well as clinical trials are ongoing aiming to disentangle the complex aetiological relationship between biological disposition and psycho-neuro-immunological factors.

P-04-16 Impulsiveness and TCI traits in amphetamine and multisubstance depended patients - preliminary report M. Sznabowicz*, S. Syrek, J. Iskra, B. Karakiewicz * Szczecin, Poland Objective: The aim of the study was to examine associations between impulsiveness and personality traits in a group of patients with substance use disorder (SUD). Method: In the trial has been recruited 69 patients with SUD from a several psychiatric inpatient centers in Poland. Studied sample consisted of 34 amphetamine addicted subjects and 35 patients with multisubstance dependence. Patients were investigated using Barrat Impulsiveness Scale, The Temperament and Character Inventory (TCI) and clinical interview based on SSAGA questionnaire. Results: We did not detect correlation between impulsiveness and age in studied group. In a group of multisubstance dependant impulsiveness was not associated with risky behaviors in contrast to amphetamine addicted patients. Women with high impulsiveness had tendency to risky behaviors and high HA scores which was not observed in man. Signicant correlations were found in the whole group between impulsiveness and TCI scores: NS, HA and in subscales NS2, NS3, NS4 and HA4. Impulsiveness was inversely correlated with TCI scores in P, C, SD and subscales C3, SD1, SD2, SD3, SD5. Multisubstance addicted patients displayed higher Impulsiveness than amphetamine addicts while the opposite pattern was noted in Cooperativeness. In the studied group correlation between age and impulsiveness score has not been observed. Conclusion: In SUD patients high impulsiveness corresponds with temperamental traits related to extravagance, disorderliness and fatigability while character traits in impulsive patients mostly feature lack of purpose, irresponsibility and unhelpfulness.

P-05-02 Accidents and Attention Decit Hyperactivity Disorder in 6-14-year-old schoolchildren in Andalusia (Spain) A. Lora-Espinosa*, M. J. Diaz-Aguilar, J. Murcia, M. Montes, N. Martinez, M. I. Vazquez, A. Prosper, J. Barea, R. Hergueta, R. Jimenez, N. Mendoza * Malaga, Spain Objective: To determine prevalence-characteristics of accidents and relationship with DSM-IV-R-ADHD from 6 to 14 year-old children in Andalusia (Spain). Determine vulnerability among subtypes. This research is part of the Comprehensive Plan of Care for Accident Andalusia 2007-2012. Method: Target population: primary and secondary school students ages 6 to 14= 686332 children; centres= 2493. Multistage cluster sampling centres= 74. 1732 children were included. Measures: Sociodemographic, accidents: types, frequency, hospital, academic and social performance. Method: Questionnaires DSM-IV-TR-ADHD and performance Vanderbilt parents-and-teachers, survey-accidents, interview and medical examination. Results: N=1732, 828 children (48.42%) had 1586 accidents, mean= 1.90 (1.42), range=1-13. Open-wounds=28.56%, burns=11.26%, fractures=10.44%, dental-break=9.07%, choking=3.63%, bicyclefall=3,51%, near-drowning=2.1%, poisoning=1.7%. M=51.04%, F=48.95%. Male gender OR=1.85 (1.51-2.27). C3 accidents male gender OR=2.39 (1.71-3.33) p\0.001. 53.04% injured are children of parents without completing primary education versus 46.96% children of parents with high school, the relationship being statistically signicant for bicycle-fall (p\0.001), fractures and open-wounds (p\0.05). Meet DSM-IV ADHD-TR-210, male gender OR=1.6 (1.222.10). Accident for ADHD OR children=1.91 (1.42-2.57), inattentive subtype=1.46 (0.95-2.25), hyperactive=2.18 (1.25-3.82), combined=2.10 (1.24-3.54). OR increases to higher number of accidents: 1-accident ADHD=1.15 (0.78-1.69), 2-accidents=2.17 (1.40-3.36), 3-accidents=3.93 (2,64-5,85). Conclusion: The male is dominant in all types of accidents, frequency and intensity. There is a higher risk of accidents in ADHD children and any of the subtypes. The association between ADHDaccidents is greater, increasing his number. There is an association between parents education and children injuries.

Friday, 27 May 2011, 14.3016.00 P-05 Epidemiology: Children and adolescents I

P-05-01 ADHD is associated to atopic eczema M. Romanos*, A. Buske-Kirschbaum, V. Rossner, S. Weidinger, J. Schmitt * Munchen, Germany Objective: During the last decades various efforts have been undertaken to elucidate the hypothesis of an association between atopic



P-05-03 The impact of coexisting mental health conditions on the cost of health service provision for children and adolescents with and without Attention Decit Hyperactivity Disorder (ADHD) in Germany M. Schlander*, O. Schwarz, G.-E. Trott, M. Viapiano, N. Bonauer, W. Scheller * Wiesbaden, Germany Objective: Coexisting mental health disorders are common in patients with ADHD and may increase utilization of health care services. The present study addresses the impact of comorbidities on the direct medical costs from the perspective of German Statutory Health Insurance (SHI) for patients with and without ADHD. Method: For a retrospective matched cohort study, concomitant diagnoses and health care resource utilization data for patients age 7 to 19 years with a diagnosis of ADHD (F90.0 and/or F90.1) and for a randomly selected control group (matched 1:1 by age and gender) were extracted from the Nordbaden claims database (year 2003), and were combined with SHI prescription data. Complete datasets were available for 2,171 children age 7-12 years and 768 adolescents age 13-19 years with a diagnosis of ADHD, plus the same number of control persons. Resource use was valued applying SHI acquisition costs. Patient subgroups were dened by the presence of conduct and personality disorders, mood and affective disorders, specic development disorders, and adjustment disorder. Results: Average costs per patient with ADHD were 622/661 (children/adolescents) compared to 245/250 for controls. ADHD

with coexisting conditions caused the following direct medical expenditures: in the additional presence of conduct and personality disorder, 703/769; mood and affective disorders, 714/761; specic development disorders, 630/766; adjustment disorder, 829/ 963. Costs for patients with the mental health disorders mentioned were also substantially increased in the absence of ADHD and will be presented in detail. Conclusion: The present data provide, for the rst time, insight into the profound impact of coexisting conditions on the nancial burden associated with a diagnosis of ADHD.

P-05-04 ADHD co-morbidity of child and juvenile sex offenders C. Cangin*, P. Taylor * Ludlow, USA Objective: To investigate ADHD prevalence, disorders co-morbidity, recidivism of 110 juvenile sex offenders JSO (age 5-17, age mean=12, SD =2.8). Method: In-person interviews, clinical assessments, judicial records of JSO Results: Over 81.8% of JSO have ADHD. All Autism, Bipolar, Intermittent Explosive Disorder, major depression, Pervasive Developmental Disorder (PDD), and Schizophrenia cases have comorbid hyperactive ADHD. All dysthmic and social phobia cases have comorbid inattentive ADHD. All Depressive disorder cases are



comorbid with inattentive or mixed ADHD. All mood Disorder and Impulse Control Disorder (ICD) cases have comorbid inattentive or hyperactive ADHD. Most Posttraumatic stress disorder (PTSD), oppositional deant disorder (ODD), Conduct Disorder, adjustment disorder, anxiety phobia, paraphilia-related disorder, and psychosis cases are comorbid with ADHD. The most severe combinatorial sexual penetration offenses (anal, combined oral-anal, combined oralvaginal penetration offenses) are committed by JSO diagnosed with either mixed or hyperactive ADHD. While 15 of 110 JSO recidivated, 12 of them have ADHD (10 hyperactive, 1 inattentive, 1 mixed ADHD). None of the juveniles with Major depression, PTSD, ODD, ICD, social phobia, Schizophrenia, Pervasive Developmental Disorders recidivated. Substance abuse associate with ADHD but substance abuse alone has low correlation with recidivism. Recidivism rates of JSO on medications (Adderall Dextroamphetamine Amphetamine, Clonidine, Concerta Methylphenidate) are 15%, 28%, 27%, respectively, all of which are higher than the recidivism rate(12.6%) of juveniles not on such ADHD medications. Cluster analysis reveals 3 groups: (1) Non-recidivated cluster with ADHD, (2) Non-recidivated cluster without ADHD, and (3) recidivated cluster mostly with ADHD. There are 77 juveniles in Non-recidivated cluster with ADHD (44 hyperactive, 14 mixed, 19 inattentive), 18 juveniles in Non-recidivated cluster without ADHD, and 15 juveniles in recidivated cluster. Conclusion: Among JSO, ADHD is prevalent and many disorders coexist with ADHD. JSO on ADHD Medications (Adderall Dextroamphetamine Amphetamine, Clonidine, Concerta Methylphenidate) have higher recidivism rates than JSO not on such ADHD Medications.

Delay of Gratication Task and a Choice Delay Task. Furthermore, we measured attention, language comprehension, and early academic skills in the domain of Quantity-Number Competencies. Results: There are interrelations between the measures of inhibition and self-regulation. The Motoric Stroop Task explains 50% of variance in Quantity-Number Competencies (see Table 1). A second regression shows that when simultaneously entering mistakes in the Test of Attention and Language Comprehension in the regression they predict 40% of variance in Quantity-Number Competencies, with both predictors making independent signicant contributions (see Table 1). At this age parental ADHD ratings are not related to Inhibition Tasks. Conclusion: Measures of inhibition seem helpful for the prediction of early academic skills, but in addition language comprehension should be taken into account. This study is planned as a longitudinal study with a sample of 80 children, a second time of measurement in kindergarten and a third time of measurement at the end of rst grade. The aim is to identify risk factors for an ADHD diagnosis early to provide affected children with treatment before school enrolment.

P-05-05 Measures of inhibition support the prediction of early academic skills J. Merkt*, C. Gawrilow * Frankfurt, Germany Objective: Children with ADHD show decits in executive functions with a core decit in inhibition (Barkley, 1997; Gawrilow & Gollwitzer, 2008) and self-regulation (Gawrilow, Gollwitzer & Oettingen; in press) inducing massive problems in academic achievement (DuPaul & Stoner, 2003). This study aims at identifying the interrelations between different measures of inhibition, self-regulation, early academic skills, and ADHD symptoms in kindergarten. Method: Thirty-four unselected children (M-age = 5.6 years, SD = 0.4; 18 girls) participated during their last year of kindergarten. We assessed inhibition with a Go/No-Go Task and two Stroop-like Tasks (i.e., one verbal, one motoric) and self-regulation with a computerized P-05-06 Children suspected to have ADHD suffer from family dysfunction instead either as sole diagnosis or as a co-morbidity A. Schmidt*, E. Paiva Ayres, C. Brandalise Antoniazzi, C. Hilgert, F. Mugnol, F. Driemeier, F. Dartora, D. Pianetti, J. Fries * Porto Alegre, Brazil Objective: The experience and statistics of an interdisciplinary team in Southern Brazil. COE (Student Guidance Center) from Porto Alegre, in Southern Brazil, is an interdisciplinary team prepared to assess and to precisely diagnose learning difculties from most etiologies. Method: Amongst 114 students from 6 to 18 years old assessed in 2009 and 2010, COE received 63 children and adolescents referred


118 because of a suspicion that they could have ADHD. This number is expectable if one considers that COE is a recognized reference to ADHD diagnosis and treatment. Results: After evaluation, we have identied ADHD in 28.57% of the 63-student sample; 55.47% had other diagnose and 15.87% had no pathology. However, we noticed another remarkable fact: 17 (29.98%) children and adolescents of the sample suffered the psychological consequences of some family dysfunction either as a comorbidity to a specic diagnosed disorder (9 children/17.29%) or as a reaction consisting of anxiety and stress itself, with no pathology associated (8 children/12.69%). In this last group of 8 children, adjustment distress due to family dysfunction emulated some ADHD symptoms, explaining mis-diagnose done by referring professionals. Conclusion: This work also describes our statistics regarding the other neuropsychiatric disorders found to be associated with ADHDsuspected students referred to us. We want to share them to be compared to data found worldwide and enhance further research on ADHD and its co-morbidities. Method: The survey was conducted between July and August 2009 via an online questionnaire, which was sent to 1217 families registered with the French ADHD association. Results: The survey response rate was 23% and key ndings include the following. Symptoms at school were the key driver in healthcare demand in 78% of cases. Waiting time for an appointment with a specialist averaged 8.2 months. More than 80% of parents felt involved in the choice of care for their children, while only 41% of families considered themselves well-informed during the diagnostic process. Of the 70% of children receiving ADHD medication at the time of the survey, 97% showed good adherence to treatment on school days. Conclusion: The survey results suggest that the care pathway for ADHD in France is lengthy, with the average time taken before a specialist consultation estimated to be about one school year. Recognition of ADHD appears to originate at school rather than in a preventive manner by the healthcare system.

P-05-07 Early school enrolment and increased rate of ADHD outpatient service use- risk of undue ADHD diagnosis? O. Albayrak*, S. Beck, J. Hebebrand * Essen, Germany Objective: Recent epidemiological data points to the risk for school children of being diagnosed with ADHD when the child0 s age is relatively young in comparison to the average age of their classmates. This might entail unnecessary clinical consequences such as medication use. We aimed to determine wheather the cut-off date for school enrolment predicts the service use of an outpatient unit for ADHD for those being born right before the cut-off date in the city of Essen, North-Rhine-Westphalia, Germany. Method: We retrospectively analyzed 1800 cases with a ICD-10 Diagnosis of ADHD (ICD-10: F90.0) or hyperkinetic conduct disorder (ICD-10: F90.1) who were referred to our university child and adolescent outpatient unit between 2005 and 2010. Variables were comorbid diagnosis, bith-date, cut-off date for school enrolment for the respective year of service use, date of rst referral, IQ and scores of the Conners teacher and parent rating scales. Results: We found a biphasic accumulation of case referrals in the summer and in the winter months. Further, we found that there were more case presentations of children born in the month before cut-off date for school enrolment than after. Conclusion: Our ndings support the assumption that early school enrolment can lead to an unwarranted diagnosis of ADHD in children who are relative immature due to their young age compared to their older classmates.

P-05-09 ADHD in Tunisia: Clinical and management particularities S. Othman*, Z. S. Abbes, S. Halayem, F. Char, A. Belhadj, A. Bouden, M. Halayem * La Manouba, Tunisia Objective: In this study we aim to analyze the clinical particularities of a sample of Tunisian patients with ADHD and to describe their management Method: This is a cross-sectional study involving 84 children aged 6-16 years old with ADHD. This study was conducted between January 2005 and December 2010. The diagnosis of ADHD was established referring to DSM IV. Every patient had a clinical examination and was assessed by the Kiddie -SADS-PL. The different symptoms and signs, comorbidity and the management of the different disorders were listed. Results: 84 children were enrolled in this study aged 6-16 years. It was found that the disorder was signicantly more common among boys (85%) than females (16%). The combined form is the most common (52%), with frequencies of 10% for the Hyperactive Impulsive and 5% for the inattentive one. We found high levels of comorbidity. ADHD was associated with oppositional disorders in 20.6% of cases, conduct disorders in 8.3% of cases, anxiety disorders in 16.7% of cases, mild mental retardation in 8.3% of cases, enuresis in 8.3% of cases. Difculty maintaining sustained attention, ease of distractibility, difculty sitting still and impulsivity were found with very high rates respectively of 95.8%, 100%, 91.7%, and 91.7%. Methods of treatment involve psychosocial intervention, some combination of behavior modication, life-style changes, counseling, and medication. A stimulant medication was prescribed in 31 of these children only next to other measures of support that is behavioral therapy, speech therapy, sports activities, psychotherapy. Conclusion: The diagnosis of ADHD is based on the observation of a set of behaviors in different environments (family, hobbies, school), and whose treatment is based on complementary and cannot be reduced to a drug approach.

P-05-08 Family healthcare and Attention Decit Hyperactivity Disorder in France C. Getin*, K. Keddad, M. Lecendreux * Groslay, France Objective: Attention Decit Hyperactivity Disorder (ADHD) is a lifetime neuro-developmental disorder, which causes severe impairment in children and adolescents. A recent epidemiological study of children presenting with ADHD in France suggests an estimated prevalence of ADHD of 3.55.6%. A survey was conducted to gather information from the families of children with ADHD about the care pathway in France in order to improve understanding of the needs in this eld.

P-05-10 Preschoolers with ADHD: clinical presentation, demographic data, frequency of methylphendidate treatment and treatment response K. Borregaard*, E. M. Olsen, T. Houmann, J. Dyrborg, C. Anhj * Hillerd, Denmark


119 Objective: Though ADHD in children and adolescents has been studied thoroughly, the increasing group of preschoolers with the diagnoses has not. Studies have shown that core and associated symptoms can be more severe in preschoolers compared to schoolage children. Comorbidity is frequent and treatment success dependent on the number of comorbid disorders. Effect of stimulant treatment is smaller, side effects are more severe, and often the reason for discontinuation of treatment.(PATS, Kollins et al., 2006.) The purpose of our study is to describe an unselected clinical population of preschoolers with ADHD to improve knowledge about symptom presentation, comorbidity, and treatment response. Method: The study is retrospective and descriptive based on medical records from 2006-2010. 90 children from two university hospitals are included. The inclusion criteria are: age below six years at time of referral, diagnosed with a Hyperkinetic Disorder (ICD-10 diagnoses F90.0-F90.8) or Attention-decit Disorder without hyperactivity F98.8. To describe a true clinical population we included children with comorbid diagnoses of PDD and mental retardation with IQscores above 35. The following are registered: sex, age, IQ, diagnosis, medication type and dose, ADHD-RS score or symptoms described in medical records before and after treatment with methylphenidate. The statistics will include descriptive analyses of distributions and Wilcoxon signed rank sum test concerning treatment outcome. Results: The registration is ongoing but will be completed in due time for the congress. Results concerning clinical presentation, frequency of methylphendidate treatment and treatment response will be presented. Conclusion: It is important to study the growing population of preschoolers with ADHD in order to improve the diagnostic process and to optimize and better predict treatment outcome. This study will add to the sparse knowledge concerning this group of patients and might contribute to an improvement of treatment practice

Friday, 27 May 2011, 14.3016.00 P-06 Epidemiology: Children and adolescents II

P-06-01 The prevalence of ADHD in children at basque country J. M. Garcia Cruz*, X. Txakartegi, A. Bilbao * Vitoria, Spain Objective: ADHD is a behavioural disorder characterised by symptoms of inattention, hyperactivity and impulsivity. ADHD can begin in early infants and most will go on in adult life. Our objective is to know the prevalence in school-age children between 6 and 16 years at basque country, Spain. Method: the performed sampling method was polietapic, stratied and proportional by clusters. 222 individuals were selected in 15 schools (primary and secondary education) at the basque country during one academic year. Results: following the screening stage, based on questionnaires targeting parents and teachers, ADHD was suspected in 18,02% of the students, and a total of 24 cases, representing a prevalence of 10,81%, were conrmed by dsm-iv and clinical interview. Conclusion: signicant differences were found regarding father0 s occupation and his level of instruction. ADHD-combined type is the most found in our research, especially boys. The parents criteria versus teachers criteria, was most appropriate diagnostic tool to patients with ADHD. Multimodal intervention is commonly needed for other conditions and co-morbidities.

P-06-02 A 3 year longitudinal ADHD and ODD prevalence research in a Turkish sample P-05-11 Epidemiological study on symptoms of attention decit and hyperactivity in a sample of 847 Brazilian children of public schools, according to the DSM-IV and teachers ratings S. Antoniuk*, S. Antoniuk, I. Bruck, M. C. Bromberg, E. Maluf, D. Carvalho, M. Richartz, M. Cat * Curitiba, Brazil Objective: To evaluate the prevalence of Attention Decit Hyperactivity Disorder (ADHD) symptoms and its subtypes in relation to school grade, age and gender, according to teachers0 rating and based on the Diagnostic and Statistic Manual for Mental Health-IV (DSMIV). Method: 847 children from 1st to 8th grades of two public schools in Curitiba were evaluated according to teachers0 ratings. Teachers completed a questionnaire with questions taken from the DSM-IV. The subjects were classied as presenting or not presenting attention decits and/or hyperactivity/impulsivity symptoms. Data was analyzed with Pearson0 s chi-square test. Results: Prevalence according to the teachers was 12%. Inattentive subtype was the most frequent (6.9%), followed by hyperactive/ impulsive (3.4%) and combined (1.8%) subtypes. Attention decit incidence was similar for all ages. Hyperactivity/impulsivity were more common for children under 10 years and 2 months (1st to 4th grade). In relation to gender, males (15.9%) were more affected than females (8.3%), with statistically signicant difference. Conclusion: Results conrmed other data in specialized literature. However, the high prevalence may suggest that symptoms were overrated. It is important to point out that the present study used only one source of information and that an accurate diagnosis requires more than one informant besides clinical assessment. B. Kabukcu Basay*, E. S. Ercan, L. A. Rohde, R. Kandulu, E. Uslu, C. Aydin * Izmir, Turkey Objective: This study is designed to nd out the prevalence of Attention Decit Hyperactivity Disorder (ADHD) and oppositional deant disorder (ODD) in a non-referred representative sample from a country in a region where no previous rates are available (Turkey). The second aim is to evaluate the differences in ADHD and ODD prevalences between three different waves with one-year gaps in reassessments. Method: This is a 3 year longitudinal ADHD and ODD prevalence research, conducted among second grades in Izmir, Turkey. The study sample size was calculated to be 1500 (measure of precision: 1%, alpha error: 5%, ADHD and ODD prevalences were assumed to be 5%). 16 schools among total 67 were determined randomly, in regard to low/middle/high socioeconomic classes. For screening, Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) was delivered to parents and teachers. Screen positive cases and matched controls constructed the study sample (ADHD group: 86 screen positive cases & 85 matched controls; ODD group: 43 screen positive cases & and 43 matched controls). For diagnostic procedures, best estimate procedure is followed and Kiddie-SADS-PL, WISC-R short form and impairment criterion were applied. The sample was reassessed in the second and third waves. Results: First wave ADHD prevalence was calculated to be 13.38%, second wave 12.64% and third wave was 12.04%. ODD prevalence was found to be 3.78% in the rst wave, 0.96% in the second and 5.42% in the third wave. Mean ODD prevalence was found to be 3.38%.


120 Conclusion: The 3 wave ADHD prevalences were remarkably more than the pooled childhood prevalence of ADHD (6.48%, Polanczyk et al. 2007). ADHD diagnosis was quite stable in reassessments after one and two years. A mean ODD prevalence consistent with the worldwide pooled prevalence (3.3%, Canino et al. 2010) was found; but diagnostic stability was much less compared to ADHD. Results: A total of 4374 students were screened, out of which 273 cases were positive, showing a prevalence of 6.24%. Furthermore, the prevalence was 9% among school boys and 3.7% among school girls, with a male to female ratio of 2.4:1. Learning difculties were as follows: 59.3% for mathematics and 53.1% for language, and the consanguinity was observed in 34.8% of the cases. Conclusion: Prevalence of ADHD in Jordan was found to be within the international values, and the male to female ratios was observed to be high in the whole group as well as in all the subtypes. Furthermore, association with learning difculties was observed to be very strong and the incidence of consanguinity was found to be very high

P-06-03 Incidence and prevalence of adult Attention Decit Hyperactivity Disorder in a large managed care organization in Southern California A. Kawatkar*, T. K. Knight, V. Sikirica, P. Hodgkins, R. A. Moss, M. H. Erder, M. B. Nichol * Pasadena, USA Objective: Incidence (IR) and prevalence rates (PR) for diagnosed treated adult Attention Decit Hyperactivity Disorder (ADHD) are scarce. This study was conducted to estimate IR and PR from a large managed care database, and assess longitudinal trends in a 4-year study period (2006-2009). Method: Kaiser Permanente Southern California (KPSC) electronic medical records from 01/01/2006-12/31/2009 were used to assess IR and PR for adult ADHD (age: 18-100). Calculations were based on: (1) presence of ADHD diagnosis only (DX), or (2) presence of ADHD DX and C 2 FDA-approved ADHD prescriptions (DX?RX), or (3) presence of ADHD DX and C 1 behavioral therapy (DX?BT) visit. IR and PR were calculated based on rst instance of any category to eliminate over-counting. Rates were compared across demographics, cohort, and year. Results: In 2006, IR ranged from 0.02% (DX?BT) to 0.07% (DX). This rate remained stable throughout the 4-year study period. PR in 2006 ranged from 0.15% (DX?RX) to 0.31% (DX). PR increased to 0.24% (DX?RX) and 0.42% (DX) in 2009. However, PR based on DX?BT declined from 0.19% in 2006 to 0.09% in 2009. During the 4-year study period, PR varied only slightly by gender, but sharply by agea roughly 9-fold higher annual increase in the 18-19-year age group versus the 60-69-year age group. Conclusion: In this integrated care population, IR and PR of adult ADHD were low. Consistent annual IR may suggest an accumulation of patients causing increased PR over the 4-year period. The increase in PR over the 4-year period was disproportionately higher in the 18-19 and 20-29 age groups versus the older age groups, suggesting a changing demography of ADHD by age group over time. Similarities in PR across males and females suggest possible equalization of ADHD diagnosis rates in adulthood.

P-06-06 Characteristics of ADHD subtypes in a group of children from canton Ticino G. P. Ramelli* * Bellinzona, Switzerland Objective: Attention Decit Hyperactivity Disorder (ADHD) is a common childhood-onset disorder with a signicant impact on public health. The aim of this study was to study ADHD symptoms and DSM-IV subtypes in children and adolescents in Ticino, along with their features, and therapy and follow-up. Method: A total of 97 children with a diagnosis of ADHD, recognized between 2002 and 2008, were examined and their clinical characteristics, school results and therapy were studied. Results: We considered 97 children (89 male/8 female) aged 3 to 14 years (mean age 8.1) who were followed by our department of child neurology. We divided the children into the three following groups: pre-school (11), primary school (67) and secondary school (18). The subtype most represented in the pre-school group was Hyperactiveimpulsive at 50%. In the primary school group we found the following divisions: Inattentiveness: 37%; Hyperactive-impulsive: 18%; and Combined: 45%. For the adolescents in the secondary school group, the most-represented subtype was inattentiveness at 67%. The therapies were distributed in the three groups in the following way: ergotherapy: 45% pre-school, 28% primary school and 27% secondary school; psychomotor: 54% pre-school, 34% primary school and 16% secondary school; pedagogical support: 18% pre-school, 70% primary school and 83% in secondary school. Drug therapy with methylfenidate was followed by 50% of the children and varied between 9% in pre-school children and 89% in the secondary school. Conclusion: The distribution of the subtype of ADHD is remarkably different between the three groups: the pre-school aged children showed more Hyperactive-impulsive problems, while later problems of inattentiveness are present. Behavioural therapies are available for the children of pre-school age, while the boys of secondary school mainly benet from therapy with methylfenidate. As the most-represented group is that of the primary school age, in the future paediatricians should be able to recognize children with ADHD already at the preschool age in order to begin therapy as soon as possible.

P-06-05 Prevalence of Attention Decit Hyperactive Disorder (ADHD) in school children in Al-Qaser district Jordan O. Na* * Karek, Jordan Objective: To determine the prevalence of Attention Decit Hyperactive Disorder (ADHD), its subtypes, its effects on learning, and some of its associations in Al-Qaser district in South Jordan. Method: School-based screening study Study Population: All school children aged 612 years (both males and females) in Al-Qaser district in South Jordan were screened. Methods: The inclusion criteria comprised hyperactivity, impulsivity, inattention, learning difculties, and failure in school exams. The Arabic version of the fourth edition of Diagnostic and Statistical Manual (DMS-IV) for the diagnosis and classication of ADHD questionnaire was applied to all the students included in the study.

P-06-07 Prevalence of ADHD in Lebanese school-agend population S. Richa* * Beirut, Lebanon Objective: In order to estimate ADHD prevalence in Lebanese school-aged population, we conducted the rst epidemiological study of this kind in our country. Method: A random cluster sampling was used in order to select 1000 children aged between 6 and 10 years, admitted in several schools


121 across all regions in Lebanon. In each of the ve administrative regions, we selected randomly two districts. In each district, we also chose randomly ve schools and in each school two classes, one from Kinder Garden 2 and one from grade 5. Ten children from each class were included randomly in the population of the study. For each child, an ADHD-Rating Scale IV (Du Paul, 1998) School-version was lled by a main teacher. The Home-version of the same scale was also lled by the childs parents. Results: We found a prevalence of ADHD equal to 32 per 1000 (30 out of 934). The prevalence of ADHD Inattentive subtype was approximately 3 per 1000, the prevalence of the HyperactiveImpulsive subtype was 12 per 1000, and that of ADHD Combined subtype was 17 per 1000. Conclusion: This is the rst epidemiological study to be conducted in Lebanon in order to estimate the prevalence of ADHD among children in school setting. Objective: Since their rst recognition in DSM-IV, the predominance of the three ADHD subtypes remains controversial in ADHD literature. The aim of the present study was to explore the prevalence of ADHD subtypes worldwide, the risk factors and the impairment across subtype classication. Method: We reviewed all the 38 available studies, published in the Pubmed and Google scholar, since 1994, sampling from the general population. Results: These studies indicate that the prevalence of the ADHDInattentive type (ADHD-I) ranges worldwide from 0.2% to 9.9%. For the hyperactive- impulsive (ADHD-HI) and the combined type (ADHD-C), prevalence ranges from 0.1 to 10.9% and from 0.6 to 8.5% respectively. The ADHD-I subtype is the most common form of ADHD, followed by ADHD-C type. In two setting studies, the most prevalent subtype is the combined, whereas in one setting studies, its the ADHD-I. The ADHD-HI type is more prevalent in studies using parent as informants. The male to female ratios for ADHD-C range from 0.6:1 to 7.5:1, averaging 3.3:1, whereas the M:F ratios for ADHD-I range from 0.4:1 to 6:1, averaging 2.0:1. For HI type, the M: F ratios range from 0.5:1 to 10:1, with the average M: F ratio being 2.4:1. The ADHD combined type is associated with greater impairment in both social and academic domains, whereas the ADHD-I shows a higher academic but lower social impairment. The HI type is more prevalent among younger ages and less academically impaired, associated mostly with moderate behavioral problems. Conclusion: Methodology and impairment features, comorbidity, population characteristics and cultural differences involved in studies seem to contribute to the existing variations in the prevalence of the ADHD subtypes worldwide. Future cross- cultural studies of standardized designs must be used in order to draw rm conclusions on the true prevalence of ADHD subtypes and the risk factors.

P-06-08 Early hospital morbidity in children treated for Attention Decit Disorder in Western Australia: A population data linkage study D. Silva*, L. Colvin, F. Stanley, C. Bower * West Perth Wa, Australia Objective: To provide an overview of the Data Linkage systems available in Western Australia (WA) that are linked to all children prescribed stimulant medication (SM) and provide an example of how this data linkage can be used to examine the risk of early hospital admissions in the Attention Decit Disorder (ADHD) child \4 years compared with age, gender and postcode matched controls. Method: Between August 2003 and December 2007, 16,883 children and adolescents (cases) between 4-25 years who have been prescribed stimulant medication in WA for ADHD were recorded on the Monitoring of Drugs Dependency System (MODDS) data base set up in 2003 following a parliamentary inquiry relating to WA having the highest prescription rates of stimulant medication (SM) in Australia. A stratied random sample of birth records with no linkage to MODDS was chosen as a comparison group (32,728). Case and comparison records were linked to the Hospital Morbidity Data Base, Mortality Data Base, Mental Health Data Base, Emergency Data Base, Corrective Services Data Base and Education Data Base, and de-identied data les provided for analysis. Results: Compared with children without MODDS records, children under 4 years who subsequently were diagnosed and treated for ADHD were around 26% more likely to be admitted to hospital with a respiratory condition (OR 1.26; CI (1.19-1.33), 52% more likely to be admitted with an accident or poison (OR 1.52; CI 1.41-1.64), 65% increase risk of admission for ear disease (OR 1.65; CI 1.53-1.78) but no signicant difference for conditions relating to the perinatal period. Gender differences were also signicant. Conclusion: There is signicant early hospital morbidity for both male and female children prior to being treated for ADHD. Data Linkage at a population level can provide information on causal pathways including early injury risk which may be a precursor of subsequent ADHD in childhood.

P-06-10 Prevalence change trend of Attention Decit Hyperactivity Disorder in Taiwan M.-Y. Wang* * Taichung, Taiwan Objective: Attention Decit Hyperactivity Disorder (ADHD) is one of the most prevalent pediatric psychiatry disorders. The prevalence ranges 2-8% among populations by DSM-IV. There are limited population based studies on the trend of this disorder. We used the universal insurance claims data to investigated the chronological trends of ADHD incidence and prevalence among children in Taiwan. Method: We used the National Health Insurance Database of a random sample of 1,000,000 insured population to analyze the annual prevalence rate of ADHD (ICD code 314) from 1996 to 2007. Sociodemographic factors associated with the disorder were also observed. Results: Prevalence rate increased from 0.09% in 1997 to1.1% in 2007 in children 18 years of age and younger, much less than the estimates in other countries. The prevlance was higher in boys than in girls with the boys-to-girls rate ratios of 1.76 in 1997 to 3.78 in 2007. The annual trend showed a dramatic increase in 2003 due to health education promotion in that year. The prevalence was higher in the urban areas than in rural areas and in children less than 10 years of age than the older children. Conclusion: Prevalence rate increased from 0.09% in 1997 to1.1% in 2007 in children 18 years of age and younger, much less than the estimates in other countries. The prevlance was higher in boys than in girls with the boys-to-girls rate ratios of 1.76 in 1997 to 3.78 in 2007. The annual trend showed a dramatic increase in 2003 due to health education promotion in that year. The prevalence was higher in the urban areas than in rural areas and in children less than 10 years of age than the older children.

P-06-09 Prevalence of ADHD subtypes worldwide M. Skounti*, L. Betts * Heraklion, Greece



Friday, 27 May 2011, 14.3016.00 P-07 Epidemiology: Adults I

P-07-01 ADHD prevalence in a sample of obese women B. P. Nazar*, C. Moreira de Sousa Pinna, R. Suwwan, J. A. Sergeant, P. Mattos * Rio de Janeiro, Brazil Objective: Recent data has suggested that there is a higher prevalence of ADHD among obese populations. Most studies used self-report instruments and data on the subject is scarce. In this study we sought to investigate the prevalence of Attention Decit Hyperactivity Disorder (ADHD) in an obese treatment-seeking sample of adult women, using a semi-structured interview for ADHD. Also, we evaluated the relationship between ADHD prevalence and obesity categories, and if present or past number of ADHD symptoms correlated with current Body Mass Index (BMI). Method: Cross-sectional study Subjects and Methods: One hundred and six adult women, with mean age of 38.9 (?10.7) years and mean body mass index (BMI) of 39.2 (?5.29), were consecutively evaluated. Subjects were interviewed by psychiatrists with the Schedule for Affective Disorders and Schizophrenia module for ADHD, adapted for adults. Patients with psychiatric or neurological conditions that could mimic ADHD symptoms were excluded. Statistical Analysis: Chi-square test was used to determine signicance of differences in the prevalence of ADHD among the WHO classication of obesity categories. The association between ADHD symptoms and BMI was assessed using bivariate correlations (Pearsons or Spearmans when indicated). Results: The ADHD prevalence found in the sample was 28.3% (n= 30; CI: 23,78% to 32,82%), and was higher as obesity categories increased (class I = 5.7%, class II = 9.4%, class III = 13.2%). However, this was but a tendency, without statistical signicance (V2= 0.591 p[0.05). Neither the number of inattention, nor the hyperactivity/impulsivity symptoms, current or past, showed signicant correlation with current BMI (p[0.1). Conclusion: Similar to previous studies, a signicant higher prevalence of ADHD was found in obese individuals, using a semistructured interview. This is way above the expected adult prevalence in population studies of 4.4% (CI: 3.8% to 5.0%). Wewe found a tendency of higher ADHD prevalence in more severe obesity category (class III) but we couldn0 t nd any relationship between the number of ADHD symptoms in different domains and BMI. Since weight regulation is a dynamic proccess it may have suffered the inuence of other factors like eating disorder symptoms (like purging behaviors). Our ndings corroborates the need of investigating ADHD in obese individuals to optimize weight loss treatment.

psychiatric comorbidities. Mental disorders are signicantly more prevalent among the imprisoned population than in communityderived samples. Among these, adult ADHD has been identied as particularly overrepresented in prison inmates. Moreover, ADHD has been linked to criminal behavior and higher probability of encountering problems with the law. Method: A cross-sectional design was used to survey a probabilistic sample of 1, 179 prison inmates in Puerto Rico. Randomly selected sentenced inmates (81.3% males) from 26 correctional institutions completed the Computer Assisted Personal Interview (CAPI) and the Composite International Diagnostic Interview (CIDI). These provide information on socio-demographic characteristics, family history of substance misuse, previous incarcerations, and overall physical and mental health history, including: SUD, Generalized Anxiety, PTSD and Major Depression diagnoses. The Wender-Utah Rating Scale (WURS) was used to assess ADHD symptomatology. 32% of respondents presented signicant ADHD symptomatology. These were contrasted in terms of all aforementioned dependent variables in the Non-ADHD group. Results: High risk behaviors such as unprotected sexual intercourse in jail, Hepatitis B and C infection and having experienced an overdose were all overrepresented in inmates with signicant ADHD symptoms (p \ .01). In terms of psychiatric comorbidity, Major Depression, history of traumatic experiences, as well as Post-traumatic Stress Disorder were more frequently occurring in participants in the ADHD group (p \ .001), albeit not Generalized Anxiety Disorder. Moreover, higher WURS scores were signicantly associated with higher proportion of SUD (p \ .001), specially, Substance Dependence. Conclusion: Overall ndings, as well as the implications for rehabilitation efforts and the provision of clinical services for this understudied and underserved population will be discussed.

P-07-03 ADHD: A new diagnosis in elderly populations J. L. Fernandez Sastre*, A. Rojo Pantoja, E. Fernandez * Vigo, Spain Objective: Attention Decit Hyperactivity Disorder (ADHD) in adults and specically in elderly people is a diagnosis that it can be considered emergent. To date, it hasnt been thought as a possible option to choose from in the differential diagnosis for some given clinical syndromes in elderly people. ADHD could have been underdiagnosed due to the overlap between many symptoms that belong to different syndromes, what is proposed as a hypothesis in this work. Method: A complete research on ADHD and the elderly through the medical literature and a semiological exam of the different symptoms that may overlap like cognitive disorder, psychomotor restlessness, or impulsivity have been made, with the support of a neuropsychological assessment in order to get a better screening. Results: No studies have been done on ADHD in elderly populations. There are just a few short informal articles. Some studies say that approximately 50% of the elderly people who are diagnosed as ADHD have another comorbid diagnosis such as alcohol abuse or anxiety. ADHD is very similar to neuropsychological prole of frontal lobe damage, with attention problems, working memory and planning. The neuropsychological assessment has low specicity and sensitivity and therefore, a high false positive rate. Conclusion: More research on ADHD and the elderly is needed. ADHD is under-diagnosed in elderly populations. Executive functions impairment is frequently attributed to dementia and ADHD isnt considered. Neuropsychological assessment could be a good tool for this. ADHD is proposed as an alternative in pseudodementia diagnose.

P-07-02 Prole of psychiatric comorbidity, health history and socio-demographic characteristics in a sample of Puerto Rican prison inmates with ADHD symptomatology R. Gonzalez*, M. Velez Pastrana, E. Lopez Toro, L. Estrada Rivera, C. Albizu Garcia * San Juan, Puerto Rico Objective: (1) Compare the characteristics of incarcerated adults with and without ADHD symptomatology, including socio-demographic and health and criminal history, psychiatric comorbidities and risk behaviors. (2) Describe a prole of inmates with ADHD symptomatology; including Substance Use Disorders (SUDs) and other


123 P-07-04 ADHD and mild cerebral dysfunction in adult psychosomatic patients M. H. Warnke*, M. Linden * Teltow, Germany Objective: ADHD is dened as an early acquired syndrome with the core symptoms attention decit, hyperactivity and impulsiveness. There is an overlap or comorbidity to neurodevelopmental, psychiatric and behavioural disorders. The transformation of ADHDSymptoms, into adulthood is of relevant number but not consistent. The resulting disorder appears as a mixture of ADHD-symptoms and neurotic components.In adulthood ADHD patients often suffer from various nervous or neurotic diseases like abuse, depression, anxiety and personality-, eating- or adjustment-disorders. The number of diagnosed cases of ADHD is beyond the expected rate. The discovery of underlying cerebral dysfunctions such as ADHD in these patients could be a relevant step to create a proper treatment strategy. Method: We investigated a test-method that was applied to every patient in a psychosomatic rehabilitation inpatient unit, admitted between 2006 and 2008. These patients suffered from a variety of psychiatric disorders, mostly diagnosed as affective and neurotic disorders. The spectrum of disorders resembled nearly the true incidence in the German working age population. We used a computerized self-rating-scale with 20 items of actual psychopathology. The items should be typical for cerebral dysfunction in minor degree. We compared the results with the computerized ADHD-scale for adults (ADHS-SB-Skala, Rosler, Retz et al. 2004). Results: 1346 patients were assessed. The in-test consistency showed a Cronbachs alpha of 0,81 which indicates a good reliability. The items of our data could be grouped into 3 main factors. These are cognition and orientation, emotion-control and motivation/ drive and vegetative stability. The correlation to the ADHD-scale was signicant. Conclusion: In a psychosomatic inpatient cohort of 1346 patients we nd a broad spectrum of typical psychiatric disorders but rarely the admission diagnosis adultADHD or other hints for cerebral dysfunction. Early acquired organic psycho-syndromes such as ADHD transform in different ways into adulthood and do not necessarily build the core-symptomatology of the actual disorder. With a selfrating-scale we can detect 3 factors that build the classic triangle of organic psycho-syndromes including cerebral dysfunctions. The result shows signicant correlation to a well-established ADHD-scale for adults. Together with the anamnesis the psychopathological items are a mean to detect a cerebral dysfunction as relevant underlying factor for actual psychiatric state. The underlying or hidden cerebral dysfunction such as ADHD could implicate a different therapeutic approach. Findings of those 30 out of 34 inmates conrmed with ADHD, were then compared with ndings of 20 adult males with ADHD assessed at a psychiatric outpatient tertiary unit specialized in ADHD, and with 18 healthy controls. Results: Among the prison group, only 2 out of 30 inmates had received a diagnosis of ADHD during childhood, despite most needed health services and educational support. All 30 subjects reported lifetime substance use disorder with amphetamine as the most preferred drug of choice. Mood- and anxiety disorders were present among half of subjects; autism spectrum disorder among one fourth and psychopathy among one tenth. Personality disorders were also common, and almost all inmates presented conduct disorder prior to antisocial personality disorder. Prison inmates reported more ADHD symptoms during both childhood and adulthood than the psychiatric outpatient group. However, collateral information from parents regarding childhood symptoms did not reveal any differences between groups. Further, the educational level was remarkably lower among inmates compared with the others. Working memory functions were similar between ADHD groups when adjusting for a lower estimated IQ among inmates; both groups performed poorer than controls. Besides, on a continuous performance test, the ADHD prison group displayed poorer results compared with both other groups. Conclusion: This study suggested that prison inmates with ADHD were severely affected by ADHD symptoms and coexisting disorders. Besides, inmates showed poorer executive functions also when controlling for IQ compared with psychiatric outpatients with ADHD and healthy controls. Our ndings imply the need for considering these severities when designing treatment programmes for prison inmates with ADHD.

P-07-06 ADHD prevalence in medical students at Ross University School of Medicine J. Bolaski*, R. Gee, M. M. Cuffy, D. Sharma, J. Douglas * Miami, USA Objective: In order to detect and treat ADHD and also avoid the abuse of stimulants by Ross University Medical Students, strict protocols were developed in 2004 by the Mental Health service of the University. This included psychological testing before treatment was initiated. Adult ADHD prevalence studies in the USA point to prevalence rates of 4.4% for ADHD in adults. There is a paucity of research on prevalence rates for ADHD for medical students in the USA. One study found a prevalence of 5.5% with the use of stimulant medication for non medical reasons being as high as 10.1% A review of the prevalence of ADHD and comparison with prevalence rates of adult ADHD in the USA was done for medical students at Ross University to determine whether there was significant difference from the numbers of adults diagnosed with ADHD in the USA. Method: Testing for ADHD was done using the Connors Adult Attention Decit and Hyperactivity rating scale. Results: For the year 2010 the prevalence rate for ADHD among Ross University students was 0.98%. Males 0.63%, females 0.35%. All cases were of the inattentive type. The prevalence for medical students of the rst semester was 0.08%. Conclusion: The prevalence rate of 0.98% at Ross University is lower than the rates of adult ADHD in the USA and points to the value of policies for medication treatment being adhered to at the University. Given the comparative low prevalence rates and the low prevalence rate in the rst semester, there is the need to educate students to seek testing earlier, when experiencing focusing and concentration problems.

P-07-05 Do prison inmates with ADHD differ from psychiatric outpatients with ADHD and healthy controls in ADHD symptom proles and executive functions? Y. Ginsberg*, T. Hirvikoski, N. Lindefors * Stockholm, Sweden Objective: To explore ADHD, coexisting disorders and executive functions among adult male longer-term prison inmates from a Swedish high-security prison, and to compare ndings with psychiatric outpatients diagnosed with ADHD and healthy controls. Method: Following a screening survey for ADHD performed at Norrtalje Prison, a group of 34 inmates were comprehensively assessed for ADHD and coexisting disorders before enrollment to a randomized clinical trial, evaluating treatment with methylphenidate.


124 P-07-07 High prevalence of adult Attention Decit Hyperactivity Disorder in Spain: Population-based study M. F. Docet*, J. L. Fernandez Sastre, R. V. Garca-Mayor * Vigo, Spain Objective: To determine the prevalence of Attention Decit Hyperactivity Disorder (ADHD) in an adult population in Spain. Method: This is a prospective population-based study. The screening version of the Adult ADHD Self-Report Scale Version-1.1 (ASRSV1.1), which is validated for Spanish population (82.2%, 95.6%, 94.8% and 84.3% for sensivity, specity, positive predictive value and negative predictive value, respectively), was administered at random to people of 18 years and over, of both genders, from March until December of 2010. The prevalence was calculated as the number of subjects who had four or more checkmarks in the ASRS-V1.1, the prevalence by gender and age was also determined. We considered three age groups: from 18 to 39 years, from 40 to 59 years and 60 years and over. The study protocol was approved by the local ethical committee and all the subjects gave their informed consent. Results: This study includes 323 subjects, with a mean age of 45.914.5 years, 215 (66.6%) women. The global adult ADHD prevalence was 9.3% (95% CI: 6.4-12.2). The prevalence of ADHD in women was 9.8% (95% CI: 6.2-13.4) while in men was 8.3% (95% CI: 3.4-13.2), without statistically signicant differences between them. The prevalence in the different age groups was 8.1% (95% CI: 3.712.5), 11.2% (95% CI: 6.4-16) and 7.6% (95% CI: 1.5-13.7), for 18-39 years, 40-59 years and 60 years and over, respectively (p[0.05). Conclusion: This is the rst population-based study that includes patients of both genders, from a wide age-range interval in which the prevalence of adult ADHD was determined in Spain. The present data is one of the highest prevalence of adult ADHD in the worldwide populations, and is also higher than previous estimations in nonpopulation-based studies in Spain. Signicant differences regarding gender and age were not found. P-07-09 The prevalence of Attention Decit Hyperactivity Disorder in older adults in the Netherlands M. Michielsen*, E. Semeijn, H. Comijs, A. Beekman, D. Deeg, S. Kooij * Amsterdam, The Netherlands Objective: The prevalence of Attention Decit Hyperactivity Disorder (ADHD) has been researched in children and adults but a study of the disorder in older adults in the general population has never been performed. The disorder may have a profound impact on the lives of older patients with ADHD and correct diagnosis and treatment is therefore crucial. In this study we estimate the prevalence of ADHD in older adults in The Netherlands. Method: Data were used from the Longitudinal Aging study Amsterdam (LASA), an ongoing population-based study. ADHD cases were found following a two-phase sampling procedure: 1494 participants at baseline were screened with an ADHD-screening list of Barkley and on 234 subjects (age 63-95 years) a Dutch structured diagnostic interview based on the DSM-IV criteria (DIVA 2.0) was administered in the summer of 2010. Then the weighted prevalence of ADHD was calculated. Results: The preliminary estimated prevalence of ADHD in older adults was 3.9%. The prevalence among men was 5.1% and among women was 2.9%. Conclusion: This is the rst population-based study on ADHD in older persons. With a prevalence of 3.9% the disorder is not rare. The results show that the disorder does not disappear in older age and that it is a lifelong condition. In the future, clinical practices should pay attention to ADHD-symptoms in older adults and consider treatment options for this impairing condition in this age group.

P-07-10 Persistance of ADHD symptoms into seniority related with social functioning F. Philipp-Wiegmann*, I. Rauber, A. Schmitt, M. Bauer, W. Retz, M. Rosler * Homburg, Germany Objective: 296 adults aged over sixty were tested for the occurrence of ADHD over the _lifespan (before and after the 50th year of life) and co-morbidities using _standardized procedures (Barkley Interview, Wender-Rheimherr-Interview, ADHD-DC, Sheehan-Scala, Checklist of co-morbid disorders). Participants were recruited from the authors acquaintances, associations, assisted living facilities and doctors ofces. Method: The two groups (ADHD, non- ADHD) were compared regarding demographic factors and impairment of organizational, emotional regulatory and social interactional abilities in daily life before and after their 50th year of life using the above-mentioned procedures. Results: 11 adults were diagnosed with ADHD by using the ADHD-DC. The 285 probands without ADHD served as the control group. In reference to the age there is no difference between probands with and without ADHD. 63,6% of persons with ADHD are male, 36,4% are female. Furthermore the affected participants are without a solid partnership more often. There are more

P-07-08 ADHD in a forensic facility S. Gangadharan* * Republic Of Singapore, Singapore Objective: the objective is to study the incidence of ADHD in a forensic remand facility in Singapore amongst adults Method: All adult remands from 1st Jan 2008 til 31 st Dec 2008, admitted to the Institute of mental Health remand ward for forensic psychiatric assessments were included in the study. Those patient diagnosed as ADHD were identied. Results: Based on a one year cohort of all cases of remands in the forensic psychiatric wards, the statistics on adhd cases are as follows. Males all cases 530 ADHD cases 3 (all cases were charged with theft) Females all cases 160 ADHD cases 0. Conclusion: The sample of remand excluded serious offences such as murder, rape and drug trafcking. The sample represents Singapore as most cases are remanded in this facility. the percentage of ADHD in the forensic population is small, only 3 out of 530, about 0.6 percent.The assessments is based on clinical psychiatric evaluations, and corroborative history from caregivers.The study did not use any rating scales.


125 academics included in the ADHD group then in the non- ADHD group (27,3%/7,7%). In addition persons with ADHD changed their profession oftentimes. Conclusion: The impairments by ADHD characterizing symptoms seem to persist into seniority. In comparison to the inconspicuous control group considerable more persons with ADHD are impaired by social dysfunctioning. There is a decrease of reported difculties in family life and partnership over time. The participants refer strong impairments in social connections and leisure activities in seniority. The problems seem to increase. Especially the combined and hyperactive subtype report impairments in social life. sleep length R2=.210). Multinomial logistic regressions showed that seasonal affective symptoms were related to hyperactivity, female gender, unemployment, and later mid-sleep (pseudo R2=.278), and a long sleep-onset latency ([30 min) was related to hyperactivity, study, retirement, short sleep, and unstable sleep rhythm (pseudo R2=.404). Higher BMI was correlated to shorter sleep in both the subject group (q=-.163; p=.042) and in the control group (q=-.165; p=.024). Conclusion: The strong relationships between hyperactive symptoms, delayed sleep, sleep-onset insomnia, seasonal affective symptoms, and BMI were apparent in both the subject and the control groups. Further investigation in a prospective cohort study is needed to understand the hypothesized common origin of the ADHD symptoms and delayed sleep phase, resulting in shorter sleep and associated psychiatric and physical health problems at the long term.

P-07-11 Why blindness adolescence doesnt report ADHD problems? H. Saberi* * Rodehen, Iran Objective: Measure comorbidity of ADHD with other emotional and behavioral problems in blindness adolesence Method: participants were 93 blindness students at high school, selected from two special school in Iran. Results: We found that no one have ADHD problems in at risk level or clinical level. 45/2% report depression problems at clinical level, 32/3% report conduct problem and 6/4% report somatic and Anxiety problems.48/4% report depression problems in at risk level, 16/1% Anxiety problem, 3/2% somatic problem, 3/2% oppositional and 61/3% conduct problems in at risk level. Analysis of question in ADHD subscale show that 51/6% report they have problems with sit quiet sometimes, 35/5% report they are total talkative. Conclusion: It may be possible, blindness change the kind of broblems of people. For example depression and conduct disorder instead ADHD.

Friday, 27 May 2011, 14.3016.00 P-08 Genetics studies

P-08-02 Methylenetetrahydrofolate reductase gene polymorphisms in children with Attention Decit Hyperactivity Disorder C. Gokcen*, N. Kocak, A. Pekgor * Gaziantep, Turkey Objective: The purpose of this study was to evaluate the relationship between 5,10- methylenetetrahydrofolate reductase (MTHFR) polymorphisms and Attention Decit Hyperactivity Disorder (ADHD) in a sample of Turkish children. Method: MTHFR gene polymorphisms were assessed 40 patients with ADHD and 30 healty controls. Two mutations in the MTHFR gene were investigated using polymerase chain reactions and restriction fragment length polymorphisms. Results: Although there were no statistically signicant differences in genotype distributions of the C677T allels between the ADHD and control groups (p=0,678) but the genotypic pattern of the distributions of the A1298C allels was different between the ADHD patients and the controls (p=0,033). When MTHFR gene allels were evaluated with respect to sex, there was no statistically signicant difference between ADHD and male control groups according to MTHFR C677T (p=0,61) and A1298C (p=0,173) allels. In females, no difference was found in respect to C677T between two groups (p=0,949). Although the ratio differed markedly between two groups (ADHD: %88,9 and Control: %42,9), the difference did not reach statistical signicance for A1298C (p=0,106). Conclusion: Preliminary data imply a possible relationship between A1298C MTHFR polymorphisms and the ADHD. Larger trials with larger patient populations are needed to reach denite conclusions whether this mutations is a noteworthy risk factor for ADHD.

P-07-12 Relationships between sleep, seasonal affective symptoms, health, and ADHD: The ASESA study D. Bijlenga*, K. B. van der Heijden, M. Breuk, M. E. H. Lie, E. J. W. van Someren, H. J. T. Swaab-Barneveld, J. J. Sandra Kooij * The Hague, The Netherlands Objective: ADHD has higher prevalence of comorbid sleep disorders, seasonal affective symptoms, unfavorable lifestyle, and health issues as compared to healthy adults. We explored the relationships between ADHD symptoms, sleep characteristics, seasonal affective symptoms, lifestyle, and physical and psychological health. Method: We asked adult patients with ADHD (subjects) and a group from the community (controls) to ll out a questionnaire, involving lifestyle, eating pattern, physical and psychological morbidities and complaints the ASESA questionnaire. We also assessed the ADHD rating scale (ADHD-RS), the Munich Chronotype Questionnaire (MCTQ), the Seasonal Pattern Assessment Questionnaire Global Seasonality Score (SPAQ-GSS), and the Dutch morningness/eveningness questionnaire (VOA). Results: We included 202 subjects and 189 controls. Subjects had signicantly more health problems and reported shorter sleep, longer sleep-onset latency, later mid-sleep, and a less stable sleep/wake pattern than controls. Later mid-sleep and shorter sleep were related to hyperactivity, male gender, younger age, and seasonal affective symptoms using multivariate linear regression (mid-sleep R2=.265;

P-08-03 A neuropeptide S receptor gene variant and adverse life events are associated with increased aggressiveness and inattention in a population representative sample of adolescents J. Harro*, E. Kiive, K.-P. Lesch, J. Maestu, T. Veidebaum, A. Reif * Tartu, Estonia Objective: It has been suggested that neuropeptide S and its receptor (NPSR) are involved in regulation of activity, anxiety and fear. We


126 explored the possible association of the functional NPSR1 gene A/T variant and adverse life events with ADHD symptoms in a population representative sample of adolescents. Method: The sample was based on the younger cohort of the longitudinal Estonian Children Personality, Behaviour and Health Study originally including 593 nine-years old subjects. During the follow-up in 2004, data of 483 participants, aged 15.60.6 years, were collected. ADHD symptoms were reported by teachers, using the Hyperactivity Scale of af Klinteberg at ages 9 and 15, and SNAP-IV at age 15. The history of adverse life events was self-reported at age 15. Genotyping of the functional NPSR1 rs 324981 locus was carried out as reported in Raszka et al. (Mol. Psychiatry 2010, 11: 1067-1074). Results: At age 9, there was a main effect of NPSR1 genotype on concentration difculties: participants homozygous for the T allele had higher scores as compared to A/A and A/T children (p=0.04). At age 15, an interaction effect of NPSR1 genotype and life events on aggressive and inattentive behaviour was found [F(3, 221)= 5.60 and 5.68, respectively, p= 0.02)]. Girls with the T/T genotype and higher experience of stressful life events had displayed signicantly more aggression and inattention than T/T girls with less frequent adverse life events. Girls with the T/T genotype who had been more often exposed to stressful life events also exhibited higher inattention scores as compared to A-allele carriers. No effect of genotype was found in boys during adolescence. Conclusion: This study provides evidence that the T/T genotype of the NPSR1 is associated with increased reactivity to adverse life events, and this is in part gender specic. Conclusion: Our results suggest that, in addition to clinical samples, the l/l genotype of 5-HTTLPR is associated with inattentive symptoms in general population.

P-08-05 Effect of ADRA2A and BDNF genegene interaction on the continuous performance test phenotype H.-W. Kim*, S.-C. Cho, B.-N. Kim Kim, J.-W. Kim, S. Y. Kim * Seoul, Republic of Korea Objective: Complex phenotypes such as performance on the continuous performance test (CPT) are likely to exhibit epistasis. Genetic polymorphisms of noradrenergic system and brain-derived neurotrophic factor (BDNF), which participates in the differentiation and survival of noradrenergic neurons, have been reported to be associated with the performance on CPT. We evaluated the effect of the adrenergic a-2A receptor (ADRA2A) and BDNF genegene interaction on performance on the CPT in a Korean population with Attention Decit Hyperactivity Disorder. Method: In all, 122 participants with Attention Decit Hyperactivity Disorder (8.6 2.3 years, 104 boys and 18 girls) completed the CPT. The DraI polymorphism of ADRA2A (rs583668) and rs11030101 polymorphism of BDNF was genotyped. Results: Signicant interaction effects were found of ADRA2A rs553668 and BDNF rs11030101 on response time variability (P = 0.011) of the CPT. Conclusion: Our study provides preliminary evidence for the effect of the BDNF and ADRA2A genegene interaction on performance on the CPT in Attention Decit Hyperactivity Disorder.

P-08-04 Effect of the serotonin transporter gene promoter polymorphism on inattentive symptoms in a population representative sample of adolescents E. Kiive*, D. Eensoo, H.-M. Loit, J. Harro * Tartu, Estonia Objective: The role of the serotonin transporter gene linked polymorphic region (5-HTTLPR) in Attention Decit Hyperactivity Disorder (ADHD) has been conrmed by several meta-analyses. However, most of the studies have been limited to clinically referred ADHD patients. The purpose of this longitudinal analysis was to investigate the relationship between the 5-HTTLPR genotype, and adolescent and adult ADHD symptoms in a population representative sample. Method: In the present analysis, data of the older cohort of the longitudinal Estonian Children Personality Behaviour and Health Study, aged 15.60.6 years during the original sampling, were used. Additional data were collected during the follow-ups in 2001 and in 2008 when the subjects were 18.30.5 and 24.70.7 years old, respectively. The original sample consisted of 593 subjects, 260 males, 333 females. Adolescents ADHD symptoms were reported at age 15 and 18 by teachers using the Hyperactivity Scale of af Klinteberg and SNAP-IV, and self-reported at age 25 by using the ASRS. Genotyping was carried out as reported previously (Paaver et al., Psychopharmacology 2007, 194: 545-554). Results: According to teachers reports, 15-years old adolescents with the l/l genotype had signicantly more concentration difculties compared to s-allele carriers (p= 0.01), and this was also observed at age 18 (p= 0.03). No difference in motor restlessness between the l/l genotype and s-allele carriers of 5-HTTLPR was observed at age 15 or 18. Inattention but not hyperactivity/impulsivity symptoms measured at age 18 were also signicantly higher in adolescents with l/l genotype (p= 0.005). At age 25, no association between 5-HTTLPR genotype and self-reported inattentive or hyperactive/impulsive symptoms was found.

P-08-06 Association between BAIAP2 gene polymorphisms and Attention Decit Hyperactivity Disorder in Han Chinese Subjects Z. Li*, Y. Wang, Q. Qian, Y. Chen, N. Ji, L. Liu, H. Li, L. Yang * Beijing, Peoples Republic of China Objective: To investigate the relationship between BAIAP2 and Attention Decit Hyperactivity Disorder (ADHD) or its subtypes and ADHD comorbidities in Han Chinese Subjects. BAIAP2 is asymmetrically expressed in two cerebral hemisphere and participates in neuronal proliferation, survival, and maturation.


127 Method: The diagnosis was ascertained on the base of DSM-IV. The clinical information and blood samples of 632 ADHD children (525 boys and 107 girls) and 381 controls (297 boys and 84 girls) were collected. 3 SNPs of BAIAP2 were genotyped implementing TaqManTM real-time PCR genotyping technique. The design of casecontrol study was carried out to evaluate the role of BAIAP2 in ADHD phenotypes, subtypes and comorbiditis. Chi-square test, and haplotype analysis were employed for statistical analyses. Results: 1. ADHD:T allele of rs4969385 had signicant association with ADHD children (Chi square=5.582, P=0.018) and male ADHD children (Chi square=3.872, P=0.049). Furthermore, T/T genotype of rs4969385 had signicant association with ADHD (Chi square=5.977, P=0.050). 2. ADHD Subtypes: T allele of rs4969385 had signicant association with ADHD-inattentive children (n=304, Chi square=7.21, P=0.007) and male ADHD-inattentive children (n=234, Chi square=4.494, P=0.034). Furthermore, T/T genotype of rs4969385 had signicant association with ADHD-inattentive children (n=304, Chi square=8.009, P=0.018), and showed higher frequency in male ADHD-inattentive children, but not signicant (n=234, Chi square=4.866, P=0.088). 3. Comorbidties: T allele of rs4969385 had signicant association with ADHD comorbid oppositional dcant disorder(ODD) (n=222, Chi square=3.916 P=0.0478)and ADHD comorbid learning disabilities (LD) (n=202, Chi square=4.907, P=0.0268), and showed higher frequency in male ADHD comordid LD, but not signicant (n=170, Chi square=3.681, P=0.0550). G allele of rs8079626 had signicant association with ADHD comorbid disruptive behavior disorder(DBD) (n=273, Chi square=3.951, P=0.0468), female ADHD comorbid DBD (n=39, Chi square=4.051, P=0.0441) and female ADHD comorbid LD (n=32, Chi square=4.442, P=0.0351), and showed higher frequency in ADHD comorbid LD, but not signicant (n=202, Chi square=3.584, P=0.0583). More details in Table 1. Conclusion: Our results suggest that BAIAP2 may be involved in the etiology of ADHD (especially in ADHD-I) and male ADHD, and may contribute to the predisposition to ADHD with comorbid DBD or LD. We will continue to enlarge the sample number, and there will be some new data added in the next few months. important owing to the increased reliance on self-ratings in the transition from adolescence to adulthood. Method: 5,641 12-year-old twin pairs from the Twins Early Development Study (TEDS) were included in analyses. ADHD symptoms were measured using the Strengths and Difculties Questionnaire (SDQ) Hyperactivity scale, completed by parents, teachers, and selfrated. Structural equation modelling was used to examine genetic and environmental contributions to phenotypic variance and covariance. Results: Heritability was highest for parent ratings (77%), lower for teacher ratings (60%) and lowest for self-ratings (49%). There was a substantial genetic overlap between parent, teacher and self ratings of ADHD symptoms: shared genetic factors contributed 37-66% of the total heritability for each rater. There were also rater-specic genetic factors, accounting for the remainder of heritability. Conclusion: Despite observed differences in heritability, parent, teacher and self-ratings of ADHD measure a common genetic liability. However, different informants also measure unique genetic factors that are not shared with other raters, indicating partial genetic distinction between different informants. These results have implications on how ADHD is measured in clinical practice and research, particularly for molecular genetic studies which require accurate phenotypic denitions for successful genotypic analyses.

P-08-08 Male biasness of Attention Decit Hyperactivity Disorder: Importance of dopaminergic gene variants and environment K. Mukhopadhyay*, M. Das, N. Bhaduri, A. Das Bhowmik, K. Sarkar, P. Ghosh, K. Sarkar, A. Ray, A. Chatterjee, S. Sinha * Kolkata, India Objective: The neurocognitive disorder Attention Decit Hyperactivity Disorder (ADHD) is highly prevalent with a male biasness though the reason still remains unknown. Objective of the present investigation was to explore relations between gene variants and environment in the male biasness of ADHD. Method: Functional polymorphisms in DRD4, DAT1, MAOA, COMT, SNAP25 and DBH genes were explored in eastern Indian ADHD cases recruited based on the DSM-IV. Peripheral blood samples collected from ADHD probands (N=126), their parents (N=233) and age-matched controls (N=96) was used for genomic DNA based analysis of SNPs and VNTRs followed by statistical analyses. Plasma DbH activity was measured by photometric analyses. Results: Signicant association of DAT1 intron8 5R allele (P=0.02), rs362988 G allele (P=0.042), DRD4 exon 3 VNTR-rs1800955 7R-T haplotype (P=0.02), and MAOA-u VNTR-rs6323 3R-T haplotype (P=0.002) with ADHD was observed. MDR analysis revealed signicant epistatic interaction between rs1800955 and rs362988 (IG=2.06%) with signicant main effects of DRD4 exon3 VNTR, DAT1 3UTR and intron 8 VNTR, rs4680 and rs362204, rs1611115 and rs1108580. Signicant correlation between different gene variants, high ADHD score and low DBH activity was also noticed, especially in male probands. Conclusion: Data point toward strong association of these markers with ADHD and partly answers the male biasness.

P-08-07 Shared genetic inuences on parent, teacher and selfratings of ADHD symptoms: A twin study in early adolescence A. Merwood*, C. Greven, T. Price, G. McLoughlin, J. Kuntsi, H. Larsson, P. Asherson * London, United Kingdom Objective: Parent and teacher ratings of ADHD symptoms yield high heritability estimates (70-80%), however a growing body of literature reveals lower heritability for ADHD self-ratings in children, adolescents and adults (*30-40%). To date, few twin studies have examined the heritability of self-ratings of ADHD using large, sameage samples during adolescence, and no study has yet examined the genetic overlap between parent, teacher and self-ratings of ADHD. Understanding the genetic overlap between different informants is

P-08-09 Preliminary results show no distinct pattern of 5,10methylenetetrahydropholate reductase gene polymorphisms in Attention Decit Hyperactivity Disorder A. Tufekci*, Y. Taneli, E. Kirhan, M. Dirican * Bursa, Turkey


128 Objective: The study aimed to investigate 5,10-methylenetetrahydropholate reductase (MTHFR) gene polymorphism in children and adolescents with Attention Decit Hyperactivity Disorder (ADHD), to test the hypothesis that MTHFR C677T or A1298C polymorphisms may change the susceptibility to ADHD via a change in D4R mediated activity. Method: Thirty-nine children and adolescents (10.3% female) with a diagnosis of ADHD according to DSM-IV were included after IRB approval and written informed consent. Mean age of the study group was 9.5 years (range 6.4-14 years). Severity of ADHD was assessed with the Clinical Global Impression - Severity Scale (CGI-S). MTHFR gene polymorphisms were determined for C677T and A1298C via strip assay (ViennaLab Labordiagnostika GmBh, Vienna, Austria) based on a Polymerase Chain Reaction Reverse Hybridization technique. For continuous variables mean standart deviation results were compared via independent samples t test and Mann Whitney U test; categorical variables were compared with Fishers Exact and Pearson chi-square (SPSS Inc, Chicago, Il, USA), with a statistical treshold of p\0.05. Results: The combined subtype of ADHD was seen in 84.6% of patients, and the predominantly attention decit subtype was seen in 15.4% of patients; the predominantly hyperactive subtype was not found in the study group. MTHFR C677C (normal homozygotic), C677T and T677T frequencies were 46.2%, 48.7% and 5.1%, respectively. MTHFR A1298A (normal homozygotic), A1298C and C1298C frequencies were 38.5%, 41.0% and %20.5%, respectively. Distribution of MTHFR C677T or A1298C polymorphisms did not differ for ADHD subtypes (p[0.05). Distribution of polymorphisms also did not differ for symptom severity of inattention or hyperactivity (p[0.05). Conclusion: In conclusion, our preliminary results do not show a distinct pattern of MTHFR gene polymorphisms in ADHD. Studies with larger samples are needed. the Norwegian sample were associated with disease. Empirical test at gene level also revealed association of Diras2 with ADHD (p= 0,0234). These results indicate that DIRAS2 may play a role in the pathomechanism of ADHD. Conclusion: To get more knowledge about this interesting candidate gene, in situ hybridisations on mouse brain slices and immunocytological double stainings of mouse hippocampal primary cells are done, recently. Moreover the expression of Diras2 in the mouse brain during development is investigated by quantitative real time PCR.

P-08-11 Why do ADHD symptoms and reading disability cooccur? A longitudinal genetic study of more than 12000 twins C. Greven*, F. Rijsdjik, P. Asherson, R. Plomin * London, United Kingdom Objective: Children with Attention Decit Hyperactivity Disorder (ADHD) often experience reading disability due to shared genetic risk factors. The present study examines stability and change of these genetic inuences, and the developmental relationship underlying this association across middle childhood to early adolescence. Method: ADHD symptoms and reading disability were assessed as continuous dimensions in a U.K. general population sample of more than 6000 twin pairs. Parent ratings of DSM-IV based ADHD symptoms and teacher ratings of reading were obtained at two assessments: the rst in middle childhood (child ages 7-8), the second in early adolescence (child ages 11-12). Cross-lagged quantitative genetic analyses were applied. Results: ADHD symptoms and reading disability were highly heritable, and their association was primarily attributable to shared genes. Each trait was signicantly inuenced by stable and age-specic genetic inuences, but their association in early adolescence was not signicantly inuenced by newly emerging genetic inuences. Furthermore, ADHD symptoms in middle childhood contributed signicantly to the presence of reading disability in early adolescence. This contribution of ADHD symptoms to later reading disability was signicantly larger and almost twice the magnitude as the reverse direction of effects. The more prominent impact of ADHD symptoms on later reading disability was largely driven by inattentiveness rather than hyperactivity-impulsivity. Conclusion: Enduring genetic mechanisms appear to be important in the association of ADHD symptoms and reading disability across time. Thus, genetically inuenced aspects of this association may best be targeted by early interventions. Moreover inattentive ADHD symptoms may serve to exacerbate reading disability across time. We are currently extending our analyses to examine the generalizability of our results to other learning disabilities.

P-08-10 Diras2: Candidate gene for Attention Decit Hyperactivity Disorder L. Weiog*, T. Nguyen, C. Jacob, M. Romanos, C. Freitag, H. Schafer, B. Cormand, J. Haavik, B. Franke, K.-P. Lesch, A. Reif * Wurzburg, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) is a clinically heterogeneous childhood behavioral neurodevelopmental disorder which is highly persistent into adulthood and shows a heritability up to 80%. In previous studies, our group delineated the 9q22 region by both linkage studies and genome-wide association studies as a candidate locus for ADHD. This region harbours the DIRAS2 (MIM: 607863) gene which is coding for a Ras GTPase. The function of the gene product is still unknown but might include the regulation of cell morphogenesis. Method: We thus conducted a case-control association study using the Sequenom iPLEX system in adult ADHD samples from Germany, The Netherlands, Norway and Spain (IMpACT study group) including a total of [1600 cases and [1800 controls. In addition, genotyping of two independent family-based childhood ADHD samples was accomplished. 14 SNPs were selected, which tagged the promoter region, the 5 and 3UTRs as well as the exons of the DIRAS2 gene. Results: In the german aADHD sample six SNPs located in or near DIRAS2 were associated with the disease. Furthermore, within each of the two haplotype blocks observed in the region, there was one associated haplotype One SNP (rs7848810) was associated with childhood ADHD, as well as learning disability. In the IMpACT sample, one marker (rs2297354) in the Dutch and one (rs9695432) in

P-08-12 Association study on NPY and NPY1R and body weight in ADHD T. Renner*, S. Baranski, T. Seip, T. Nguyen, M. Romanos, J. Heinrich, C. Tiesler, M. Gerlach, A. Warnke * Wurzburg, Germany Objective: The Neuropeptide Y (NPY), well established in the development of obesity, is also involved in the pathophysiology of neuropsychiatric disorders. In a previous study an association between a rare functional duplication of NPY and the simultaneous prevalency of obesity and ADHD in a multigenerational family was shown. Here, the role of frequent genetic polymorphisms in NPY and its receptor NPY1R on ADHD symptoms and body weight is


129 investigated in samples of affected children, healthy controls and an epidemiologic sample of children. Method: The study sample consists of 276 children, diagnosed according to DSM-IV criteria, 144 healthy controls and 522 children of a German epidemiological sample (GINI/LISA). Genotyping of the ADHD sample and the healthy controls comprised 2 SNPs of NPY and 3 SNPs of NPY1R, genotypes of the epidemiological sample were retrieved by GWAS data. Statistical analysis is performed by ANOVA and regression model. Results: Partial analysis shows a trend of an association of the functional NPY SNP rs16147 with body weight in ADHD children. Further analyses are in process. Conclusion: Due to its involvement in neurotransmitter pathways NPY could play a role in the pathophysiology of ADHD, especially in a potential subgroup suffering from comorbid obesity. Further studies on functional aspects of the NPY system are required. P-08-14 Family based genetic study of child ADHD and DRD2/ ANKK1 gene in a french sample M. Wohl*, C. Boni, D. Purper-Ouakil, S. Bahabori * Colombes, France Objective: Association studies found a signicant association between A1 allele of DRD2 gene and ADHD. The substantial heterogeneity underline the need of clinical, temperamental, pharmacogenetic and cognitive samples description accoding to the reward deciency model. Method: A family based association study was conducted on 193 french families with a child ADHD proband. The SNPs were selected to cover the DRD2 gene (rs 6277), the intergenic junction of ANKK1 and DRD2 (rs 2242592), and the ANKK1 gene (Taq1A). DSM IV comorbidities, rs degrees Alcoholism, Cloninger temperamental traits, cognitive prole and methylphenidate response were assessed. Transmission disequilibrium test and genotypes comparisons were done. Results: Nor allelic neither haplotypic transmission bias was observed in the global sample. Alcoholism in relatives, pregnancy smoking and oppositionnal comorbidity did not differ according to genotype. Genotypes differences was observed in methylphenidate response for rs 6277, in conduct disorder comorbidity for rs 2242592, in ADHD subtype, Generalized Anxiety comoirbidity and Trail Making Test performance for Taq1A. An overtransmission of the A1 allele was found in the subsample with generalized anxiety disorder. Conclusion: No global transmission bias of DRD2/ANKK1 gene were observed in our sample. This result is accorded to main previous family based studies but is in contrast with case-controls reports. A signicant transmission bias of A1 allele of Taq1A polymorphism was observed in a sub-sample with Generalized anxiety.

P-08-13 COMT x DRD4 epistasis impacts neural and behavioral response control in adult patients with Attention Decit Hyperactivity Disorder (ADHD) and healthy controls T. Dresler*, C. G. Bahne, M. Heine, A. Boreatti-Hummer, C. P. Jacob, T. J. Renner, A. Reif, K.-P. Lesch, A. J. Fallgatter, A.-C. Ehlis, S. Heinzel * Wurzburg, Germany Objective: Genetic inuences explain up to 80% of phenotypic variability in patients with Attention Decit Hyperactivity Disorder (ADHD). While the prefrontal cortex plays a major role in the expression of ADHD symptoms, it is unclear how putative risk genes and gene-gene interactions (genetic epistasis) might impact neural prefrontal processing and behavioral phenotypes. Here, both dopamine availability and receptor function have been linked to important principles of prefrontal processing, behavioral outcome and genetic risk of ADHD. Method: We genotyped for dopamine D4 receptor (DRD4; 48bp VNTR) and catechol-O-methyltransferase (COMT; Val158Met) gene variation in adult ADHD patients (n=181) and healthy controls (n=114). Gene main effects and DRD4 x COMT epistasis on behavioral and neurophysiological correlates of response control were investigated. To this end, reaction time data and neural response control (NoGo-anteriorization, NGA) were measured by means of a Go-NoGo task and electroencephalography (EEG). Results: While main effects were absent, DRD4 and COMT showed an epistatic interaction on reaction time variability (Go-RT SD) as well as on the NGA. Subjects lacking DRD4 7-repeat alleles (no 7R) displayed a U-relationship between the number of COMT Met-alleles and Go-RT SD, whereas 7R carriers showed an inverted U-relationship. Conversely, NGA values followed an inverted U-relationship in no 7R carriers, whereas 7R carriers showed a U-relationship. Additional gene-dosage analyses further supported the interrelation between prefrontal dopamine levels (COMT) and D4 receptor sensitivity impacting cognitive response control. Conclusion: Our ndings provide rst evidence for an interaction of genotype-dependent dopamine availability with D4 receptor function impacting prefrontal processing and behavioral functioning. Considering these interdependencies, which are discussed regarding differential effects on neural network dynamics, might help to disentangle mechanisms of prefrontal information processing underlying, for instance, signal-to-noise ratios and stable vs. exible neural network dynamics. Furthermore, our ndings may provide important hypotheses of genetic epistasis for future association studies of ADHD.

Friday, 27 May 2011, 14.3016.00 P-09 Etiopathogenesis

P-09-02 Alexithymia and attachment styles in parents of Children with Attention Decit Hyperactivity Disorder C. Paloscia*, C. Rosa, F. Manaresi, R. Guerini, A. Pasini * Rome, Italy Objective: To test the hypothesis that the alexithymic traits and insecure attachment in parents of children with ADHD can modulate


130 the severity of ADHD core symptoms. We hypothesized that 1) parents of children with ADHD will show higher impairment in their emotion processing and an higher prevalence of insecure attachment compared to control subjects, and (b) insecure attachment and high impairment in emotion processing in parents will be associated with severity of symptoms in children with ADHD. Method: The study included 48 parents of boys with DSM-IV-TR ADHD (7-13 years) and 44 parents of health controls in the same age range. We recruited 48 parents of ADHD children, admitted consecutively to our Institute and to a child outpatients service. Fortyfour parents of children, matched with the patient sample, were recruited in one school of Rome. Clinical evaluation of children was performed with the Kiddie Schedule of Affective Disorders (K-SADS) and Conners Rating Scale. Alexithymia in parents was measured by the 20-item Toronto Alexithymia Scale (TAS-20). Attachment was evaluated with Attachment Style Questionnaire. Analysis of Covariance and regression analysis were used to analyze differences between parents and controls and to evaluate a possible association between attachment styles and symptoms severity Results: Signicant differences were found between controls and ADHD parents in attachment styles. Parents of ADHD children were more alexithymic (p\0.001) and showed an higher prevalence of insecure attachment respect to control group (p\0.001). The severity of symptoms, in ADHD children, was associated to insecure attachment in parents (p\0.001). Conclusion: Alexithymic traits and insecure attachment disrupt parents ability to recognize and regulate their own infant/childs emotional life. These difculties in fathers and mothers of ADHD children could reduce treatment response to classic parent training strategies. By delineating the different possible pathways to modulate ADHD expression, clinicians may be able to develop specic multimodal treatment programmes which address cognitive, emotional and attachment components more adequately. p=0,05, df=68). Preliminary data concerning stress response results dependent on genetic predispositions will be presented. Conclusion: The morning decrease of cortisol level seem to be more rapid in boys with ADHD symptoms just as their stress reaction to cognitive stressor seem to terminate more rapidly than in healthy children. Further research is needed to clarify the role of genetic and environmental factors inuencing the HPA axis function, so that they could be considered in future preventive and therapy concepts.

P-09-05 ADHD symptoms in adults are related to the biological clock H. Caci*, V. Oliveri, K. Dollet * Nice, France Objective: Morningness-eveningness is a genetically-determined trait that measurable in childhood to adulthood and mainly reects the phase of the biological clock. An unique mutation on the CLOCK gene, related to the orientation toward eveningness, was more recently identied as a possible risk factor for ADHD in adults. The aim of this study is to replicate our previous ndings that showed a relationship between inattentive symptoms of ADHD and eveningness in adults. Method: Data were collected as part of the Child and Parents with ADHD and Related Disorders (ChiP-ARD) study. Children aged from 5 to 18 years were randomly selected in a sample of public schools. Upon signed agreement of their parents, the pupils were included. Teachers rated the childs behaviour on several scales using a secured Web site. Besides rating their childs behaviour, parents lled out questionnaires to rate their own behaviour. Their booklet included the Adult ADHD Self-Report Scale (ASRS) and the Composite Scale of Morningness (CSM). Results: 844 booklets were returned but only complete questionnaires (784 ASRS and 809 CSM) were analyzed. The nal sample counts 318 men and 438 women. There is no effect of gender on both total scores, while morningness tends to increase with age (rho=0.106, p\0.004). Factor analyses of the 31 items identied 4 factors: morningness, inattention, hyperactivity and eveningness, respectively. Inattention was more strongly correlated (negatively) with morningness than Hyperactivity. Conclusion: On this random sample of adults from the general population, we replicate our previous ndings on a sample of parents of children referred for ADHD. This is in line with recent neuropsychological and genetical studies. It encourages more integration between chronobiology and neurosciences.

P-09-04 The importance of HPA axis as an etiological factor for ADHD N. Vuksanovic*, M. Bidlingmaier, D. Rujescu, K. Zeber, J. Borns, C. Kern, K. H. Brisch * Munich, Germany Objective: Through the experimental research utilizing animal models, we better understand how early life stress induces alterations in epigenetic programming, subsequent HPA stress response and development of aggressiveness/hyperactive behavior. Additionally, genetic factors seem to play an important role in this process. The objective of our cross-sectional study was to compare HPA axis functionality in children with ADHD and healthy controls. Method: Salivary cortisol levels were measured in a group of boys with ADHD symptoms (N=36, age 4-9 yrs) and in a control group (N=34, age 4-8 yrs) at ve stages: prior to the rst experimental session (K1), before (K2) and after a cognitive stressor (K3), 30 min after the task (K4) and 60 min after (K5). The basal morning cortisol levels were accessed on two different days. Genetic data was collected from all children and their parents. Results: Although there was no difference in morning cortisol levels between the two groups, boys with ADHD-Symptoms showed a faster decrease during the rst two hours and had a highly signicant lower cortisol level at the beginning of the session (T-Wert -4,048, p=0,000, df=69)). The cognitive task was an effective stressor for both groups of children (p\0,01). Boys with ADHD symptoms showed a tendency of faster decrease of cortisol level after the stressor and ended up with signicantly lower cortisol level than healthy controls (T-1,988,

P-09-06 Environmental exposure to bisphenol A and phthalates in relation to childhood attention, behavior, learning, and intelligence, as well as the diagnosis of Attention Decit Hyperactivity Disorder S.-C. Cho*, S.-B. Hong, J.-W. Kim, E.-J. Park, M.-S. Shin, B.-N. Kim, H.-J. Yoo, I.-H. Cho, S.-Y. Bhang, Y.-C. Hong * Seoul, Republic of Korea Objective: Bisphenol A (BPA) is an industrial chemical, widespread in our environment. It is commonly used to synthesize polycarbonate plastics and epoxy resins, and these plastic polymers are extensively applied to the manufacture of various articles of daily use. BPA has been shown to affect brain and behavior in rodents and nonhuman primates, but studies have been lacking on its relationship with human neurodevelopment. Previous studies on phthalate exposure have shown that phthalate concentration was signicantly associated with


131 verbal IQ and symptoms of Attention Decit Hyperactivity Disorder (ADHD) in school-aged children. We aimed to investigate the relationship between environmental exposure to BPA or phthalates and childhood neurodevelopment. Method: Urinary concentrations of BPA and phthalate metabolites were measured among 1,089 children, aged 8-11 years. Main outcome measures included an intelligence quotient (IQ) test (KEDI-WISC), a continuous performance test (CPT), the Stroop Color-Word Test, the ADHD Rating Scale (ARS), the Child Behavior Checklist (CBCL), and the Learning Disability Evaluation Scale (LDES). Presence of ADHD was also determined with the Diagnostic Interview Schedule for Children Version IV (DISC-IV). Results: Urinary levels of BPA were positively associated with the CBCL scores of anxiety/depression, social problems, attention problems, and total problems, and negatively associated with the Stroop interference score, the LDES scores of listening, thinking, reading, mathematical calculations, and the learning quotient (Table 2). Signicant differences among quartile groups of urinary BPA level were found for the CBCL score of delinquent behavior, the LDES score of listening, and the Stroop color-word score (Table 3). The effects of BPA tended to manifest differently across gender, and inuenced the risk for ADHD (Table 4). Urinary levels of phthalate metabolites were signicantly associated with the KEDI-WISC vocabulary score and the CPT commission errors (Table 5), and the path analysis model revealed that these two variables mediated the association between urinary phthalate levels and the CBCL scores of anxiety/ depression, social problems, attention problems, and aggressive behavior (Figure 2). Conclusion: We have demonstrated adverse impacts of environmental exposure to BPA on childhood cognitive, behavioral, emotional, and learning development. The results suggest its genderdifferential effects, and BPA exposure may increase the risk of developing ADHD. Environmental exposure to phthalates may play a role in social and attention problems of children by contributing to poorer verbal IQ and more impulsive errors. received or returned from her father to the parent house. The hyperactivity episodes were immediately resolved as the little girl has to care for the pet. Conclusion: 1.It is typical in times of extreme family tension that children develop pseudo-behavioral ADHD (pronounced kinetic behavior, unstable emotional variability, cognitive disorganization), with a purely social triggering event (traumatic experience of family breakdown).2. The introduction of a therapeutic pet in a childs everyday life is able to function as a comfort, soothing the childs psychomotor explosions. Prerequisite is an advanced cooperation with both parents.

P-09-08 Ferritin and hyperactivity symptoms in a large clinical sample P. Oner*, O. Oner, E. Cop, K. Munir * Ankara, Turkey Objective: Iron is a co-factor of tyrosine hydroxylase, a critical enzyme in dopamine synthesis. Dopamine is implicated in ADHD pathophysiology. We investigated the association of iron-storage protein ferritin with parent and teacher ratings and cognitive measures after controlling for age, gender, ADHD subtype, comorbid conditions, hemoglobin, mean corpuscular volume and reticulosite distribution width in a large sample of children and adolescents with DSM-IV-TR ADHD. Method: We studied 514 ADHD subjects (439 males; age 7-15, meanstandard deviation: 9.32.2). All index and comorbid diagnoses were established by semi-structured interviews. Conners Parent Rating Scale (CPRS) and Conners Teacher Rating Scale (CTRS) were also obtained. WISC-R Digit Span and Digit Symbol and Trail Making Test parts A (TMT A) and B (TMT B) were assessed as measures of attention and executive function. Multiple regression analyses evaluated the effects of age, gender, ferritin, hematological values, subtype and comorbidity on the CPRS and CTRS Attention, Behavior and Hyperactivity, WISC-R Digit Span and Digit Symbol subtest and the TMT A and TMT B scores. Results: CPRS Hyperactivity score was signicantly associated with ferritin level (B=-.15; t=-3.4; p=.001) with only a statistical trend for CTRS Hyperactivity score. Other CPRS and CTRS scores and cognitive measures were not associated with ferritin level. The hematological values were not associated with any of the measures. Conclusion: This largest cross-sectional eld study to date suggests that lower ferritin level may be a risk factor for parent-reported hyperactivity after controlling for age, gender, ADHD ADHD subtype and comorbidity.

P-09-07 The therapeutic pet as a supporting form of intervention in child pseudo-behavior Attention Defecit Hyperactivity Disorder (ADHD) E. Fourlani*, P. Gouveris, E. Michael, T. Syriopoulou, E. Karachanidi, K. Straka, I. Maggana, A. Hristopoulou * Athens, Greece Objective: The process of a divorce is a traumatic event in a childs everyday life. Preschoolers especially display stressful behaviors as a counterweight to the inherent emotional stress that they suffer. The case of a female infant (4.5 years) with divorced parents is presented with onset of pseudo-behavioral ADHD, supportive-through pettherapy intervention and outcome. Method: The parents (through individual and joint interviews) invoked hyperkinetic behavior on the part of their child: during the return to the parent house, and after staying at the house of her father displayed by highly reactive behavior with elements of panic accompanied by a sudden hyperactivity (refusing to sit quietly in the car, great proneness to minor accidents, long hours engagement with the lift of the parent home), resulting in an extremely difcult delivery time for parents and herself. A thorough social history investigation revealed the childs special love for pets. Therefore it was proposed to bring up one small pet (rabbit), which could be carried both to the mothers and the fathers houses, believing that the pet -as a transitional animate object-, would act as a comfort during stressful time of delivery. Results: The parents followed the instructions: the child was accompanied (it was in her arms) by the rabbit each time that has been

Friday, 27 May 2011, 14.3016.00 P-10 Imaging studies: Children and adolescents
P-10-01 Single-dose Methylphenidate normalized resting-state brain dysfunction in boys with Attention Decit Hyperactivity Disorder: A functional MRI study L. An*, X. Cao, Y. Zang, Q. Cao, L. Sun, J. Ren, Z. Qing, Y. Wang * Beijing, Peoples Republic of China Objective: The neurophysiologic mechanism of methylphenidate hydrochlorides (MPH) therapeutic effect on Attention Decit Hyperactivity Disorder (ADHD) is not fully understood. The regions most frequently involved in MPH effect are frontal cortex, parietal cortex, basal ganglia and cerebellum (vermis). Regional homogeneity


132 (ReHo) is a newly-developed analytic method for resting-state fMRI study which reects the temporal synchrony of the regional BOLD signal. The specic goals of the present study were (1) to dene the anatomy of ReHo responses related to single-dose MPH in ADHD children with functional MRI; (2) to test the amelioration/normalization effects of single-dose MPH. Method: There were 27 boys with ADHD and 32 age-matched healthy boys. Children with ADHD were scanned twice, in a double-blinded, randomized, counterbalanced way, either after 10 mg MPH or placebo. While control boys were scanned once without MPH or placebo. Data preprocessing was performed in SPM8 (http://www.l.ion.ucl. and data from 5 patients and 2 normal subjects were excluded due to excessive head motion. Subsequent ReHo calculation was done in the software REST ( And the nal statistical analysis was performed using SPM8. Voxels with a P value \0.01and cluster size [40 voxels (a corrected threshold of P\0.05 by AlphaSim) were considered to show signicant difference between MPH and placebo condition in ADHD group. Results: 1. Relative to placebo condition, single-dose MPH decreased ReHo in right lingual gyrus and right postcentral gyrus, while increased ReHo in left inferior prefrontal cortex, right superior prefrontal cortex and vermis in ADHD group. 2. Single-dose MPH normalized ReHo differences between ADHD and control group in most clusters (4 in 5) with signicant difference between placebo and MPH condition in ADHD group. Conclusion: Single-dose methylphenidate can normalize most resting-state brain dysfunction in ADHD boys, and the frontal-parietalcerebellum circuit plays an important role in mechanism of MPHs effect on ADHD. Conclusion: We found there was a specic IC showing resting state related abnormality in medication-nave ADHD group. Our results suggest that the abnormality in the non-goal-directed default-mode network prevent attentional lapses might interfere frontal foci involved cognitive control network in ADHD. To conrm the interaction between networks, further studies including task-based intrasubject variability are needed.

P-10-03 ADHD and psychosocial stressors. The DTI ndings about myelinization process among these patients E. Curty*, R. Dominguez, I. Souza, P. Mattos * Rio de Janeiro, Brazil Objective: To identify possible abnormalities in the myelinization process among ADHD children and to investigate how adversities such familial stressors, including domestic violence and parental negligence could be associated with white matter microstructural integrity. Method: ADHD youths and controls were evaluated using structured interviews to investigate ADHD symptoms and other psychiatric disorders. After this process, a diffusion tensor imaging was conducted in eight different areas of interest: cerebral peduncle bilaterally (RCP and LCP), anterior limbs of the internal capsule bilaterally (ALIC), genu (GCC),splenium (SCC) and part of body of corpus callosum (BCC) and cingulum (CI) in order to correlate white matter integrity with ADHD symptoms, psychiatric disoredrs and familial and social stressors. Results: a signicant negative correlation between symptoms of inattention, hyperactivity and IQ was detected and lower IQ was associated with reduced fractional anysotropy (FA) in right cerebral peduncle.Inattention and hyperactivity symptoms by themselves were statistically nonsignicant when correlated to the decrease in FA in the studied areas. Among ADHD children who faced important psychosocial stressors during their lives, FA in the left size of the prefrontal area was decreased when compared with ADHD children without life stressors. Conclusion: Lower IQ and psychosocial stressors are relate to impairments in the white matter integrity.

P-10-02 Default mode network abnormality in medication-naive ADHD boys: Resting-state fMRI study J. Choi*, B. Jeong * Daejeon, Republic of Korea Objective: Pathophysiologic models of ADHD have focused on prefrontal-striatal and mesolimbic circuits on the basis of ndings of executive and motivational dysfunction. A complementary approach is to examine the neural substrates of ADHD-relevant behaviors, such as attentional lapses, through functional connectivity analysis. Momentary lapses in attention have been associated with failure to suppress activity in the default-mode network. For broader understanding of neural correlates in pathophysiology of ADHD, we hypothesized that resting state default mode network activity might be compromised in medication-nave boys with ADHD, and analyzed the resting state brain activity using independent component analysis (ICA), which is data-driven approach, rather than theory-driven analysis. The aim of this study is to test whether resting state default mode network brain activity is compromised in medication-nave boys with Attention Decit Hyperactivity Disorder (ADHD), using independent component analysis (ICA) of Functional MR data. Method: Twenty medication-nave boys with ADHD (mean age 10.32.5) and 28 age-, gender-matched healthy volunteers (mean age 10.32.0) were measured resting state brain activity with a 1.5T Philips scanner and clinical assessment. Functional MR data acquired during resting state of 7 min were analyzed using independent component analysis (ICA). Results: No demographic difference was found between two groups except IQ, which was higher in healthy control group (P\0.001). ADHD group showed signicantly higher scores than control groups in Korean ADHD Rating Scale (P\0.001). An independent component (IC) which includes bilateral precuneus/posterior cingulate cortex, occipito-temporal junction, and anterior cingulate cortex was signicantly less activated in ADHD than in control groups (P\0.05).

P-10-04 Examining volumetric differences in the PFC of a pediatric spanish sample with ADHD and normal controls using a highly-calibrated manual tracing protocol E. Direnfeld*, M. A. Garcia-Barrera, J. Hatter, R. Cauleld, L. Shayegi Nick, J. Wilson, N. Trujillo-Orrego, E. Perez-Hernandez * Victoria, Canada Objective: Studies on the neural correlates of ADHD have identied total PFC volume differences, with either smaller volumes of the right


133 or left PFC. Some studies have observed a linear relationship between large PFC and impaired attention. Recent studies have examined of subregional volumes of the PFC in greater detail. This study examined the relationship between volumes of four PFC subregions and ADHD in a pediatric sample from Spain. Method: Structural MRI scans of ten children with ADHD and matched controls (N = 20) were collected in Spain. Volumetric manual tracing was conducted using ANALYZE 9.0 (Mayo Clinic, 2009). After preprocessing, PFC-parcellation was completed using a highly-calibrated and reliable protocol previously established within our lab (Garcia-Barrera et al., 2010). Non-parametric Mann-Whitney U analyses were conducted for between-group comparisons and left/ right asymmetry was examined. Inter- and intra-rater reliability was measured using intra-class correlations. IQ was measured using the WISC-IV (Spanish version). Results: Signicantly larger volumes were found in the ADHD group relative to controls in left-PFC (LPFC), U=23.00, z=-2.04, p=.041, r=.46, and right dorsolateral-PFC (RDPFC), U=24.00, z=-1.97, p=.049, r=-.44. Both groups showed similar patterns of left-right asymmetry in all PFC regions (ps[.05). Total brain volume (TBV) did not differ between groups nor did it explain observed differences. Inter-rater (.96-1.0) and intra-rater (.87-1.0) reliability was high. Conclusion: Consistent with only a handful of studies, and in contrast to our ndings with American samples, this study demonstrated larger DLPFC volumes in the right hemisphere of Spanish children with ADHD. TBV did not account for these differences, however our groups differed by IQ which may explain some of these results. Delayed neuronal pruning may also play a role in these volumetric differences. P-10-06 Magnetic Resonance spectroscopy study in cerebellar vermis difference between school age children with Attention Decit Hyperactivity Disorder compared with healthy school age controls N. Gonzalez*, E. Barragan, S. Garza, J. Hernandez, F. Eduardo * Mexico, Mexico Objective: The objective of this study was to evaluate the differences in neurometabolite concentrations in the cerebellar vermis of children with ADHD and healthy controls using proton magnetic resonance spectroscopy (1H MRS). Method: Nine patients were evaluated, ve had a previous diagnosis of ADHD and four were healthy controls. Peaks of N-acetylaspartate (NAA), choline (Cho) and glutamate-glutamine (Glx) were measured and the ratios of the peaks calculated. Results: In children with ADHD, a signicantly increased NAA/Cr ratio (2.62) was found compared to NAA/Cr ratio in healthy controls (1.95). No other differences in measured metabolite concentrations were observed. Conclusion: These results suggest the cerebellar vermis as part of the neurophysiological dysfunction in ADHD, nevertheless further studies are needed to conrm this.

P-10-07 Difference in the cerebellar vermis volume between school age children with Attention Decit Hyperactivity Disorder compared with healthy school age controls; N. Gonzalez*, S. Liendo, J. L. Madrigal, J. Hernandez, E. Barragan, S. Garza, A. Rizzoli

P-10-05 fMRI study with MSIT: Difference in neural activity between school age children with Attention Decit Hyperactivity Disorder compared with healthy school age controls N. Gonzalez*, A. Rizzoli-Cordoba, S. Liendo, E. Barragan * Mexico, Mexico Objective: The objective of this study was to investigate the neural activity in patients with ADHD in the Medial Cortex Cingulate and other frontoparietal regions subserving attention during the MultiSource Interference Task (MSIT). Method: Methods ve children (8-11 years of age) with combinedtype ADHD and ve healthy children underwent block functional magnetic resonance imaging (fMRI) while performing the MSIT. Data was analyzed with SPM2 using general linear model with a synthetic hemodynamic response function. Results: Comparison between the patients and healthy controls during the MSIT. Overall, patients exhibited reduced activation in caudate and putamen, as well as parietal cortex. These are preliminary results. Conclusion: The MSIT produces reliable and robust activation of daMCC and the rest of the cingulo-fronto-parietal attention network in healthy individuals. However we observed hypoactivity in basal ganglia in children with combined-type ADHD. Recent study showed in adults with ADHD Methylphenidate OROS increased daMCC activation during the MSIT and may act, in part, by normalizing daMCC hypofunction in ADHD.. For other hand studies suggested that smaller gray matter volumes in the caudate observed in children with ADHDshow normalization during late adolescence. Our results show probably the children have a different pathways for resolve MSIT and the ADHD children have more decit in basal ganglia than adults. One limitation of our study is the relatively small number of patients tested. However, our sample size is a preliminary result.

* Mexico, Mexico Objective: Structural imaging studies indicate that cerebellum, in particular the posterior inferior vermis, is smaller in Attention Decit Hyperactivity Disorder (ADHD) children compared with control subjects. Our goal was tested these ndings in a sample of Mexican school age children with ADHD compared with a group of healthy school age children Method: Setting: outpatient clinic of pediatric neurology department. Subjects: 7 patients (4 boys and 3 girls) newly diagnosed with ADHD based on DSM-IV criteria, without pharmacological treatment, mean age of 7.42 years (SD: 1.02) and 6 healthy control children, with mean age of 10.34 years (SD: 2.4 years), with an IQ greater than or equal to 80 with Wechsler Intelligence Scale for Children IV (WISC-IV), and without comorbid psychiatric disease veried with a structured interview Kiddie-Schedule for Affective Disorders (K-SADS). Interventions: Children underwent Magnetic Resonance of 10 min total, with a sequence of volumes of 5 min. Images were of adequate quality and found no structural abnormalities of the brain in any patient. MRI were processed using software DICOM and the volume of the cerebellar vermis was measured with MRIcro software. Results: The mean volume of the cerebellar vermis in the control group was 493.21 mm 3 (SD 1.74 mm3). The average volume in ADHD patients was 463.51 mm 3 (SD: 14.98). We found a statistically signicant difference of 29.7 mm 3 between groups. Patients with ADHD had 6.02% less volume than controls. These are preliminar results Conclusion: The ndings of this study, conducted with Mexican pediatric population, are similar to results in previous publications on the subject. The cerebellar vermis is one of the candidate brain regions hypothesized to be involved in the pathophysiology of ADHD. Future studies should explore abnormalities of cerebellar vermis functionality in ADHD populations


134 P-10-08 The impact of reward on episodic memory formation in Attention Decit Hyperactivity Disorder U. Malecki*, E. Duezel, H. Hinrichs, C. Rehe, S. Tyll, T. Noesselt, H.-H. Flechtner, K. Krauel * Magdeburg, Germany Objective: Motivational and cognitive impairments in Attention Decit Hyperactivity Disorder (ADHD) are commonly ascribed to a dysfunction in dopaminergic frontostriatal pathways. Animal studies have accentuated the importance of dopaminergic reward signals for the consolidation of episodic memories in the hippocampus. This study investigated the effect of reward anticipation on incidental memory formation in children and adolescents with ADHD. Method: Boys with ADHD (N=12, 11-15 years) and normally developing adolescents (n=12, 1117 years) performed an episodic memory paradigm. Event-related fMRI recordings during incidental encoding of visual stimuli in the context of anticipation of reward or non-reward were analyzed with regard to later recognition performance. Results: Even though ADHD patients recognized overall signicantly fewer pictures than healthy adolescents, both groups showed a clear benet in memory performance for stimuli following reward anticipation. In contrast to previous studies, reward anticipation was associated with activations in the ventral striatum and the dopaminergic midbrain in both ADHD patients and healthy controls. In the control group, striatal and midbrain activation was limited to the reward cue. ADHD patients, however, continued to show this activation pattern during the stimulus presentation following the reward cue. Conclusion: Our ndings provide evidence for the dopamine transfer decit hypothesis (Tripp & Wickens, 2008). While healthy control subjects successfully transferred the reward signal to the earliest time point for reward prediction, adolescents with ADHD were reliant on a continued reward signaling in the ventral striatum and dopaminergic midbrain. Tripp G, Wickens JR (2008) J Child Psychol Psychiatry 49:691-704. P-10-10 Differences in neurometabolites measurementes in the cingulus of scholar patients with and without Attention Decit Hyperactivity Disorder by proton MR spectroscopy M. Pizarro*, A. Rizzoli, E. Barragan, E. Flores, A. Partida, S. Garza * Df, Mexico Objective: To describe the differences in neurometabolites measurements in the dorsal anterior cingulal cortex in scholar patients with and without ADHD by proton MR spectroscopy Method: Comparative study of 4 scholar patients with ADHD and 4 controls, univoxel spectroscopy of the left dACC was performed. Results: Mean age of patients was 9 years (2.16) for ADHD group and 9.5(1.29) for controls (non signicative p), mean IQ ADHD 105(3.5) and 9.16(3.81) (non signicative p). Absolute measurement between neurometabolites was statistical signicative only NAA (p=0.021) but not for Glx and Cho (p=1 and p=0.564 respectively). Mean relations between neurometabolites (NAA/Cr and Glx/Cr and Cho/Cr) show not statistical signicatives differences. Conclusion: Results of this study become parte of crescent evidence of estructural, biochemical and functional disorders of the cingulus in escolar ADHD patients. Conclusion: These ndings are consistent with neurofunctional circuits correlates of neuropsychological decits of some working memory and attentional decits commonly found in ADHD.

P-10-11 Functional connectivity patterns differences in drug naive children with ADHD during working memory-related processes H. Slama*, P. Peigneux, A. Mary, M. Kavec, S. Linotte, D. Baleriaux, T. Metens, I. Massat * Brussels, Belgium Objective: The present fMRI (3T) study aimed at investigating and comparing the neurophysiological basis of working memory (WM) in prepubertal children with Attention Decit Hyperactivity Disorder (ADHD) and healthy controls, selected with stringent criteria minimizing potential confounds. Indeed, while decits in WM are key neuropsychological features in ADHD, their underlying cerebral substrates remain poorly understood in children. Moreover, high rates of comorbidity, ongoing medications and behavioural differences in performance may be considered as potential confounds in neuroimaging studies in ADHD, each of these parameters having the potential to impact independently on patterns of cerebral activity involved in WM. Method: Nineteen right-handed, never medicated children fullling DSM-IV criteria for the ADHD combined type and fourteen healthy volunteers participated in this study. WM performance and underlying cerebral activity were measured using a verbal N-back task under two different conditions. In the vigilant/control 0-back condition, subjects had to detect the presence of the digit 2 in a series of digits. In the WM 2-back condition, subjects had to press a button when the displayed digit was identical to the one presented two trials before. Data were analysed using SPM8b. Results: Despite similar WM behavioural performance compared to healthy participants (U=103, p=0.29), children with ADHD exhibit decreased, below baseline WM-related activation levels in a widespread cortico-subcortical network encompassing the bilateral occipital and inferior parietal areas, caudate nucleus and cerebellum. Differential functional connectivity in ADHD as compared to healthy participants was highlighted between these areas and a large network of subcortical and cortical regions involved in WM, as well as between the cerebellum and the functionally connected brainstem red nucleus area.

P-10-09 Voxel-Morphometry and Neuropsychological Analysis in a sample of ADHD children C. B. de Mello*, A. Jackowski, R. G. Nogueira, S. Rizzutti, O. F. A. Bueno, M. Muszkat * Sao Paulo, Brazil Objective: The aim of this study is to examine cerebral gray (GM) and white (WM) matter abnormalities in a group of ADHD children using a voxel-based morphometry protocol and correlate to performance in measures of Continuous Performance Test sensitive to attention functions such as omission, commission and reaction time (Hit Rt) scores, as well to performance in working memory and cancellation tasks, Copy and memory of complex gure of Rey. Method: The sample consisted of 12 children/adolescents with DSMIV TR diagnosis of ADHD (aged 714 years) who were compared with 12 healthy volunteer children/adolescents. A morphological analysis in a 3.0T MRI scan was performed, with incoherent ultra-fast volumetric acquisition T1 weighted images (FSPGRE cubic-pixel) and axial spin-echo T2 weight images, FLAIR, IR and GRE T2, multivoxel morphometry. Results: Comparing to control ADHD subjects showed regionally specic effects (volume reduction) in GM and WM in the left median frontal areas (anterior, motor and right somatosensory cortex), anterior cingulate cortex and parietal lobe and left caudate. Neuropsychological analysis showed difference in Reaction Time (Hit RT), digit span backwards and number of omissions in cancellation tests.


135 Conclusion: Our results yield novel evidence for a core functional neuroanatomical network subtending WM-related processes in ADHD children, which may participate to the pathophysiology and the expression of clinical symptoms in this disorder. P-10-13 Is the clinical, cognitive and brain biochemical expression of Attention Decit Hyperactivity Disorder different in children born late preterm versus children born at term? L. Ben Amor*, S. Chantal, A. Bairam * Levis, Canada Objective: Attention Decit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in school age children, and prematurity is a recognised risk factor. Late preterm birth, which represents 75% of premature births is associated with ADHD symptoms, more impaired cognitive performance, and increased behaviour problems, than at term birth. However, little is known of the characteristics of ADHD associated with late prematurity. Few studies have directly compared late premature children with ADHD to at term children with ADHD. Objective: To compare the clinical, cognitive and neurobiochemical characteristics associated with ADHD in late preterm children to those of ADHD at-term children. Method: Nine ADHD late preterm children, aged 5 to 13, were matched by age, gender and ADHD subtype with nine ADHD at term children. The Diagnostic Interview Schedule for Children -IV and the Continuous Performance Test were used to evaluate the clinical and cognitive characteristics. Proton magnetic resonance spectroscopy was used to measure the ratio to creatine of glutamate, choline and glutamate-glutamine in both prefrontal and striatal regions, and the left cerebellum. Results: The groups did not differ on clinical outcomes. However, compared to ADHD at term group, ADHD late term group has reduced reaction time on the Connors continuous performance test (p B 0.005), as well as lower ratios of choline in the right striatum (p B 0.05) and of Glutamate in the left cerebellum (p B 0.03). Conclusion: Among children with ADHD, those born late preterm have increased performance on an attention test, associated with lower relative concentrations of brain metabolites in the striato-cerebellar regions than those born at term. Conclusion: Etiological factors of ADHD could play a role in the expression and course of ADHD.

P-10-12 Adolescent brain have different activation pattern against different reward condition. J. Son*, W.-H. Choi, Y.-F. Kim, S. Y. Park * Cheongju, Republic of Korea Objective: Adolescence have a tendency to seek any kind of reward. The purpose of this study was to investigate the brain activity when adolescence perform some task with various reward system. Method: 15 adolescence were recruted. After they performed the right-left discrimination test, 4 kinds of feedback were showed - no reward, performance reward, evaluative reward, monetary reward. And the brain activity was measured using FMRI. Results: In performance reward situation vs. no reward situation, lt.superior frontal gyrus(BA 9) and caudate nucleus were signicantly activated. In evaluative reward situation vs. no reward situation, caudate nucleus and rt. culmen of cerebellum were signicantly activated. Finally, in monetary reward situation vs. no reward situation, rt. middle frontal gyrus(BA 10) and other brain regions were signicantly activated. Conclusion: These results suggest the activation pattern of adolescent brain in different reward situation would be different from each other.

P-10-14 Basal ganglia differences between good or bad responders to metilphenidate in ADHD children. A VBM and a ROI-based study A. Moreno*, L. Duno, E. Hoekzema, M. Picado, L. M. Martin, O. Vilarroya * Barcelona, Spain Objective: The rst choice pharmacological treatment for Attention Decit Hyperactivity Disorder (ADHD) is methylphenidate (MPH). However, around 30% of the patients do not show signicant improvement in response to MPH (Grizenko et al., 2006; TerStepanian et al., 2010). An identication of eventual bad responders at the moment of the diagnosis could benet such patients, improving their management and avoiding possible complications. Yet, no clinical or neurobiological markers have been found so far that can distinguish good and bad responders. Our study aims to evaluate whether there are structural brain differences between good or bad responders to MPH. Our hypothesis is that differences would be found in territories rich in dopamine receptors, such as the striatum. Method: We performed a Voxel-Based Morphometry (VBM) analysis on anatomical brain MRI scans obtained from 27 ADHD medication-nave subjects at the moment of the diagnosis. Following


136 the acquisition, the subjects began MPH treatment. Decision about good or bad response to MPH was established approximately one month after treatment initiation based on clinical criteria. Images were acquired in a 3T MRI Scanner and the analysis was performed using SPM5 software implemented in Matlab 7.0. Region of interest (ROI) analyses were performed in the nucleus accumbens, the caudate and the cerebellum. Results: Sixteen patients showed signicant improvement with the treatment, while eleven were qualied as bad responders. The VBM and ROI analyses indicated greater gray matter volume in good responders in bilateral nucleus accumbens and bilateral caudate head. Conclusion: Our ndings not only support the hypothesis that these structures play an important role in the pathophysiology of ADHD, but also implicate the neurochemical characteristics of these structures in the response to pharmacological treatment. These ndings might be useful to determine a neuroanatomical phenotype that differentiates good and bad responders at the moment of the diagnosis. sample of unprecedented size compared with a matched control group of healthy study participants. Method: Diffusion weighted images images have been acquired for 92 patients and 84 healthy controls, matched in gender, age and IQ. The obtained fractional anisotropy (FA) and mean diffusivity (MD) maps of each subject were normalized to an originally created study template derived from the 84 structural T1-weighted images of the healthy control samples using Dartel diffeomorphic algorithm (Ashburner 2007). Results: Comparing FA values of the patients and controls in a voxelwise analysis showed signicant differences between groups in the right cerebellar hemisphere0 s white matter. Other areas failed to reach signicance. MD values did not vary signicantly across groups. Conclusion: The current study is the rst to report cerebellar FA abnormalities in adult ADHD patients. Correspondingly, cerebellar volume differences have been described in a study comparing a large sample of ADHD children to healthy controls (Castellanos 2002). It has been hypothesized that cerebellar functions comprise the reproduction of an internal model which contains essential properties of cerebral mental representations (Ito 2008; Schmahmann et al. 2007). Cerebellar dysfunction may affect those internal models contributing to symptoms like affect dysregulation, as well as poor attentional and behavioral control.

P-11-02 Cerebellar volume decits in adult ADHD S. Maier*, E. Dieter, E. Perlov, S. Kloppel, A. Philipsen, L. Tebartz van Elst * Freiburg, Germany Objective: Volumetric decits have been reported in many studies of ADHD in children (Valera:2007) and in a smaller number of mostly recent studies on adult ADHD (Ahrendts et al. 2010, Seidman et al. 2010). In adult ADHD volume differences have been reported for several different areas, among those the anterior cingulate, dorsolateral prefrontal, orbitofrontal and occipital cortex, the basal ganglia and the cerebellum (Ahrendts et al. 2010, Amico et al. 2010, Hesslinger et al. 2002, Seidman et al. 2006). A recent study investigating a large sample of ADHD patients and controls found a reduced caudate volume in ADHD patients (Seidman et al. 2010). In the present study we investigated structural decits in ADHD using voxel based morphometry in a sample of unprecedented group size. Method: T1-weighted structural images of 99 ADHD patients and 92 healthy controls, matched in age, IQ and sex have been acquired on a 3 tesla scanner. Structural image were analyzed in SPM8 using VBM8 image segmentation (Christian Gaser, University of Jena) and registered onto a template applying dartel diffeomorphic image registration (Ashburner 2007). Results: Compared to healthy control subjects, ADHD patients showed signicantly smaller volumes in the right cerebellar and insular white matter after controlling for family wise errors. Other brain areas and grey matter structures failed to reach signicance. Conclusion: Our results of cerebellar volume abnormalities in ADHD patients are in line with earlier studies in children reporting smaller cerebellar volumes (Castellanos et al. 2002, Valera et al. 2007). Apart from its function in motor control the cerebellum is thought to serve as modeling unit for affective and cognitive processes (Ito 2008). Patients suffering from lesions affecting the posterior cerebellar lobe manifest affective, behavioral and cognitive impairments (Schmahmann et al. 2007) which show overlap with symptoms of inattention, poor behavioral and poor affect control described in ADHD.

Friday, 27 May 2011, 14.3016.00 P-11 Imaging studies: Adults

P-11-01 Altered integrity of cerebellar white matter in adult patients diagnosed with ADHD P. Goll*, S. Maier, E. Perlov, S. Kloppel, D. Endres, A. Philipsen, L. Tebartz van Elst * Freiburg, Germany Objective: Structural and functional abnormalities in ADHD neuroimaging studies have been reported for various distinct brain areas. White matter (WM) volume abnormalities and disrupted white matter integrity were detected in children and adults affected by ADHD in several brain regions (Castellanos et al. 2002; Ashtari, M. et al. 2005; Seidman et al. 2006). As for adults, frontal and temporal white matter disruptions have recently been described (Konrad et al. 2010). The focus in this study was to examine structural connectivity in a patient


137 P-11-03 A proton MRS study of the Basal Ganglia, Dorsolateral Prefrontal Cortex and Parietal lobe in Adults with Attention Decit Hyperactivity Disorder S. Maltezos*, S. Coghlan, T. Lavender, R. OGorman, C. Skirrow, K. Xenitidis, P. Mark, D. Spain, P. Asherson, D. Murphy * London, United Kingdom Objective: 1H-MRS studies have demonstrated alterations in several brain metabolites concentrations including glutamate/glutamine (Glx), N-acetylaspartate (NAA), choline (Cho) in individuals with ADHD. The purpose of this study was to investigate neurochemical differences (using 1H-MRS) in frontal, striatal, and parietal regions and the effect of psychostimulant medication, comparing psycho stimulant nave and medicated adults with ADHD and a healthy group. Method: 39 adults with ADHD (combined type: 22, inattentive type: 17) were compared to 21 age, gender and IQ matched controls. 22 of the individuals with ADHD were psychostimulant naive. Connors Adult ADHD Diagnostic Interview (CAADID) was used as screening/ diagnostic measure. MRS studies were performed with a 1.5T GE HDx MRI scanner equipped with TwinSpeed gradients. Single voxel 1H MR spectra were acquired with a PRESS sequence with repetition time (TR) = 3000 ms and echo time (TE) = 30 ms. Voxels of interest (VOI) were positioned in the left medial parietal lobe (20 9 20 9 20 mm3) left dorso-lateral prefrontal cortex (DLPFC) (16 9 24 9 20 mm3), and left basal ganglia (BG) (20 9 20 9 15 mm3). MRS concentrations were corrected for VOI CSF and grey/white matter content. Results: Subjects with ADHD had a signicant reduction: 1) in BG concentration of Cr?PCr, NAA, Glx, and Cho, 2) in DLPFC NAA, Cr?PCr and Cho, and 3) in Parietal NAA and Glx. We found signicant correlations between Parietal Glx and symptom severity as indexed by CAADID scores. No differences were found between psychostimulant medicated and unmedicated ADHD subjects. Conclusion: These observed decreases in concentration of various neurometabolites point to a systemic decit in mitochondrial/neuronal dysfunction or myelination, cellular energy metabolism, and neurotransmission across a widespread network of frontal, striatal, and parietal regions suggesting that neurochemical abnormalities in ADHD patients are likely to continue beyond childhood into adulthood. These observed differences are unlikely to represent treatment effects, but rather reect the underlying pathophysiology of ADHD. Results: We tested (a) whether we can replicate recent ndings of amygdala subdivision connectivity in healthy subjects and (b) whether patients with ADHD and healthy controls differ regarding amygdala subdivision connectivity strength and (c) whether ADHD symptom severity is correlated with resting state connectivity. Conclusion: Exploring amygdala-based networks may help to better understand distinct aspects of the clinical phenotype. Implications for motivational theories of ADHD are discussed.

P-11-05 Functional brain imaging of delay aversion in adult ADHD G. Wilbertz*, A. Trug, J. Blechert, L. Tebartz van Elst, E. Sonuga-Barke * Freiburg, Germany Objective: To explore behavioral as well as physiological signs for delay aversion in adult ADHD. Method: Preliminary data consist of twelve adult patients with ADHD (all subtypes, 4 men, mean age 39 years) and twelve matched control subjects tested on four tasks regarding delay aversion: a hypothetical delay discounting task (DD, Rachlin et al., 1991), the continuous delay aversion task (ConDAT, Muller et al., 2006), the delay frustration task (DeFT, Bitsakou et al., 2009) and a modied version of the monetary incentive delay task (Knutson et al., 2001) with three levels of forced delay as punishment during the trials (the motivational delay avoidance test, MoDAT). Functional magnetic resonance imaging (fMRI) was measured during both of the last two tasks. Results: Behavioral data show signicant associations of ADHD symptom severity with DD and ConDAT but no reliable group differences. Brain activity in the amygdala, ventral striatum and anterior insular cortex is signicantly more affected by delay anticipation in the ADHD than in the control group. In contrast, healthy subjects exhibit a stronger modulation of the anterior cingulate cortex. For the processing of delay punishment no clear pattern appears. Groups do not differ regarding DeFT. Conclusion: Abnormal delay aversion can be demonstrated behaviorally as well as physiologically in adult ADHD and seems to account for the impulsive symptomatology. However, heterogeneity and small effect sizes point to yet undened subtypes of ADHD. Establishing methods to reliably assess delay aversion is important for the validation of current psychopathological models.

P-11-04 Amygdala subdivision connectivity in adult patients with ADHD M. M. Plichta*, S. Esther, D. Mier, C. Sauer, O. Grimm, A. B. M. Gerdes, D. Sabljic, B. Alm, P. Kirsch * Mannheim, Germany Objective: Cumulating evidence suggests the importance of decits in emotional brain circuits for the pathophysiology of ADHD. Functional as well as structural alterations of the amygdala have been recently reported in patients with ADHD. Animal research, however, has shown that the amygdala is composed of several nuclei which may differentially contribute to the processing of emotion through interactions with other subcortical and cortical structures. Thus, exploring amygdala-based networks may help to better understand distinct aspects of the clinical phenotype. Method: We examined functional connectivity of three cytoarchitectonically dened subdivisions of the amygdala (laterobasal, centromedial, supercial) during rest using seed voxel method in adult patients with ADHD and healthy controls.

P-11-06 No difference of dopamine transporter availability in adults with Attention Decit Hyperactivity Disorder C.-B. Yeh*, M.-C. Lo, C.-J. Chang, K.-H. Ma, W.-S. Huang * Taipei, Taiwan Objective: Attention Decit Hyperactivity Disorder (ADHD) affected 5-10% of children and 4% of adults. Previous studies showed that the dopamine system is involved in ADHD. The aim of this study was to investigate the relationship between ADHD and the availability of dopamine transporter (DAT). Method: The subjects were divided into ADHD group and healthy controls. They were interviewed to assess the severity of ADHD symptoms and received SPECT using TRODAT to explore the availability of DAT in the brain. They also received neuropsychological tests including Continuous Performance Test (CPT), Iowa gambling test. Results: Thirty-two ADHD patients and twelve normal healthy controls were recruited. No signicant difference of availability of


138 DAT between ADHD and control groups found. The availability of DAT was associated with the result of CPT. Conclusion: The ADHD adults not comorbid with oppositional deant disorder, conduct disorder or substance use disorder might be without the abnormality in dopamine system. However, the DAT availability was associated with the impaired executive functions in ADHD. Our result was not line with previous studies might be due to the younger age of control group, or the neurotransmitters other than dopamine are involved in ADHD. the infraorbital prefrontal cortex and the bilateral antero-medial temporal lobes, i.e, the pattern often seen in SPECT scans of patients with ADHD. The patient was treated with lisdexamfetamine 50mg per day, with excellent resolution of her BPD symptoms. The 3D SPECT scans of this patient are presented. Conclusion: Some patients with a clinical diagnosis of BPD may show 3D SPECT neuroimaging results of a dysfunctional prefrontal cortex, similar to what is seen in ADHD patients. Such patients may respond to the same stimulants used to treat ADHD. More work is indicated in this area. P-11-08 Correlation of inattention and impulsivity with regional brain volume in adult patients with ADHD A. Konrad*, T. Dielentheis, G. Vucurevic, M. Huss H. Schneider*, M. McLean, M. Freeman, J. Thornton, M. van Lierop, R. Tarzwell * Toronto, Canada Objective: Work by Philipsen has shown that adults with BPD (Borderline Personality Disorder) have an increased prevalence of childhood ADHD (Attention Decit Hyperactivity Disorder). Brain SPECT (single photon emission computed tomography) scans indirectly show functional (metabolic) activity via measurement of regional cerebral blood ow. How do brain 3D SPECT patterns compare for patients with a clinical diagnosis of BPD versus ADHD? Method: Three hundred community patients (approximately 5% with BPD, 20% with ADHD, 75% other diagnoses) across the lifespan received 3D SPECT scans. * Mainz, Germany Objective: Inattention and impulsivity are key symptoms of Attention Decit Hyperactivity Disorder (ADHD). Structural and functional neuroimaging studies of subjects with ADHD demonstrated abnormalities primarily in the frontal-striatal circuitry. However, there is only little evidence about the correlation of these abnormalities with ADHD symptomatology. Therefore, the aim of this magnetic resonance imaging (MRI) study was to examine the correlation of regional brain structure with attentional performance and impulsivity in adult ADHD patients.

P-11-07 3D brain SPECT imaging of ADHD presenting as Borderline personality disorder: A case report

Results: The majority of patients with a clinical diagnosis of BPD were found to have on SPECT scan functional defects in the infraorbital prefrontal cortex, the same pattern seen in our patients with ADHD. Functional defects were also seen in the antero-medial temporal lobes in both the ADHD group and the BPD group, but more often in the latter. We present the case of a 15 year old female who presented with a several year history of 8/9 of the DSM-IV criteria of BPD without meeting fully the DSM-IV criteria for ADHD. A 3D SPECT scan of the patients brain showed large functional defects in

Method: We investigated 29 adult ADHD patients (16 males), all subjects underwent a detailed clinical interview as well as a neuropsychological test battery. Attentional performance and impulsivity were assessed with the Test of Variables of Attention (TOVA). Structural MRI datasets were acquired on a 1.5 T scanner. Voxelbased-morphometry (VBM) was conducted using the optimized protocol implemented in SPM8 (statistical parametric mapping). Voxelbased correlation analyses with measures of attentional performance and impulsivity were performed, the results were thresholded at an uncorrected P \ 0.001. Results: The VBM correlation analyses showed signicant (positive) correlations between attentional performance in the caudate nucleus. Impulsivity scores correlated negatively with regional caudate


139 volume, though this correlation failed to be signicant at an uncorrected P \ 0.001. Conclusion: This is the rst VBM study showing a correlation between attentional performance and volume of the caudate nucleus. We provide further evidence that basal ganglia abnormalities contribute essentially to ADHD symptomatology. P-11-09 Increased Creatin, Cholin and Glutamate 1 Glutamin (Glx) concentrations in hyperactive patients with ADHD D. Endres*, E. Perlov, S. Maier, P. Goll, A. Philipsen, L. Tebartz van Elst * Freiburg, Germany Objective: Cerebral neurometabolic alterations, especially of dopamine, might play an important role in the pathogenesis of ADHD. According to Carlsson and coworkers there is a highly regulated interplay between dopaminergic and glutamatergic neurotransmission (Carlsson, 1999; Carlsson, 2001). In a previous study of the cerebellum using chemical shift imaging, we showed increased Glx/Cre ratios in the left cerebellar hemisphere (Perlov, 2010). To test for cerebellar involvement in pathogenesis of ADHD, we examined a region of interest in the left cerebellar hemisphere using single voxel spectroscopy. Method: We measured 118 patients with ADHD and 83 controls. For analysis, we used single voxel spectroscopy for absolute quantication of neurometabolites using the LC model algorithm (Provencher, 1993). Measured metabolites were Creatin (Cre), Cholin (Cho), Glutamat?Glutamin (Glx), N-Acetylaspartate (NAA) and Myoinositol (Ins). CAARS Rating Scale was used to distinguish the DSM-IV ADHD subscales of inattentive, hyperactive-impulsive and total ADHD symptoms. Results: We found no signicant differences in the measured metabolite concentrations in left cerebellar hemisphere between controls and ADHD patients. However, in a subgroup analysis we found signicantly higher absolute concentrations of Cre (p=0,012), Cho (p=0,023) and Glx (p=0,023) in patients with ADHD fullling the DSM criteria for hyperactivity and impulsivity (n=33) compared to a control group (n=33) matched in sex, age and IQ. Conclusion: According to our previous ndings, we found signicant higher concentrations of cerebellar Glx in patients, but only in the subgroup with symptoms of hyperactivity and impulsivity. Recent theories discuss a cerebellar involvement in behavioral regulation and affective control (Ito, 2008; Schmahmann et al. 2007), two domains which are known to be impaired in ADHD. Whether cerebellar abnormalities found in the present study contribute to ADHD symptoms of poor impulse and affect control should be addressed in future studies. treatment. The control group was composed of 32 scholars from public schools and followed the same inclusion criteria regarding age and sex. The evaluation was made through the Motor Development Scale, described by Rosa Neto, which were used in all tests available: ne motricity, gross motricity, balance, body scheme, spatial and temporal organization. All tests were applied in one session, wtith medium time of 40 min. For the statistical analysis used Stata software version 11.0 (Stata Corporation, College Station, TX, USA) and used the Shapiro-Wilks tests, Student t test, Mann-U test Whitnney. Results: The results showed that the functions in all areas studied were lower in case group than the control group, although in most cases represent normal values according to scale (53% had normal development medium, 29% normal low, 9% much inferior 6% normal high and 3% inferior). Most children with ADHD (88.3%) achieved negative ages (average -12.8 months) in the difference general motor age and chronological age. In the control group, the average of negative age was equal to 3.9 months and occurred in 53.1% of the sample. Statistically signicant differences between groups in general motor age (p = 0.004), general motor quotient (p \0.001), balance (p = 0.008), spatial organization (p \0.001), ne motricity (p = 0.009) and gross motricity (p = 0.008). Conclusion: The ADHD combined type patients usually have problems in psychomotor performance. Knowledge about the psychomotor prole of these children may assist in determining treatment proposals in order to minimize losses in their quality of life.

P-12-02 The relation between cognitive empathy, beliefs about aggression and proactive aggression in children and adolescents with disruptive behaviour disorders L. Su*, Y. P. Ooi, R. P. Ang, S.-J. Weng, J. C. Liu, A. Raine, D. S. Fung * Singapore, Singapore Objective: Existing literature has reported signicant relationships between empathy, beliefs and aggression. Empathy has also been discussed as a multi-dimensional construct, where individual components may have different effects on aggression. In this study, the relationships between cognitive empathy, beliefs about aggression, and proactive aggression were examined. Method: Participants were 101 patients aged 916 from a child psychiatric clinic in Singapore, diagnosed with disruptive behaviour disorders (DBD), i.e. ADHD, CD and ODD, through the Computerised Diagnostic Interview Schedule for Children (C-DISC). As part of a larger, ongoing study, participants completed the Normative Beliefs about Aggression Questionnaire (NOBAG) (Huesmann & Guerra, 1997), Cognitive-Affective-Somatic Empathy Scale (CASES) (Raine, 2009) and Reactive-Proactive Aggression Questionnaire (Raine et. al., 2006). Linear regression and correlational analyses were conducted to examine the relationships between beliefs about aggression, cognitive empathy and proactive aggression. Results: Stronger beliefs about aggression was found to signicantly predict higher proactive aggression, b = .26, t (86) = 2.58, p \ .05. Higher cognitive empathy also signicantly predicted higher proactive aggression, b = .25, t (86) = 2.44, p \ .05. Beliefs was not signicantly correlated to cognitive empathy, r (103) = .06, p [ .05. Conclusion: The nding on beliefs predicting proactive aggression is consistent with existing literature, further supporting the use of cognitive-behavioural therapy (CBT) programmes that target change of aggressive beliefs. Contrary to previous ndings, higher cognitive empathy was associated with higher proactive aggression. Higher cognitive empathy may indicate a higher capacity to understand and manipulate the thoughts and feelings of others, which is typical in individuals carrying out proactive-aggressive acts such as bullying. By targeting different dimensions of empathy, effectiveness of

Friday, 27 May 2011, 14.3016.00 P-12 Pathophysiology: Children and adolescents I

P-12-01 Psychomotor prole of children with Attention Decit Hyperactivity Disorder combined type J. Goulardins*, E. Barbante Casella, J. Marques, M. Periotto, S. Pacheco, T. Freire, U. Reed * Sao Paulo, Brazil Objective: The aim of this study was to determine the psychomotor prole of children with ADHD combined type. Method: The case group consisted of 34 boys, aged between seven and 11 years, with the diagnosis for ADHD combined type, without comorbidity (except oppositional deant disorder) and virgin of


140 interventions may hence be improved. Also, non-signicant correlations between cognitive empathy and beliefs about aggression have clinical implications on CBT programmes that assume co-existence of beliefs and empathy issues. and the BRIEF (Behavior Rating Inventory of Executive Function) to complete data on information processing. Results: The comparative analysis shows, in terms of information processing, that the control group achieves higher scores in both the overall K-ABC and, the existence of a greater difculty in sequential processing in students with ADHD.The inattentive group show difculties in simultaneous processing of the information, too. Conclusion: We suggest that is necessary to be able to carry out an accurate early diagnosis al school level, especially for those students in the inattentive ADHD group and that there is evidenve of the need to implement differential learning and strategies.

P-12-03 Motivation and interference control in children and adolescents with Attention Decit Hyperactivity Disorder: A research plan I. Ma*, K. H. Putnam, A. Scheres * Nijmegen, The Netherlands Objective: Decits in executive function domains and an altered reward sensitivity are typically thought to be main underlying causes associated with symptoms of ADHD. Most studies have focused on one of these two decits separately. However, daily life often requires one to inhibit responses to stimuli with a certain valence. Therefore, in order to create executive function tasks with a higher ecological validity, we propose the use of stimuli of varied valence. We hypothesize that effect sizes of AD/HD-control differences will increase when such valence manipulations are applied in AD/HD studies. Method: Methods/research plan: Participants aged 9-17 will be included, consisting of three groups (AD/HD-I, AD/HD-C and healthy controls), n= 36 per group. The motivational Stroop task will consist of two conditions, using words related to 1.reward and 2.punishment. The emotional Stroop task will also have two conditions with words related to 1.happiness and 2.anger. Neutral control words will be matched for length and word frequency. Results: Two pilot studies conducted at the University of Arizona have shown that stimuli with a positive valence (words related to reward) indeed caused a higher interference effect, compared to matched neutral words, in a motivational Stroop task. This effect was exacerbated in children and adults with higher levels of AD/HDrelated behaviours. To a lesser extent, negative valence words facilitated interference control.

P-12-05 Children with ADHD show the same pattern of impairment in working and long-term memory S. Rhodes*, J. Park, S. Seth, D. Coghill * Glasgow, United Kingdom Objective: While extensive evidence shows that children with Attention Decit Hyperactivity Disorder (ADHD) show impaired working memory (WM), very limited focus has been given to longterm memory (LTM) functioning. Neuropsychological case dissociations between WM and LTM suggest that WM impairment does not necessarily indicate LTM difculties. The aim of the current study was to determine if children with ADHD show impaired LTM. Verbal and spatial aspects of LTM were examined to ascertain if the well established verbal/spatial WM dissociation in children with ADHD, with greater impairment observed on spatial than verbal tasks, also extends to LTM. Method: Twenty-one drug-nave boys with ADHD (mean age: 9.5) were compared with 26 age matched typically developing (TYP) boys. All ADHD children had undergone comprehensive diagnostic assessment. All children performed verbal and spatial STM and executive WM component tasks. They also completed verbal and spatial LTM recognition and free recall tasks from the CANTAB neuropsychological battery. Results: Children with ADHD showed impaired WM and LTM, but impairment was greater in spatial than verbal functioning across WM and LTM tasks. Verbal WM impairment was selective to an executive WM task and there was no evidence of impairment on verbal LTM tasks. Conclusion: Children with ADHD show impaired LTM, in addition to their well documented WM difculties. Dissociation between verbal and spatial LTM mirrors the pattern of functioning observed on WM tasks showing that spatial memory impairments are a key cognitive feature of ADHD. As verbal and spatial aspects of memory are related differentially to the learning of academic subjects (verbal to literature based subjects and spatial to mathematics and science based subjects) the ndings have implications for educational learning.

P-12-04 The differential aspects of cognitive proles of students with Attention Decit Hyperactivity Disorder ` A. Mies*, A. Fornieles, E. Jurado, M. Quintana * Bellaterra, Spain Objective: The purpose of this study is to analyse the cognitive processes involved in information processing of children with ADHD and to compare them with students of the same age who do not have a manifest disorder. The main objectives are based on assessing the performance in planning and sequencing tasks, and detecting differences and similarities between both groups, according to the results of previous studies in which the scores obtained by students with ADHD tend to be lower in planning, attention and sequential processing (Perez Alvarez and Timoneda, 2001; Fernandez Dean and Dean, 2004). Method: The study sample involves 23 boys and girls ages 8 to 10 years old with ADHD enrolled in public and charter schools and 23children of the same age and academic level without a specic disorder, belonging to the same schools as the study sample. To develop the cognitive proles participants in both groups have made various subtests of the K-ABC (Kaufman Assessment Battery for Children) relating to the type of processing and academic knowledge.There have also administered several questionnaires to the parents such as the SNAP- IV (Swanson, Nolan and Pelham Questionnaire), to classify participants according to the subtype of ADHD,

P-12-06 Higher order theory of mind in preschool boys at risk of ADHD M. Wozniak-Prus*, E. Pisula * Warszawa, Poland Objective: Difculties with impulse control, attentional capacity and hyperactivity hinder social development. Unfortunately only few studies have been conducted on the social problems of preschoolers at risk of ADHD and our knowledge concerning antecedents of social


141 impairments in hyperactive and inattentive children is limited. One of the posssible explanations is impairment in mentalising skills, but the results of previous studies were inconclusive. The aim of the study was to investigate potential delays in the theory of mind development especially in understanding of emotions and intentions and falsebelief understanding. Method: Participants were 30 boys at risk of ADHD aged 4,56 years and aged-matched control boys. Verbal ability and non-verbal intelligence were controlled. The development of a higher order theory of mind and understanding of emotions were measured by two picture stories. First tells a story of a boy who needs to seek his toy and a subject was asked to answer questions concerning second-order false belief understanding and understanding of emotions and intentions. In the second story a problem of a girl in an unexpected situation has been described. Children were asked to explain the situation and feelings of the character. Results: Statistical analyses concerning between groups comparisions were performed. There were no signicant differences between the groups on the advanced theory of mind measures. Although boys at risk of ADHD explanations about what had happen were fewer positive than control boys. Boys at risk of ADHD had also more problems with answer they refused answering the questions more often than control boys. Conclusion: Outcomes indicate that there is no delay in the theory of mind development in the group of preschoolers at risk of ADHD, but they show different prole of mentalising skills. P-12-08 Working memory decits in Attention Decit Hyperactivity Disorder K. Knight*, A. Scheres * Boulder, USA Objective: Decits in Working Memory are commonly associated with Attention Decit Hyperactivity Disorder (ADHD) and a number of studies have specically implicated updating of working memory. Some research has suggested that the cognitive decits seen in the inattentive subtype vs. the combined subtype might be signicantly different. Therefore, this study assessed the association between various aspects of visuospatial working memory, including updating, and symptoms of inattention and hyperactivity/ impulsivity. Method: This study included 60 adolescents aged 12-17 with varying levels of inattentive and hyperactive/impulsive symptoms, including typically developing controls, ADHD-Inattentive Type (ADHD-I), and ADHD-Combined Type (ADHD-C). To test working memory, we used a visuospatial working memory task in which working memory load varied from a series of 2-9 memory stimuli. At each difculty level, there were the following conditions: no delay or distracter; delay only; distracter only; delay plus distracter. The distracter and delay trials were intended to distinguish between updating vs. maintenance of working memory. The dependent variables for this task are the highest number of correct responses in each condition: (1) no delay, no distracter; (2) delay, no distracter; (3) distracter, no delay; (4) delay and distracter. Results: Preliminary results of 25 typically developing controls and 20 participants with ADHD-I indicated the following: (1) the task manipulation worked: especially on trials with a distracter AND a delay, participants has lower scores than on the other trials; (2) the decrement in working memory performance due to the presence of distracters was larger in the ADHD-I group than in the control group; (3) the decrement in working memory performance resulting from the presence of delays, on the other hand was the same for the ADHD-I and the control group. Conclusion: These preliminary ndings suggest that ADHD-I may be characterized by a specic working memory decit in updating, but not in maintenance.

P-12-07 Sensory processing prole in children with Attention Decit Hyperactivity V. Tiemi Shimizu*, M. Carolina Miranda * Guarulhos, Brazil Objective: The purpose of this study was to assess the sensory processing in children with Attention Decit Hiperactivity (ADHD) based on Sensory Prole (SP), a parent-reporting measure of childrens sensory processing and modulation, besides behavioral and emotional responses in daily life. Method: The clinical group was composed by 37 children from 6 to 11 years old (30 M and 7 F) with a primary diagnosis of ADHD excluding children with neurological disorders (e.g., pervasive developmental disorder, epilepsy, brain lesions, syndromes or prematurity) with intellectual disability and using psychotropic medications or stimulants to treat ADHD. The ADHD group was matched to the control group by age, gender and socio economic conditions, excluding children with signs of hyperactivity/inattention or other development disorders. The sensory responses from both groups were compared by Mann-Whitney U tests and the associations between the Sensory Prole and Child Behavior Checklist (CBCL) scores were examined by Pearson correlation coefcients. Results: Children with ADHD demonstrated statistically signicant differences from children without ADHD in their sensory processing and modulation, besides behavioral and emotional responses as reected in 11 out of 14 section scores (ps\ .0018) and on their sensory responses as reected in 6 out of 9 factors scores (ps\ .001). Scores on the Sensory Prole indicated statistically signicant moderate correlations (r =.30-.49) with scores on the CBCL. Conclusion: The ndings of the present study indicate that children with ADHD may have decits in sensory processing contributing to the impairment in adaptive functioning, including behavioral responses and learning, suggesting the sensory processing as a dimension also being considered and studied as part of the symptomatology of ADHD.

P-12-09 Working memory performance of children with ADHD versus clinical controls J. Lemiere*, E. Rymen, J. Dillen, M. Danckaerts * Gingelom, Belgium Objective: A number of meta-analyses have demonstrated that children with ADHD exhibit signicant working memory (WM) problems. The strongest effect size was found for visuospatial working memory. The aim of the present study was to investigate the sensitivity and specicity of WM problems in a clinical referred sample of ADHD children. Method: Subjects were recruited from the multidisciplinary ADHD outpatient clinic and parents gave informed consent. Exclusion criteria were mental retardation and neurological problems. 170 subjects underwent a comprehensive child psychiatric investigation. This consisted of a standardized protocol: semi-structured interview, Child behaviour checklist, social communication questionnaire, Highfunctioning autism spectrum screening scale. The working memory tasks consisted of a digit span task (from children memory scale) and a visuospatial span task (from the working memory battery test for children). 99 children received a diagnosis of ADHD, 27 another DSM-IV diagnosis, 44 no DSM-IV diagnosis MANOVAs were


142 conducted to test whether the ADHD group performs worse than the clinical control group. Results: No group differences were found, but the scores for the total group were signicantly below the average score from the general population. Post hoc analyses demonstrated some differences between the 3 groups. Additional analyses are planned to investigate the role of age, sex, comorbidity. Conclusion: The preliminary results of the present study suggest that WM problems are present in a clinical referred sample, irrespective of the type of diagnosis. These results and additional data will be presented. assessment involved 205 children aged 7 to 14 referred to NANI at UNIFESP with complaints of attention difculties and/or hyperactivity. Method: They were assessed by a multidisciplinary team and a battery of neuropsychological tests: DSM-IV criteria, Continuous Performance Test (CPT), ve subtestes from Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Results: 116 children (88 M and 28 F) fullled the criteria for ADHD, among which 45 were of the inattentive type, 59 of combined type and 12 were hyperactive/impulsive. There was negative correlation between the digit score and the Corsi test, especially in reverse order. Children with high scores for hyperactivity and impulsivity had a low performance for functional memory. Children with oppositional deant disorder presented pattern changes in adaptability when there was a change in the rhythm the stimuli were presented and lower adaptation to time variability (Hit RT), in addition to higher rates of omission in the CPT. Conclusion: This study suggests multiple interrelations between the scores of neuropsychological battery, which are useful for a more detailed delimitation of the clinical prole of children with ADHD in order to select better approaches in a cognitive rehabilitation program.

P-12-10 Analysis of affective disorder in children with Attention Decit Hyperactivity Disorder - ADHD by Rorschach Test R. Figaro*, C. A. Araujo, M. Muszkat, M. C. Miranda, S. Rizzutti, S. M. M. Palma, L. F. Coelho, F. Dias, O. F. A. Bueno * Sao Paulo, Brazil Objective: This study investigated the affective characteristics of children with Attention Decit Disorder and Hyperactivity Disorder (ADHD) combined type (study group) after neuropsychological assessment and multidisciplinary, comparing them to children who had no disorder (control group) by the Rorschach Test, as the Exner Comprehensive System. Method: The groups were composed of 30 children between 6 and 10 years of age. In the study group participated 93.3% of male children and 6.7% of female and in the control group 86.7% were female and 13.3% male. We applied the descriptive quantitative methodology, using the theoretical framework of Analytical Psychology, to draw inferences about the emotional development of children with ADHD. We evaluate the variables of Affect Module, including the variables Lambda, Note D and Adjusted D (ADJ D), experience-based (eb), style of living extratensive (EB), that compose the Module of Control and Stress Tolerance and Positive Constellations, which may indicate the presence of psychiatric disorder. The answers were classied and coded by three judges. A comparison between groups was analyzed statistically with t test for independent samples and Fishers test for dependent samples. Results: The disorder group showed greater susceptibility to depressive disorders, difculties in inhibitory control related to permanent stress, intense ideational activity, undermining the processes of attention and concentration when compared to control group. Conclusion: Children with ADHD have affective characteristics that distinguish them from others regarding the ability to feel pleasure. Invaded by unpleasant and painful feelings, have insufcient resources to manage psychological stress. They experience feelings of loss of control that affect the course of deliberate thoughts, ideations intense activity taking place, which creates discomfort and interfere with attention and concentration. This study suggests that treatments include strategies to alleviate the emotional pain that they present.

Friday, 27 May 2011, 14.3016.00 P-13 Pathophysiology: Children and adolescents II

P-13-01 Symptoms of Attention Decit Hyperactivity Disorder in children: Differential effects on response inhibition? L. Srensen*, J. Plessen, S. Adolfsdottir, E. Wehling, A. J. Lundervold * Bergen, Norway Objective: Children with Attention Decit Hyperactivity Disorder (ADHD) have problems inhibiting responses, which predominantly seem to be inuenced by symptoms of inattention (Willcutt et al., 2005). The concept of response inhibition, however, comprises different subfunctions, also including interference control and behavioral inhibition (Friedman & Miyake, 2004; Nigg, 2000). The present study investigated if ADHD symptoms of hyperactivity/impulsivity and symptoms of inattention have a differentiated impact on these two subfunctions in children selected from a population-based sample. We hypothesized that symptoms of hyperactivity/impulsivity would show the highest contribution in explaining performance on tests of behavioral inhibition, whereas symptoms of inattention primarily would contribute to explain performance on tests of interference control. Method: A sample of 253 children aged 8 to 11 years participated in the Bergen Child Study. Children were tested on psychometric measures of response inhibition (i.e. behavioral inhibition: commissions score from Conners0 Continuous Performance Test II (CPT); Interference control: Interference score from Stroop Color Word Interference Test (Stroop) and Conict score from Attention Network Test (ANT)). In addition, parents of the children lled in a questionnaire asking of ADHD symptoms (according to DSM-IV symptom criteria for ADHD). Results: Multivariate effects of symptoms of inattention and hyperactivity/impulsivity were revealed. Symptoms of inattention showed a statistically signicant impact on the interference score from Stroop in the univariate analyses, whereas hyperactivity/impulsivity symptoms inuenced the commission score from the CPT and the conict score from the ANT.

P-12-11 Clinical and neuropsychological prole in a sample of children with Attention Decit Hyperactivity Disorders (ADHD) S. Rizzutti*, L. F. Coelho, S. M. Mota Palma, R. Figaro, D. Barbosa, F. Dias, M. Miranda, O. F. A Bueno, M. Muszkat * Sao Paulo, Brazil Objective: The aim of this study was to evaluate clinical and neuropsychological ndings in children with suspicion of ADHD. The


143 Conclusion: Findings in the present study supported the hypothesis that symptoms of hyperactivity/impulsivity contribute to problems in behavioral inhibition, whereas inattention contribute to problems in solving tasks measuring interference control. Method: Of all 55 ADHD children, 34 children was ADHD, combined type (ADHD-C), and 21 were ADHD, predominantly inattentive type (ADHD-I). Neuropsychological tests to measure cognitive function (WISC-R), executive functions (ROCF, CCTT, Stroop, WCST), and attention(CPT) were individually administered to children. And the estimated scores of those tests were calculated based on the age norm for each test. Results: There were no signicant differences in FSIQ, VIQ, and PIQ between the two groups. However, ADHD-I group tended to show higher scores on the subtest of Coding. In terms of inhibition, there was no difference between two subtypes of ADHD children. But ADHD-I group showed higher prompt errors on CCTT-2 than ADHD-C group children. The ADHD-C group scored signicantly lower on cognitive exibility, but higher on planning scores in WCST than ADHD-I group. Conclusion: The ADHD-I children also have inhibition problems like ADHD-C children. The ADHD-C children have better planning ability, but have less cognitive exibility than ADHD-I children.

P-13-02 Selected executive functions in ADHD diagnosed children M. Dabkowska*, W. Chytra-Gedek, M. Mitros * Bydgoszcz, Poland Objective: The study evaluated a selection of cognitive functions in ADHD diagnosed children in relation to age and gender and to anxiety disorder diagnosed children. The examined group was composed of 29 children with ADHD. The majority of children were boys - 22 and only 5 girls. Among 29 children, the diagnosis of the combined subtype ADHD was the most frequent 86%, only 14% of the predominantly inattentive subtype. The same cognitive functions in ADHD diagnosed children were compared to results of neuropsychological tests in 43 anxiety disorder diagnosed children (26 boys and 17 girls). Method: I. Neuropsychological evaluation: TMT A&B (Trail Making Test A & B) and Stroops Test (Colour-Word Perseveration Test). Trail Making Test comprises two parts. Part A evaluates psychomotor speed, and part B examines visuospatial working memory and set-shifting ability after learning one rule of conduct. Good visuomotor coordination is an advantage. Tests result is provided in seconds (tasks are timed). Stroops Test is used to assess verbal working memory and attention span and comprises two parts: RCnb (reading colour names in black) and NCWd (naming colour of word-different). The test assesses perseveration and during its second part a previously studied criterion needs to be neglected and substituted with a novel criterion, with the former one still present. Tests results are based on completion times of parts one and two, and on the number of perseveration mistakes made during part two. II. Evaluation of presence and intensity of ADHD: ADHD was diagnosed in agreement with the DSM IV TR research criteria. The parents evaluated the intensity of particular symptoms of the Attention Decit Hyperactivity Disorder by means of the ADHD Rating Scale questionnaire IV version for parents. Results: Analysis of results indicates that children with ADHD need signicantly more time to perform NCWd part of Stroop Test and B part of TMT. The results did not reveal signicant differences in selected neuropsychological tests performance between the boys and the girls with ADHD. ADHD younger subjects performed worse on the Stroops Test and TMT A&B; younger age correlated with longer completion time of tests. Conclusion: Selective cognitive functions signicantly distinguish between children with ADHD and children with anxiety disorders. In the research on children with ADHD the use of tests and neuropsychological trials designer for evaluation of executive functions is justiable.

P-13-04 Visuospatial abilities in children with and without Attention Decit Hyperactivity Disorder H. Alizadeh*, S. Dehghan Manshadi * Birjand, Iran Objective: This study examines visuospatial ability in children with and without Attention Decit Hyperactivity Disorder (ADHD). Also, a comparison was done on the ADHD subtypes and the visuospatial abilities. Method: In this causal-comparative research, through a cluster random sampling technique, 80 students ageing 8 to 10 (60 with and 20 without ADHD), were recruited. In the ADHD group, 20 children were Inattentive subtype, 20 were hyperactive-Impulsive subtype, and 20 were Combined subtype.Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (2000) criteria for ADHD diagnosis, and Kohs Blocks Design Test for visuospatial abilities, were utilized to collect the data. Results: One-way ANOVA revealed a signicant difference between the two groups of with and without ADHD. Furthermore, a signicant difference was found among the subtypes. Conclusion: Accordingly, we can suggest that weaker visuospatial abilities in ADHD children may be related to their nonverbal problems, and be helpful for intervention programs.

P-13-05 A comparison of childrens attention and cognitive function across noise conditions a randomized controlled study S.-Y. Bhang*, J. Lee, C. Lee, J. Yoon, C. Shim, J. Sung * Ulsan, Republic of Korea Objective: The purpose of this study was to investigate the impact of environmental noise on attention and cognition in elementary school students while controlling for various confounders. Method: From November 15th, 2010 to December 8th 2010, 268 students from three elementary schools (135 boys, 133 girls, 10-12 years old) in Ulsan city, Republic of Korea were enrolled in this study. With respect to experimental design, we divided the students into two groups: 1) Noisy environment group (N) was given an additional 15-17 dB compared with the ambient background noise in the school; 2) Control environment group (C) was given background noise as existed in the school.We used the abbreviated form of the Wechsler Intelligence Scale for Children, the Stroop Color-Word Test

P-13-03 Comparison of neuropsychological functions in subtypes of children with ADHD M.-S. Shin*, J.-K. Ahn * Seoul, Republic of Korea Objective: This study was conducted to investigate differential characteristics of neuropsychological functions, especially in executive functions between subtypes of ADHD.


144 (STROOP), the Childrens Color Trail Test (CCTT), and a computerized continuous performance test (CPT). Results: After adjusting for socio-demographic covariates, multiple general linear regression analysis showed that noise exposure was signicantly and negatively associated with CPT scores: 1) the response time on the auditory selective attention test (85.19 for C group vs. 91.51 for N group, p=0.007), 2) the omission error and response time on the divided attention test (92.98 for C group vs. 86.01 for N group, p=0.034; 98.84 for C group vs. 104.72 for N group, p=0.047; respectively), and 3) the forward memory span and forward correct response on the spatial working memory test (96.80 for C group vs. 91.42 for N group, p=0.045; 95.21 for C group vs. 89.23 for N group, p=0.020; respectively). Also, the full-scale IQ scores (116.71 for C vs. 109.68 for N, p\0.001) and verbal IQ scores were negatively associated with the existence of experimental noise. On the CCTT and STROOP tests, CCTT-1 total time (20.51 for C group vs. 22.50 for N group, p=0.021) and word score (50.82 for C group vs. 48.22 for N group, p=0.030), which both represent reading speed, were negatively associated with the experimental noise, respectively. Conclusion: Thus, it is suggested that noise (more than 15 dB higher than background) is hazardous to attention and performance in elementary school students. Further study of the broad line level of noise is needed with respect to the positive effect and negative impact on cognitive function. support visual attention (e.g., exposure time, color and valence intensity) on REFE in children with ADHD. We hypothesized that attention-supported exposure conditions would enhance REFE in children with ADHD to the level of the controls. Method: A cross-sectional study with repeated measures in two contexts (N=79, 2/3 males, aged 15 2.5 y, typical IQ) compared REFE performance of children with ADHD and controls as a function of three independent factors: color [natural colors (C) vs. black & white (B&W)], exposure time (200 ms vs. 600 ms) and valence (low, moderate, high). 96 stimuli from 6 emotions: happy, sad, worried, angry, surprised, and disgusted (Matsumoto et al., 2000) were randomly displayed in 2 genders, 2 colors and 2 exposure-time conditions. Additionally, 36 comparable stimuli were presented in 3 valence levels. Results: MANOVA with repeated measures showed that children with ADHD erred more frequently on the least supported condition (B&W-200 ms, p\0.001) and on the low and moderate intensity stimuli (ps\0.05); Effects sizes rose from 2% in the C-600 ms condition, to 9% for B&W-200 ms. They also took longer to respond to most conditions (B&W, Low and high valence (ps\0.05) and C-600, p\0.001). For the most part there were no specic emotion ndings, indicating attention-bias rather than specic emotion insensitivity. Regression modeling showed that reaction times were positively related to Achenbachs social problems index in children with ADHD (p\0.05). Conclusion: Data support the relations between speed of social information processing and social adaptation in ADHD. Results may contribute to the development of a REFE-based intervention to improve interpersonal relations in children with ADHD.

P-13-06 Neuropsychological functioning in clinical subtypes of drug nave girls with Attention Decit Hyperativity Disorder C. Paloscia*, R. Alessandrelli, C. Rosa, A. Pasini * Rome, Italy Objective: Very little is known about the neurocognitive functions of young females with Attention Decit Hyperactivity Disorder (ADHD). This study examined the relationship between attentionexecutive impairment and clinical subtypes of ADHD in a sample of young girls. Method: The research included 30 girls with ADHD between the ages of 7 and 14 and 35 controls in the same age range. All subjects performed both a clinical-psychopathological and a neuropsychological test battery. Five main domains of executive functions (EFs) and attention were studied. Executive function-related neurocognitive abilities were used as control tasks. Results: All ADHD patients and inattentive and combined subtypes differed from controls regarding response inhibition, divided attention, working memory and planning. Comparison of ADHD subtypes in ve main EF domains showed no evidence of different executive function proles. Conclusion: Data revealed that girls neuropsychological prole was comparable to boys. In particular, our results conrm that in young females there is no difference in neurocognitive performance between ADHD combined and ADHD inattentive subtypes.

P-13-09 Investigation of the relationship between executive functions and theory of mind in Attention Decit Hyperactivity Disorder H. Slama*, P. Mousty, P. Peigneux, I. Massat, A. Mary * Brussels, Belgium Objective: Besides behavioural symptoms, Attention Decit Hyperactivity Disorder (ADHD) characterizes by cognitive impairments, mainly in attentional and executive functions (EFs), and socio-emotional difculties possibly linked with decits in Theory of Mind (ToM). In this study, we probed the relationship between ToM and EFs in ADHD. Method: Twenty-two children with ADHD (8-12 years, IQ[85). and twenty seven matched healthy controls participated in this study. Assessment and differential diagnosis were carried out using the Kiddie-SADS and the DSM IV criteria. We assessed ToM with two tasks involving different levels of executive control: the Reading the Mind in the Eyes (RME) task (low executive demands), and the Faux Pas (FP) task (higher executive demands). Participants were also administered a large cognitive battery, mainly assessing EFs (inhibition, planning and exibility), working memory (WM) and attention. ANOVAs, Pearsons correlational analyses and linear regression analyses were performed on behavioural data. Results: ADHD children showed impaired performance as compared to controls in WM, attention and EFs. Concerning ToM, ADHD children performed more poorly than controls in FP task (F(1,47)=5.49, p=0.02) and in RME task (F(1,48)=6.57, p=0.01). Pearsons correlational analyses were computed between ToM and EF in our 2 groups. In the control group, ToM was correlated with tasks involving WM, attention, exibility and inhibition. In the ADHD group, ToM was correlated with tasks involving WM, attention, inhibition, planning and exibility. Linear regression analyses in ADHD group indicated that FP task was best predicted by inhibition, exibility and planning and RME task by exibility and attention.

P-13-08 Attention supporting conditions enhance recognition of emotional facial expressions (REFE) in children with ADHD R. Geva*, D. Tamari * Ramat Gan, Israel Objective: Interpersonal deciencies are a central component of ADHD. Perceptual decits in recognition of emotional facial expressions (REFE) have been recently proposed as the mechanism involved. The aim was to examine the effect of conditions that


145 Conclusion: Our results yield evidence for ToM decits in ADHD children. Correlation and regression analyses suggest a close link between performance on ToM and EFs tasks, but also with attention. Altogether our results corroborate the hypothesis of ToM alterations in children with ADHD possibly linked with EFs decits, which may contribute to the socio-emotional difculties frequently experienced in this population. and interaction. The difference in combined l scores was signicant at one tail. For the paper and pencil dual-task were not found signicant effects. The signicant test-retest reliability was found for the computerised and paper and pencil l scores and correlation between two types of tasks. Conclusion: The dual-task coordination is available in children/ adolescents with ADHD in general and in its subtypes as in age and years of education matched NC.

P-13-10 Fluency strategies in ADHD: language-based compensatory behavior in task solving A. Takacs*, A. Kobor, Z. Tarnok, V. Csepe * Budapest, Hungary Objective: Fluency tasks (verbal and nonverbal) are commonly used in cognitive and developmental neuropsychology in assessing executive functions, language skills or divergent thinking. The current Attention Decit Hyperactivity Disorder (ADHD) research produces ambiguous results when uency tasks are used. However, the additional use of qualitative (switching, clustering and complexity) scoring may clarify the possible background of various achievements indicated so far. Method: 22 typically developing children and 22 children with ADHD (8-12 years old) were examined by using the Verbal Fluency and Design Fluency tasks of NEPSY-I (Hungarian version, used by permission for research purposes only) and other neuropsychological measurements. Results: The main difference between the two groups was found in the subjects performance time that related to difculties in strategy using; where children with ADHD had a time lag in applying relevant lexical or executive strategies. However, when agglomerative hierarchical cluster analyses was performed, a compensating group performing better in the Verbal Fluency task was identied. This advantage could not be used whenever the relevant language skills were not available to solve the test, so that children with ADHD could not lean on compensatory mechanisms. Conclusion: Our results underline the impact of cognitive approach on developing and using complex neuropsychological tasks including language-based components relevant in the clinical diagnostics of ADHD. A better detection of compensatory mechanisms playing a possible role in overcoming the decit is crucial. It is of particular importance to know all those atypical but efcient ways in problem solving (not just in the uency tasks) that are usable in treatment relying on effective and complex methods. However, further studies are needed to nd the latent factors contributing to compensation present in the performance of ADHD children.

P-13-12 A qualitative study on the effects of silently-whispered and/or softly-pronounced vs loud and serious verbal instructions during occupational therapy sessions on an iranian sample of children with Attention Decit Hyperactivity Disorder S. Nakhai*, F. Behnia * Tehran, Iran Objective: Research shows that children with Attention Decit Hyperactivity Disorder (ADHD) nd it hard to ignore environmental sounds and are easily distracted by them when doing a task, while the effects of task-relevant sounds have barely been studied. We compared silently-whispered and/or softly-pronounced verbal instructions to loud and serious ones during occupational therapy(OT) activities for ADHD children to see whether task-relevant sounds (here, therapists voice) could also have negative effects on the symptoms. Method: 24 ADHD children referred to the OT clinic by child psychiatrists received OT, half of them with silently-whispered and/or softly-pronounced verbal instructions (G1=12) while the other half with normally loud and serious verbal instructions (G2=12). Their parents joined family group discussions once every three sessions. During family discussions the childs problems and improvements were discussed. After 20 sessions a nal family group discussion was held to see if the parents of the two groups reported any difference. we also asked the psychiatrists their professional opinions about each child. Results: According to parents, both groups improved but G1 showed more improvement than G2. They showed wider attention spans and higher concentration levels. G1 parents reported more purposeful and adaptive behaviors, ability to follow instructions, obeying rules, selfentertaining with functional activities for a longer time, more concentration while doing homework, decrease in impulsive behaviors and emotional overreactions. The psychiatrists were satised with improvements of both groups, but were specically pleased with G1s improvements and in some cases lowered or stopped the medication dosage for G1. Conclusion: This study shows that not only environmental (taskirrelevant) sounds but also task-relevant ones could negatively affect ADHD children. Although further research is necessary, but our results could open new doors to therapeutic techniques for ADHD children, like suggesting parents, teachers, and therapists speak softly and quietly to them with lower than normal voice.

P-13-11 Is dual task coordination available in ADHD? K. Inasaridze*, V. Bzhalava, L. Chikvaidze * Tbilisi, Georgian Objective: The study aimed at dening the dual-task performance in control and ADHD children on the computerised and the paper and pencil dual-task methods. Method: The 6-16 years old 91 controls and 91 ADHD children matched on age, years of education and WISC-III were studied. The ADHD and its subtypes have been diagnosed with the DSM-IV. The computerized and paper and pencil (Tbilisi paper and pencil motor task) versions of the dual-task were used. Results: For the computerized tracking task there was signicant effect of type of task, of group and interaction. For the List Memory Task was found signicant effect of type of task, no effect of group

Friday, 27 May 2011, 14.3016.00 P-14 Pathophysiology: Adults I

P-14-01 Self-report of executive function decits and self-concept in adults with ADHD R. Drechsler*, P. Rizzo, H.-C. Steinhausen * Zurich, Switzerland


146 Objective: A positive illusory bias in the perception of difculties has been reported by several studies for children with ADHD. Whether self-report on cognitive functioning is biased or realistic in adults with ADHD, is still matter of debate. Method: Adults with ADHD and normal control subjects, matched pairwise for age, gender and profession, completed self-report questionnaires on executive function decits (Dysexecutive Questionnaire DEX) and on self-concept (Frankfurter Selbstkonzeptskalen FSKN). ADHD patients and controls were also rated on the DEX by a signicant other. Results: Adults with ADHD rated themselves as signicantly more impaired in executive functioning than controls. Compared to ratings by signicant others, self-reports of adults with ADHD were accurate or tended to over- rather than to underestimate executive function decits. This tendency was also found in controls. Although adults with ADHD displayed generally more negative self concepts than controls, their ratings of emotional and interpersonal facets of selfconcept were unrelated to self reports on executive functions. In control subjects, in contrast, these facets of self-concept were correlated with self-report on cognitive failures. Conclusion: Adults with ADHD seem to perceive cognitive problems in everyday life adequately. Their cognitive complaints appear unrelated to general negative self concept. This does not support the assumption of a general positive illusory bias in adult ADHD. P-14-02 Utility of the INECO Frontal Screening (IFS) for the detection of executive dysfunction in patients with adult ADHD and bipolar disorder B. Sandra*, E. Gleichgerrcht, H. Urquina, A. Lischinsky, M. Roca, F. Manes, T. Torralva * Buenos Aires, Argentina Objective: Adult Attention Decit Hyperactivity Disorder (ADHD) and bipolar disorder (BD) share several clinical symptoms and present high rates of comorbidity. Cognitive difculties in both disorders are mostly present in the executive domain. The detection of executive dysfunction usually requires the administration of an extensive neuropsychological battery, as there are few screening tests specically designed to evaluate executive functions. The INECO Frontal Screening (IFS) is a solid and brief tool, which has proved useful for the assessment of the executive functions in patients with dementia. The aim of this study was to assess the utility of the IFS to detect executive dysfunction in ADHD and BD patients. Method: 20 ADHD patients, 20 BD patients and 26 controls (matched for age, sex and years of education), were assessed with a neuropsychological battery that included the IFS and classical executive tests. Results: Both clinical groups showed signicantly lower scores than controls on the IFS total score and on the spatial working memory subscale. Performance on the abstraction capacity subscale was signicantly lower in ADHD compared with controls. The IFS total score correlated signicantly with several executive tasks (phonological uency task, Trail Making Test- B, digits backward span, letters and numbers sequencing, arithmetic and commission errors on Go- no go task). Conclusion: The IFS is a solid and useful tool for the detection of executive dysfunction in ADHD and BD patients. P-14-03 Classication of ADHD and healthy control adults using event-related potentials and independent component analysis A. Muller*, G. Candrian, J. D. Kropotov, G. M. Baschera, V. Arntsberg Grane, V. Ponomarev * Chur, Switzerland Objective: In the context of sensory and cognitive-processing decits in ADHD patients, there is considerable evidence of altered eventrelated potentials (ERPs). Most of the studies, however, are limited to group differences in children. By means of independent component analysis (ICA), ERPs can be decomposed into functionally different components. Using the classication method of support vector machine (SVM), this study investigated whether features of independent ERP components can be used for separating ADHD adults from healthy subjects. Method: Two groups of age- and sex-matched adults (75 ADHD, 75 controls) performed a visual two stimulus go/nogo task. ERP responses were decomposed into independent components by means of ICA. A feature selection algorithm dened a set of independent component features which were used for SVM classication. Predictive power of the SVM classier was validated using an independent sample of 17 ADHD adults from a different laboratory. Results: The feature set, composed of a combination of ve features with best classication performance, predominantly consisted of latency measures collected from four different independent ERP components. Using a 10-fold cross-validation approach, classication accuracy was 91%. Moreover, 94% of the independently diagnosed ADHD subjects were correctly classied as having ADHD. Amplitude and latency measures differentiating best between ADHD patients and non-clinical subjects primarily originated from independent ERP components associated with inhibitory and noveltyrelated processes. Conclusion: Classication by means of SVM on the basis of ERP data is feasible in the context of clinical groups. Furthermore, independent ERP components have been shown to provide features that can be used for characterizing ADHD adults. The project aims for a more objective diagnosis of ADHD in clinical work. As a next step, differential diagnostic categorization of patients is to be investigated.

P-14-04 Frequency and dental consequences of bruxism in adults with Attention Decit Hyperactivity Disorder (ADHD) M. A. Silva*, L. M. D. Aguiar, E. F. O. Firsoff, C. M. Agra, M. Louza, G. F. Vieira * Sao Paulo, Brazil Objective: To investigate the frequency and dental consequences of bruxism in adults with ADHD. Method: Thirty seven adults with DSM-IV criteria of ADHD were included; 20 males and 17 females, median age of 37.5 years (22 to 63 yo). All subjects were investigated for the occurrence of bruxism before they initiated the use of psychostimulants. The diagnosis of bruxism was established using questionnaires and clinical-dental examination (presence of worn facets, occlusal interferences, gengival regression, local dental pain, midline relationship, facial asymmetry, limitation of mouth opening, presence of disocclusion guides, presence of noises, muscle pain, and behavior of the condyle during mandibular movements). Results: The frequency of bruxism in the ADHD group was 97.3%. The most commom ndings were: worn facets (78.4%), dental grinding (78.4%), abfraction (67.6%), muscle pain (78.4%) and headache (51.4%). Conclusion: Bruxism is highly prevalent in the ADHD population, in comparison to the general population (8 to 20%)1,2. To prevent oral health problems related to bruxism, patients with ADHD should be referred to dentists. Dentists should also consider the possibility of ADHD in patients who present with oral signs and symptoms of bruxism. References: 1. Lavigne GJ, Khoury S, Abe S. et al. Bruxism physiology and pathology: an overview for clinicians.


147 J. Oral Rehabilitation, 2008, 35;476-494 2. Lavigne GJ. Neurobiological mechanisms involved in sleep bruxism. CROBM 2003, 14(1):30-46. investigated performance in the GDT after boredom induction in a subset of the sample. Differences in the behaviour inhibition (BIS) and behaviour approach system (BAS) as well as cognitive exibility were also assessed. Results: We found that patients with ADHD make risky decisions signicantly more often than the controls and selected the disadvantageous alternatives without using feedback propitiously. Their ctive money loss was higher than in the control group. After boredom induction such a difference between ADHD patients and controls was not longer signicant. Conclusion: Adult ADHD patients show signicant decits in decision making under risk. These decits mirror the disadvantageous daily decision-making behaviour and may be important for the outcome of patients with ADHD.

P-14-05 Neuropsychological assessment of executive functions and psychology prole in adult with ADHD B. Rubio*, J. Bravo, S. Hernandez, P. Gonzalez Perez * La Laguna, Spain Objective: ADHD in children is one of the most studied childhood disorders. However, there are relatively few studies of the clinical and neuropsychological prole of adults with ADHD. The aim of this study is to provide new insights in this area by studying the executive functioning and the psychological prole among a group of adults with ADHD and a control group. Method: Subjects: 9 adults with ADHD (Xage=29.78; SDage=8.51) and 9 healthy control subjects (Xage=29.33; Sdage=8.87) were evaluated. Materials: The neuropsychological set included: Paced Auditory Serial Addition Test (PASAT); Digit subtest (WMS-III) visual Span (WMS-III), Tower of Hanoi Test Stroop; Test of the Wisconsin Card Sorting (WCST); Controlled Oral Word Association Test (COWAT), Continuous Performance Test, Trail Making Test. The psychological prole was assessed by the Questionnaire of 90 Symptoms (SCL-90). A factorial design was implemented, with the independent variable Group (ADHD, Control) and the dependent variable test performance. Results: Differences in verbal working memory and sustained attention were found. Scores between both groups for the rest of the tests used to assess executive performance were similar. The psychological prole meassured by SCL-90 showed signicant differences beetwen both groups. Symptoms in all items except somatization were present in the ADHD group, but not in the control group. Conclusion: These results suggest that the ADHD subjects developed compensatory cognitive-behavioral strategies allowing normal performance in the executive functions that were assessed. However, these strategies appear to be insufcient to cope with real-life situations. The higher rates of psychopathology might partially explain the persistence of difculties arising from nuclear symptoms, where planning, problem solving and inhibition decits, might lead to the typical prole of personal, family and work problems in the course of their life.

P-14-07 Emotion regulation by the use of mindfulness instruction in adult Attention Decit Hyperactivity Disorder S. Matthies*, J. Svaldi, C. Sadohara, P. Borel, A. Philipsen * Freiburg, Germany Objective: Emotion dysregulation even though not a criterion of current ofcial diagnostic systems for Attention Decit Hyperactivity Disorder (ADHD), is since the publication of the Utah criteria by Wender a recognized and clinically important symptom of adult ADHD. The aim of this study is to investigate the impact of specic emotion regulation strategies on adult ADHD symptoms. Method: Thirty-nine adult participants diagnosed with ADHD und 35 age matched control participants were randomly assigned to one of two emotion regulation strategies. One group was instructed to apply suppression of the arising emotion; the other was instructed to apply mindfulness. Participants then watched a short sadness-provoking lm, and estimated current levels of subjective emotion-related ADHD symptoms (internal restlessness, boredom, irritability and emotional overow) as well as the intensity of the inducted emotion before, immediately after and two minutes after the lm using visual analog scales. In addition difculties in emotion regulation were assessed with the DERS (Difculties in Emotion Regulation Scale) to investigate the relation between emotion regulation difculties/preferences and the inducted sadness intensity as well as aforesaid symptoms. Results: First, ADHD patients perceived more difculties in emotion regulation than controls. Second, the ADHD symptoms in the ADHD group were intensied via sadness induction, but not in the control group. Third, the patients0 ADHD symptoms were reduced in the mindfulness condition after two minutes, whereas symptoms persisted in the group which applied suppression of emotions. Fourthly, a preference to suppress emotions was associated to persistence of ADHD symptoms after sadness induction in the ADHD group. Conclusion: In this study ADHD patients had more difculties in emotion regulation than controls. Emotion suppression was associated to sadness intensication and persistence of ADHD symptoms in the ADHD group. Mindfulness appeared to be an effective strategy for ADHD patients to regulate sadness and emotion-related ADHD symptoms.

P-14-06 Performance in the game of dice task in adults with ADHD S. Matthies*, J. Svaldi, C. Nober, A. Philipsen * Freiburg, Germany Objective: Risky decision making and disadvantageous choices are considered a core characteristic of patients with Attention Decit Hyperactivity Disorder. Fronto-striatal dysfunction as well as imbalances in catecholaminergic and dopaminergic pathways may be neurobiological correlates of impulsive namely risky decision making behaviour in these patients. To further understand these behaviours in adults with ADHD we wanted to experimentally assess decision making with the Game of Dice Task (GDT). Method: In this laboratory study, 29 adult patients with ADHD according to DSM-IV criteria and 29 control probands were compared in the GDT. The GDT is a well established decision-making task explicitly providing rules for gains and losses and feedback after each choice. The task assesses decision-making under risk. In addition we

P-14-08 Adult ADHD and sensation seeking T.-L. Austin* * Johannesburg, South Africa Objective: A study by Faraone, Kunwar, Adamson and Biederman (2009) provides some evidence that those who have been diagnosed with adult Attention Decit Hyperactivity Disorder (aADHD) show


148 specic personality traits, amongst which, novelty seeking, can, arguably, be seen as a characteristic of both sensation seeking and aADHD. Zuckerman maintains that sensation seeking, as a construct, is normally distributed in the population and that one may nd individuals on both ends of the spectrum (i.e. low and high sensation seekers), however, given the behavioural symptoms reported in aADHD one could argue that adults with ADHD would be more prone to high sensation seeking, or vice versa. The aim of this study was to establish whether levels of sensation seeking are higher in adults with ADHD than adults who do not suffer from ADHD. Method: 402 young adults (1825 years) were recruited by various means. All the participants were required to complete the following questionnaires: Internal Restlessness Scale (IRS), Current Symptoms Scale (CSS), Adult ADHD Self-Report Scale(ASRS), Wender Utah Rating Scale (WURS) and the Brief Sensation Seeking Scale (BSS). Results: The results of a multiple regression analysis that was performed on the data indicate that it is inaccurate to view ADHD as a single construct, and correlate this with sensation seeking. It was found that a history of ADHD in childhood, combined with a history of Oppositional Deant and Conduct disorders are the best predictors of sensation seeking. ADHD, in the absence of childhood conduct problems, has no signicant relationship with sensation seeking. Conclusion: The ndings, reported above, are promising as it seems as if there is a shared neurological substrate for sensation seeking and ADHD with conduct problems. Based on these results, the next step in this research will be to conduct an EEG study in order to look at the cortical arousal of the frontal lobe when participants are presented with specic stimuli, which may or may not elicit sensation seeking tendencies, in turn measuring their impulse control capabilities. Because there is a relationship between sensation seeking and ADHD, there may very well be correspondence in the brain structures that are involved, hence, the nal step will be to conduct an fMRI study in order to investigate the brain structures involved in both ADHD and Sensation Seeking physiological responses, lability/impulsivity, irritability, mistrust/ defensiveness, behavioral inhibition and explosiveness. The EBS is a 36-item measure of sensation seeking, including 4 subscales: Novelty, Thrill and Adventure seeking, Interpersonal and Romantic/sexual. Spanish- and English-language versions have been validated in crosscultural studies in Puerto Rico and Australia. Results: Correlations among the subscales of the WURS, the EE and EBS are examined to clarify how the specic dimensions of reactive inhibition, emotional regulation and ADHD symptoms and behaviors are related to each other. Conclusion: Clinical and research implications are discussed.

P-14-10 Emotional reagibility and working memory performance - differential effects of emotional interference control in subjects with and without ADHD I. Marx*, G. Domes, C. Havenstein, C. Berger, L. Schulze, S. C. Herpertz * Rostock, Germany Objective: In a number of studies, it has been shown that subjects with ADHD show decits in executive functioning, i.e. in cognitive functions that subserve planning, monitoring and control of goal-directed behaviour, as well as in emotion regulation. However, no study exists so far examining the interaction between cognition and emotion regulation in subjects with ADHD. In our study, we aimed to examine to what extend arousing emotional picture stimuli may account for differential effects in performance quality in subjects with and without ADHD. Method: Thirty-nine males and females with ADHD aged 18 to 40 years and 40 matched controls performed a working memory n-back task (1-back, 2-back). The task was performed with and without neutral and negative background pictures from the International Affective Picture System (IAPS) which varied in arousal (low, medium, high). Results: Irrespective of ADHD diagnosis, all subjects demonstrated lower performance accuracy in the 2-back condition compared with the 1-back condition. In comparison to healthy controls, subjects with ADHD displayed a decit in working memory performance in terms of decreased performance accuracy. Beyond this, we found that whereas healthy controls did not display performance decits until they were presented with high-arousal background pictures, subjects with ADHD were already impaired when presented with mediumarousal background pictures. Conclusion: Beyond the cognitive distractibility that has been reported in the literature, subjects with ADHD seem to be unusually sensitive to emotional distractors. The implications of these and further ndings will be discussed.

P-14-09 Attention Decit Hyperactivity Disorder, reactive inhibition and emotional regulation in Puerto Rican adults T. Ilarraza*, M. Velez Pastrana, M. Rivera, J. Rodriguez * San Juan, Puerto Rico Objective: This study examines the relationship between emotional regulation, reactive inhibition and characteristics related to ADHD in adults. We seek to shed light on the processes of self-regulation by examining the associations between the expression/inhibition of anger and sensation seeking traits, as they relate to symptoms and behaviors present in ADHD. Executive Function is a complex construct, generally dened as higher order cognitive abilities that facilitate strategic planning, cognitive exibility, goal-directed behavior and self-regulation (Weyandt, 2005), theoretically associated to the development of ADHD phenomena (Barkley, 1997). Emotional regulation, as a function mediated by higher order pre-frontal structures (Ochsner & Gross, 2008), has been linked to development and maintenance of internalizing and externalizing behavioral symptoms (Krueger, 2005). This study focuses on emotional regulation as it manifests in the expression of anger, and reactive inhibition, expressed in its polar opposite, sensation seeking (Blaskey et al., 2008). Method: 300 Puerto Rican adults complete the Wender Utah Rating Scale (WURS), the Emotions Scale (EE) and the Sensation Seeking Scale (EBS). The WURS is a 25-item self-report scale measuring ADHD-relevant childhood behaviors and symptoms in adults. The EE is a 64-item scale that assesses the expression of anger and hostility. It has 8 subscales and considers affective, cognitive and behavioral aspects of anger, including dimensions such as

P-14-11 Neurocognitive deciencies in adult ADHD; cognitive functions as marker and core decit O. Pazvantoglu*, A. Aker Alptekin, K. Karabekiroglu, G. Sarisoy, S. Akbas, S. Baykal, I. Zabun Korkmaz, E. Alkan Pazvantoglu, O. Boke, A. Rifat Sahin * Samsun, Turkey Objective: This study had three aims. First, we aimed to investigate cognitive decits in aADHD and to determine neuropsychological test that might be helpful to reveal these impairments in a more reliable manner, second, we intended to determine a neuropsychological marker for aADHD, and thirdly we aimed to reveal the cognitive function differences between aADHD cases and subjects with childhood ADHD whose symptoms did not persist from childhood to adulthood.


149 Method: Parents of children with ADHD (N=103) were included. The cognitive functions of these parents, divided into three groups on the basis of diagnostic status (non-ADHD, n=34; childhood ADHD, n=35; aADHD, n=34) and a healthy control (HC) group of 35 individuals, were evaluated with a series of neuropsychological tests (NPts) and psychometric instruments Results: The aADHD group exhibited a worse performance in the majority of NPts compared to the HC group. Compared to the other groups, mostly the aADHD group demonstrated statistically signicant differences in terms of cognitive functions, while the Stroop test 5th sub-test (ST 5) and Part B of the Trail Making Test (TMT-B) were found to be associated with genetic loading (having a child with ADHD). In contrast to all the other measurements, only the ST 5 scores were associated with persistence of ADHD in adulthood. Conclusion: Results indicate that aADHD patients have decits in cognitive functions in terms of attention, vigilance, interference control and set-shifting, and these differential dysfuntions may be revealed by more complex NPts in particular. The decits with regard to interference control and set-shifting processes may be assumed as a neuropsychological marker for aADHD. Interference control-associated functional decit may be a core decit for ADHD that indicates a vulnerability factor. anxiety measures. The relationship between changes in self-reported symptoms of ADHD and anxiety will also be presented. Conclusion: Preliminary data suggests that ATMX is effective in modifying core ADHD symptoms compared to placebo, but had no effect on subjectively-rated anxiety. Future analyses will incorporate the objective IntegNeuroTM data.

P-15-02 Attention Decit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD): A case series demonstrating improved outcome when comorbid ADHD is treated with long-acting stimulant medication (LAS) G. Farrelly*, M. Zwiers * Calgary, Canada Objective: To demonstrate that optimization of ADHD treatment in the target population (ASD with ADHD) improves core ADHD symptoms as well as overall functioning, quality of life, social interaction, communication, and ability to manage environmental challenges. Method: 32 individuals, aged 4-18 years with Low Average to Very Superior IQ and meeting DSM-IV criteria for ADHD and ASD [Aspergers Syndrome (AS) and High Functioning Autism (HFA)] were assessed and followed through two multidisciplinary clinics from 1994 to 2011.Compared with other ADHD populations, this subset of individuals (ADHD ? ASD) appeared signicantly more sensitive to rapid on/off effects when treated with short-acting stimulants (SAS) prior to the introduction of LAS to the Canadian market in 2003. Even when core ADHD symptoms improved with treatment, the short duration of action intensied anxiety, irritability, agitation and temper. After 2003, all subjects were switched to or started on LAS and titrated slowly to optimized medication and dosage. Results: Improved quality of focus and impulse control were achieved by optimizing ADHD treatment with LAS. Subjects appeared to be less overwhelmed and more aware of their environment and social requirements. In turn, this enhanced their ability to use strategies to improve social skills, communication, and overall quality of life. Conclusion: Effectiveness and tolerability results differed from earlier research, possibly explained by variances in: population (higher IQ and more subjects with AS and HFA); use of LAS (both dextroamphetamines and methylphenidate) vs. SAS only; and individualized optimization of medication and dosage vs. forceddosage trials. Signicantly, few studies of stimulant treatment with PDD subjects have considered benets beyond the effective management of core ADHD symptoms. The current case series suggests that LAS may avoid polypharmacy, treat core symptoms of ADHD, and improve quality of life (social-emotional benets) in ASD populations.

Friday, 27 May 2011, 14.3016.00 P-15 Pharmacological treatment: Children and adolescents I
P-15-01 Examining the efcacy of atomoxetine on measures of cognition, emotional function and anxiety in children and adolescents with ADHD The ACTION study M. Kohn*, T. W. Tsang, D. F. Hermens, S. D. Clarke, C. R. Clark, C. Lamb, D. Efron, N. Cranswick, L. M. Williams * Westmead, Australia Objective: The ACTION study (Attention Decit Hyperactivity Disorder Controlled Trial Investigation of a Non-stimulant) was a multicentre, double blind randomised cross-over trial of a non-stimulant medication, Atomoxetine (ATMX), in children and adolescents with Attention Decit Hyperactivity Disorder (ADHD) [1]. The primary aim of this study was to examine the efcacy of ATMX for improving cognition and emotional function in ADHD, dichotomised by the presence or absence of anxiety. Method: A clinic population of 6 to 17 year-old boys and girls with a primary diagnosis of ADHD were randomised to receive either placebo or ATMX over a six-week period, followed by a washout period of one week, before cross over for the next six weeks. Testing occurred at baseline and at the end of each six week period on measures of anxiety and ADHD symptoms. Presence of comorbid anxiety was determined using the ADISC, and the mean dose of ATMX received was 1.2 mg/kg, once daily. A standardised battery was used, including objective psychometric measures for cognition and emotional function (IntegNeuroTM), and self report measures rating anxiety (CPRS-L, DASS and STAI-C) and ADHD symptoms (ADHD-RS IV and CPRS-L). Results: Of the 102 participants (81.4% male) who completed the study 26.5% had comorbid anxiety. Core ADHD symptoms of inattention, hyperactivity and impulsiveness were all reduced with treatment of ATMX compared to placebo (p\0.05). Preliminary analysis revealed a statistically signicant reduction in the CPRS: Anxious-shy t score (p=0.043) in participants with comorbid anxiety, but not in any other

P-15-03 Aripiprazole in children and adolescents with conduct disorder: A single-center, open-label study E. S. Ercan*, T. Uysal, E. Ercan, U. Akyol Ardic * Izmir, Turkey Objective: The aim of this study was to determine the effectiveness and safety of aripiprazole in children and adolescents with both Attention Decit Hyperactivity Disorder (ADHD) and conduct disorder (CD). Method: Twenty children and adolescents, ranging in age from 6-16 years, participated in a single-center, open-label study (19 to com-


150 pletion). Children and adolescents were eligible for this study if they met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for ADHD comorbid with severe CD. We began treating patients with 2.5 mg of aripiprazole in an open-label fashion for 8 weeks. Outcome measures included the Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV), the Clinical Global Impression Scale (CGI), the Child Behavior Checklist (CBCL), the Teachers Report Form (TRF) and the Extrapyramidal Symptom Rating Scale (ESRS), along with laboratory assessments. Results: The mean daily dosage of aripiprazole at the end of 8 weeks was 8.55 mg (SD=1.73), with a maximum dosage of 10 mg. Based on the global improvement subscale of the CGI, we classied 12 of 19 patients (63.1%) as responders (very much or much improved). We observed signicant improvements after aripiprazole treatment with regard to inattention, hyperactivity/impulsivity, ODD, and CD subscales of the T-DSM-IV (parent, teacher and clinician forms). We also observed signicant improvements on many of the CBCL and TRF subscales (e.g., attention problems as well as delinquent and aggressive behavior). The participants tolerated aripiprazole, and no patient was excluded from the study because of adverse drug events. Conclusion: Aripiprazole is an effective and well-tolerated treatment for ADHD and CD symptoms; however, additional studies (specically, placebo-controlled and double-blind studies) are needed to better dene the clinical use of aripiprazole in children and adolescents with ADHD-CD. P-15-05 Methylphenidate-induced changes of cerebral frontal inhibitory functions in patients with Attention Decit Hyperactivity Disorder T. H. Kim*, D.-H. Song, S.-J. KIm * Seoul, Republic of Korea Objective: We showed the result of the Methylphenidate (MPH)induced changes of cerebral frontal inhibitory functions in patients with Attention Decit Hyperactivity Disorder(ADHD). Previous studies reported that ADHD resulted from the decit of selective attention and sustained attention. But recent studies showed that the executive function problems decreased cerebral frontal inhibitory function in ADHD. Method: 16 patients with ADHD from outpatient clinic were recruited. After pharmacotherapy with methylphenidate for 12 weeks, We examined result of ADHD Diagnostic System (ADS) and the Stroop Test. Results: The study group showed improvement in the both test signicantly. In ADS test, in visual task there was decrease of the omission error rate and in auditory task there was decrease of both the positive responding time and the standard deviation of the positive responding time signicantly. In the Stroop Test, there was a decrease in the word task, the color task and the color-word task signicantly. Conclusion: Our result suggest that the range in the clinical improvement of ADHD symptom corresponds with the result of the cerebral frontal inhibitory functions test instead of attentions test. This result implies that we should be more interested in the improvement of executive function than attention decit clinically.

P-15-04 Does medication alleviate executive working memory decits in children with ADHD? T. Schleepen*, L. Jonkman * Maastricht, The Netherlands Objective: Prior research has established working memory (WM) decits in children with ADHD, especially in tasks that pose high demands on executive control controlled by brain networks involving the Prefrontal Cortex. It is however not clear to what extent children with ADHD still suffer from such executive WM-decits when taking their regular medication. The current study addressed this issue. Method: 29 ADHD children receiving their regular medication (ritalin and concerta) and 36 age-matched typically developing (TD) controls performed a verbal N-back task including 0-, 1- and 2-back conditions that differ in executive control demands. While the 0-back task does not involve any WM processes, the 1-back task involves the maintenance of only one letter in WM. Executive control is in particular required in the 2-back task, since besides simple maintenance, also the executive processes of updating and interference control are needed. By comparing performance between 0-vs. 1- and 1-vs. 2-back conditions, the process of maintenance and maintenance during executive control can be parcelled out, respectively. 2 9 2 ANOVA analyses were performed to examine group x condition differences. Results: Accuracy decreased from the 0 to 1-back and from the 1 to 2-back task in all subjects, but accuracy decreases were similar in both groups. Memory response decision time did also increase from 0- to 1 back and from 1-2 back in both groups, but ADHD children needed signicantly (and considerably) more time to reach a memory decision in the 2-back task that demanded high levels of executive control than TD children. Conclusion: The above results show that ADHD children who are on their regular medication still experience decits in verbal WM when high demands are placed on executive control. These decits manifest themselves in the form of more time that is needed to update information and ignore irrelevant items while maintaining information online.

P-15-06 Twelve-week administration of long-acting methylphenidate increases NAA/Cr and decreases Glu/Cr and Cho/Cr in the bilateral prefrontal cortices of schoolage children in Indonesia: study using 1H Magnetic Resonance Spectroscopy (MRS) T. Wiguna* * Jakarta, Indonesia Objective: This study is aimed to analyze the effect of 12 weeks administration of long-acting methylphenidate 20 mg toward the neurometabolites in prefrontal cortex in ADHD children by using 1H magnetic resonance spectroscopy. Method: This was a prospective study with one group using pretest and posttest design to evaluate the response of DA neurotransmission to long-acting methylphenidate 20 mg. We examined 21 ADHD children without any co-morbidity age 7 to 10 year old who were drug nave. A low Time Echo (TE) MRS scans sampled voxels of interest (1.5 9 1.5 9 2.0) both from the right and left prefrontal cortex in all subjects. Compounds which can be visualized with MRS included N-acetylaspartate (NAA), glutamate/glutamine (Glu), creatine/phosphocreatine (Cr), cholin (Cho) and myo-Inositol (mI). A pair t-test was used to analyze the mean difference of NAA/Cr, Glu/Cr, Cho/Cr and mI/Cr ratios. A standardized mean effect size (d) is also calculated by using the effect size calculator. Results: There was signicantly decreased of Glu/Cr, Cho/Cr ratio both in the right and left prefrontal cortex (p\0.05) after the subjects took 20 mg long-acting methylphenidate for 12 weeks. In this nding, NAA/Cr ratio increased signicantly (p\0.05) as well. All standardized mean effect sizes ranged from 0.541.17. Conclusion: these ndings suggested that administering long-acting methylphenidate 20 mg for 12 weeks is associated with enhancement of dopaminergic neurotransmission in prefrontal cortex areas.


151 P-15-07 Five year follow up of psychosocial, sexual and academic outcome in children with Attention Decit Hyperactivity Disorder (ADHD) under treatment R. Sagar*, K. Sinha Deb, M. Mehta * New Delhi, India Objective: To study the long term outcome of treatment in children diagnosed with ADHD in the areas of severity of ADHD, psychosocial and sexual Adjustment and educational achievement. Method: The study was a naturalistic, descriptive follow-up study carried at the Child Psychiatry Clinic OPD, at the All India Institute of Medical Sciences, New Delhi, India. The study sample included 10 children with a clinical diagnosis of ADHD coming for regular follow up to the clinic for the past 5 years. All subjects were assessed clinically (as routine clinic protocol) to ascertain the diagnosis of ADHD. After diagnosis all patients were started on treatment as usual including medications for ADHD and counseling of family members by the clinical staff. Subsequently, severity of ADHD was assessed by Conners Parent Rating Scale. Psychosocial functioning was assessed by Strength and Difculty questionnaire (SDQ) and Childrens Global Assessment Scale (CGAS). Academic performance was assessed by Result of last school test. Descriptive statistics were used to nd major problem areas in various phases of treatment and age of patient. Results: The data was collected between 2005 and 2011. The sample was predominantly male (90%), with a mean age of 8.24 years at intake, and a mean age of 13.24 years at present time. Review of the 10 cases revealed that hyperactivity got controlled within months of initiation of therapy. Inattention was more difcult to control in the initial years. Conduct traits were most difcult to control and often required additional medications. Signicant improvement in academic performance was seen within the rst year of institution of treatment. Discontinuation of treatment happened at least once during the rst year in majority of the cases. However, compliance improved in all cases with time. New problems came to focus in later years, including the management of loss of appetite, decrease in body weight, difculty in interaction with peers and members of opposite gender adolescent sexual issues and substance abuse (in one case). Routine counseling of family members were instrumental in helping them to understand the problems and maintain compliance. Conclusion: The study highlights the various problems faced by patients of ADHD that are beyond the hyperactivity, inattention and conduct spectrum during a 5 year follow up of the cases. They are causes of concern for the parents and are important for the overall improvement of the patient and can be tackled easily by simple counseling. clinically to ascertain the diagnosis. Severity of ADHD was assessed by Conners Parent Rating Scale. Psychosocial functioning was assessed by Strength and Difculty questionnaire (SDQ) and Childrens Global Assessment Scale (CGAS). Academic performance was assessed by Review of Teachers Observation Report (TOR) and Result of last school test. After initial assessment all patients were started on treatment as usual and subjects were reassessed at 6 months using same measures. Informed consent and ethical clearance was taken. Statistical analysis was done by the SPSS (Version 10) software package. Comparison between baseline and follow-up measures were done by Paired t-test and Wilcoxon signed-rank test. Results: Of the 41 patients recruited in the rst visit 32 patients came for follow-up at six months resulting in 9 drop outs. The sample was predominantly male (92.68%), with a mean age of 10.04 years, belonging to nuclear family (75.61%) and predominantly of the ADHD HI (Hyperactive-Impulsive) subtype (51.22%). Comparison between baseline and follow up data revealed signicant reductions in severity in CPRS scores in all categories except in patients who were non-compliant to drugs and in patients with co-morbid disorders. The SDQ revealed signicant reduction in total difculty score (TDS) and conduct problem sub-scale (CPS), Peer relationship problem score (PPS) but no change in Emotional Symptom Sub-scale (ESS). There was signicant increase in CGAS scores at follow up. Results were most signicant in the drug compliant patients while age, sex, family type, family income, birth order, number of siblings, diagnostic subtype and IQ were not related to the outcome. Conclusion: Signicant improvement in severity of ADHD and academic and psychosocial functioning is possible in ADHD. Maintaining of therapeutic contact and compliance to medication are the most important parameters in improving the outcome in naturalistic settings.

P-15-09 Evaluation of cardiovascular effects of atomoxetine treatment upon children with Attention Decit Hyperactivity Disorder C. Gokcen*, A. Sert, E. Aypar, D. Odabas * Gaziantep, Turkey Objective: Atomoxetine is a central norepinephrine reuptake inhibitor used to treat Attention Decit Hyperactivity Disorder (ADHD). There are a few reports in literature upon the cardiovascular effects of atomoxetine therapy in children. The aim of this study was to determine whether atomoxetine treatment for 5 weeks is effective in changing mean heart rate, mean systolic and diastolic blood pressure (BP), QTc and left ventricular systolic functions in children with ADHD. Method: Fourty children with ADHD (6 females, 34 males) were included this study. Treatment was initiated at a standard specied dose (0.5 mg/kg/day) for all patients and increased to 1.2 mg/kg/day respectively based on parent and clinicians report at the rst week. Mean systolic BP and diastolic BP, heart rate, QTc, left ventricular systolic functions before and 5 weeks after atomoxetine treatment were recorded. Results: Atomoxetine decreased baseline mean systolic BP (from 94,88,5 to 93,512,3 mmHg, p=0,486) and baseline mean diastolic BP (from 61,210,1 to 60,77,3 mmHg, p=0,802); baseline mean heart rate slowed (from 88,317,5 to 85,415,3 beats/min, p=0,097); baseline mean QTc mildly increased (from 39124 to 39626 ms, p=0,245). Atomoxetine decreased baseline mean ejection fraction (from 71,15,1% to 69,14,7%, p=0,084) and baseline mean shortening fraction (from 39,84,3% to 38,1 3,7%, p=0,098) but there was statistically no signicant difference in terms of mean heart rate, mean systolic and diastolic BP, QTc and left ventricular systolic functions 4 weeks after atomoxetine treatment. Conclusion: Data suggest that atomoxetine do not cause statistically or clinically signicant alterations in systolic BP and diastolic BP,

P-15-08 Effectiveness of treatment on psychosocial adjustment and academic outcome in children with Attention Decit Hyperactivity Disorder (ADHD): A six month follow-up study K. Sinha Deb*, R. Sagar, A. Mittal, M. Mehta * New Delhi, India Objective: To study the short term outcome of initiating treatment in children diagnosed with ADHD in the areas of 1. Severity of ADHD. 2. Psychosocial Adjustment. 3. Educational achievement. Method: The study was a prospective, six month follow-up study carried at the Child Psychiatry Clinic OPD, at the All India Institute of Medical Sciences, New Delhi, India. The study sample included 32 newly registered children with a diagnosis of ADHD as per DSM-IV(TR) meeting inclusion criteria. Children with mental retardation (IQ\70), serious medical co-morbidity and children whose parents were unable or unwilling to provide information from the teachers were excluded. At intake all subjects were assessed


152 heart rate, QTc and left ventricular systolic functions during shortterm treatment in children with ADHD. Cardiovascular effects of atomoxetine were minimal, and atomoxetine was well tolerated in short term study. However, double-blind, randomized, placebo-controlled studies are needed to conrm this. Method: Change in ADHD symptoms, as rated by parents and teachers on the German ADHD Symptom Checklist (FBB-ADHD), was examined post hoc in patients who had measurements at all 3 study visits (baseline, 13 weeks and 612 weeks after rst use of Equasym XL), using growth mixture modelling to detect trajectories. Sex, age, methylphenidate dosage before switch to Equasym XL, conduct problems, emotional symptoms and quality of life were considered as predictors of trajectory groups. Model selection was based on a formal statistical criterion (Bayesian information criterion) and clinical considerations. Results: Models with up to 8 classes were computed for parent (n=699) and teacher (n=521) ratings. Under consideration of the covariates, a 4-class solution tted the data best for both informants. Of these 4 classes, 1 class had low ADHD symptoms in the beginning and a stable course over the entire study (low-stable); the other 3 had high ADHD symptoms at study start. Among these high-symptom classes, 1 showed a stable course (high-stable), 1 had a strong decrease immediately after medication switch (high-baseline response), and 1 had a strong decrease during Equasym XL treatment (high-intervention response). All covariates except sex were signicant in predicting trajectory classes. Conclusion: Different treatment-response trajectories can be detected and group membership can be predicted. These results help to inform practitioners which patients are most likely to benet from treatment with Equasym XL. Supported by Shire Development Inc.

P-15-10 Effects of w3 Long-Chain Polyunsaturated Fatty Acids (LCPUFA) supplementation on information processing of ADHD children medicated with Methylphenidate D. Isenberg Bechar*, R. Geva, E. Granot, D. Margalit * Ramat-Gan, Israel Objective: Recent data suggest that impairments in information processing are central to ADHD (Mulder et al., 2010; Sohn et al., 2010). Increasing evidence suggests a positive association between FA and cognitive performance, including speed of information processing (Groot et al., 2007). The present study is part of a larger study aimed to investigate effects of combined treatment of MPH with x-3 LCPUFA on ADHD long term medicated children on various cognitive measures. Here we report on preliminary results of information processing speed. We hypothesized that x-3 supplementation will improve information processing through heightened alertness and inhibition. Method: 14 children (8 trial; 6 placebo, mean age 11.1 SD 2.3) were given 2 daily capsules containing 500/100 mg./d EPA/DHA ratio each, or placebo. Fatty acids were analyzed in serum phospholipids and red blood cell membranes at baseline and endpoint with gas chromatography. The study measured information processing speed and efciency as a function of three independent factors: commission errors and reaction time on the go/no-go task and word and color reaction time on the verbal interference task. Measures were the assessed using a touch-screen computerized battery (IntegNeuroTM). Results: ANOVA with repeated measures showed a signicant reduction (F=5.69; df=[12,1];p\0.05) in the go/no-go reaction time measure, but not on accuracy, since there were no reductions in Commission errors, in the LCPUFA trial group, compared with control. A reduction in the commission errors was also found, although not signicant. Changes in verbal interference were not signicant, but a greater reduction in the color, compared with the word reaction time, was found in the trial group. Conclusion: data partially support the potential role of x-3 LCPUFA in the regulation of information processing. These improvements may be related with Executive efciency. Further exploration of added LCPUFA to MPH intervention is encouraged.

Friday, 27 May 2011, 14.3016.00 P-16 Pharmacological treatment: Children and adolescents II
P-16-01 A single-center, single-blind, randomized, oral dose crossover study in prepuberal boys with ADHD to investigate efcacy and bioequivalence of two modied release Methylphenidate formulations C. Fleischhaker*, K. Hennighausen, K. Schneider-Momm, E. Schulz * Freiburg, Germany Objective: The primary objective of the study was to determine Pharmacokinetics (PK) and bioequivalence of 20 mg Ritalin LA compared to 20 mg Medikinet retard. Method: 24 prepubertal boys aged 8 - 14 years with ADHD were enrolled. Cohorts of 6 subjects each were assessed on two 9-hour classroom setting. Serum MPH concentrations, ratings of classroom behavior on the SKAMP were measured repeatedly. Results: Among the patients, the complete determination of the pharmacokinetic parameters could be performed for 20 patients. Equivalence could not be concluded for Cmax serum MPH concentration at a 5% signicance level. In approx. 50% of patients, MPH concentrations have formed two distinctive peak levels. In a crossover analysis, the SKAMP Scales showed no signicant treatment effects. Regarding the subjects condition in the week prior to the visits, however, there was a signicant positive effect in favorite of Ritalin LA as assessed by the primary caregiver. For both medications, no serious adverse events could be observed. Conclusion: An analogue classroom setting provides a reliable parallel assessment of behavioral and PK data. PK data showed remarkable inter-individual variations. In both medication groups, the pharmacokinetic proles have revealed two distinctive peak levels in more than 50% of patients.

P-15-12 Treatment response heterogeneity in children with ADHD during treatment with modied-release methylphenidate in the observational OBSEER study M. Dopfner*, C. Hautmann, A. Rothenberger * Koln, Germany Objective: OBSEER was a prospective, observational study examining effectiveness and safety outcomes over 3 months in patients (aged 617 years) with Attention Decit Hyperactivity Disorder (ADHD) receiving once-daily modied-release methylphenidate (Equasym XL) under routine care. Children with ADHD vary in their response to drug treatment and follow different trajectories of symptom severity over time. This analysis investigated predictors for different treatment-response trajectories.


153 P-16-02 Side effects in adhd patients treated with methilphenidate: A comparison between different formulations M. Pinto*, C. Cordovil, C. Amado * Barcarena, Portugal Objective: Methylphenidate (MPH) is the most widely used stimulant medication in the treatment of Attention Decit Hyperactivity Disorder (ADHD). In our country it is available in short- (2-4h) (SF), intermediate- (6-8) (IF) and long-acting (10-12h) (LF) formulations. Choice is usually made individually but side effects often lead to treatment changes. The aim of our study was to evaluate side effects in ADHD patients treated with different formulations to see if adverse effects were depending on formulation type or on total daily dose. Method: Adverse effects questionnaires were given to parents of ADHD patients on MPH treatment in our clinic. Patients were distributed according to the formulation type they were receiving into SF, IF or LF groups. Sex, age, weight and total daily dose were also registered. Statistical analysis was performed stratied by formulation type, gender and total daily dose/weight. To evaluate the association between side effects and formulation type we used Pearsons Chi-squared test with simulated p-value and Goodman & Kruskals lambda. Results: A total of 155 questionnaires were received (104 males; 51 females), 37 in the SF, 86 in the IF and 32 the LF groups. Median age was 9, 10 and 13 years, respectively. Most frequent side effects reported were poor appetite (p-value = 0.1) and sleeping problems (pvalue = 0.2). However none of the side effects showed to be strongly dependent of formulation group and side effects presence and intensity were not dosage/weight dependent. Conclusion: Side effects are rarely reported by parents of ADHD patients receiving MPH, being most frequently poor appetite and sleeping problems. There seems to be individual variability and not dependence on formulation type or on total dosage, so treatment must be tailored to each patient based on other factors. However side effects still need to be monitored and formulation changed when they occur. addition, parents demonstrated an association between anxiety comorbid disorders and a better response to a high dose of methylphenidate. Conclusion: This study suggests that a strong reactivity of the HPA axis improves the clinical response at high dose, but that chronically elevated cortisol might be a marker for nonresponders. The results of this study should be seen as preliminary and require further testing of the possible interactions between ADHD medication and HPA activity.

P-16-04 Methylphenidate effect on neuro-cognitive test battery E. S. Ercan*, E. Ercan, F. S. Durak * Izmir, Turkey Objective: The aim of this study was to assess the effectiveness of methylphenidate treatment for ADHD cases by using neuro-cognitive test battery (CNSVS Test Battery) and nd out differences between ADHD combined type and ADHD attention deciency subtypes. Method: Sample of the study included 198 children and adolescent aged between 8- 18 years (156 boys, 42 girls; mean of age, 11.422.47) who met the DSM-IV diagnosis of ADHD based on the assessment Schedule for Affective Disorders and Schizophrenia for School-Aged ChildrenEpidemiologic (Version 1; K-SADS-PL). Eighty two cases were diagnosed as ADHD attention deciency subtype and 116 cases were diagnosed as ADHD combined subtype. The sample group was evaluated with CNSVS Test Battery which is a computerized assessment including verbal memory test, visual memory test, nger tapping test, symbol digit coding, stroop test, shifting attention test and continuous performance test and is sensitive to assess performance of children and adolescence with ADHD (Gualtieri & Johnson, 2006). Improvement of the cases on the neurocognitive tests was evaluated before and after the methylphenidate treatment. In addition, clinical improvements of the sample group were compared with DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale for parents and clinical global (CGI) improvement impression subscale. Results: Before and after methylphenidate administration, neurocognitive performance as measured by CNS Vital Sign Battery showed signicant improvement between pre-and post test administration (p\.001) except memory test. Conclusion: According to this, methylphenidate treatment signicantly improved neuro-cognitive performance of Turkish sample. Resuls also revealed that ADHD combined and attention deciency subtypes were almost equally improved on CNSVS Test Battery except memory subtest.

P-16-03 Effect of increasing doses of methylphenidate as a function of free salivary cortisol and comorbid anxiety in children with ADHD P. Robaey*, R. Menneh, P. Hastings, I. Fortier, L. Simard * Ottawa, Canada Objective: The most prescribed medication for ADHD is methylphenidate, a psychostimulant that blocks the dopamine transporter and increases dopamine availability in the synaptic cleft. Preclinical and clinical studies show that cortisol may enhance dopamine effects. Dysregulation of the hypothalamic-pituitary-adrenal axis is also associated with many psychiatric disorders such as depression, bipolar disease, and anxiety. We hypothesized that cortisol has an inuence on the efcacy of the treatment of ADHD symptoms with methylphenidate. Method: The objective of this study was to measure the salivary level of cortisol in a sample of 8-year-old children with ADHD upon waking and in response to a venipuncture. The children were then randomized to three doses of methylphenidate and a placebo in a double-blind cross-over design. Teachers and parents rated the behaviour of the children using the SWAN and a side effect rating scale. Results: The results showed that high morning cortisol is a good predictor of a nonresponder under active medication, as reported by parents. Also, the high cortisol stress reactivity group, but not the low cortisol stress reactivity group, demonstrated a greater benet going to a higher dose of methylphenidate, according to teachers. In

P-16-05 Possible interaction effect of dopaminergic and noradrenergic gene polymorphisms on methylphenidate response in a Korean ADHD sample S. B. Hong*, H.-J. Yoo, B.-N. Kim, M.-S. Shin, S.-C. Cho, J.-W. Kim * Seoul, Republic of Korea Objective: Leading candidate genes of Attention Decit Hyperactivity Disorder (ADHD) include those involved in dopaminergic or noradrenergic neurotransmission, and these genes have also been implicated in the response to ADHD medication. We aimed to investigate the independent and interaction effects of selected polymorphisms at four major candidate genes for ADHD, namely dopamine transporter gene (DAT1), dopamine D4 receptor gene (DRD4), adrenergic alpha-2A receptor gene (ADRA2A), and


154 norepinephrine transporter gene (SLC6A2), with regard to treatment response to methylphenidate (MPH). Method: The participants of the study were children and adolescents diagnosed as having ADHD according to the DSM-IV criteria. They were enrolled in an 8-week, open-label trial of MPH. The good responder group was dened as subjects having a 50% or greater decrease in the ADHD Rating Scale-IV (ADHD-RS) total score from the baseline, and at the same time a Clinical Global ImpressionImprovement Scale (CGI-I) score of 1 or 2, both at the 8th week of MPH treatment. Multivariate logistic regression was performed to examine the independent and interaction effects of genotypes on the dichotomized MPH treatment response. The statistical model included terms for each genetic polymorphism and at the same time terms for each pairwise interaction of these polymorphisms; then stepwise variable selection procedure using backward elimination (Wald) was employed, with a signicance level for removal from the model set as 0.10. Results: Signicant interaction effects on MPH response were detected between the genotypes of the DRD4 VNTR polymorphisms and those of either the ADRA2A DraI or the SLC6A2 -3081(A/T) polymorphisms; signicant interaction effects were also detected between the genotypes of the ADRA2A DraI polymorphisms and those of either the SLC6A2 G1287A or the SLC6A2 -3081(A/T) polymorphisms. No signicant independent effect of a certain genotype was detected according to the stepwise logistic regression results (Table 3, Figure 1). Conclusion: We have selected the two most promising polymorphisms from each of the two major neurotransmitter systems implicated in MPH response, the dopaminergic and noradrenergic systems, and the consequent results support that genes involved in these two systems might interact to form important predictors of short-term response to MPH. The combined response criterion of the parent-rated ADHD-RS scores and the clinician-rated CGI-I scores might have improved the reliability of our data. Nonetheless, more objective outcome measurements, preferably involving endophenotypes of ADHD, are recommended for future studies. haplotype showed much better improvement than those with 3GT and 4TC haplotypes (ADHD-RS total and subscale score changes: MANOVA, F = 2.234, p = 0.043, with moderate effect size: r = 0.40*0.60). In the second sample using OROS MPH, four out of ve polymorphisms were nd associated with ADHD-RS score change (rs5905859, rs2239448, rs3027400, rs1137070), especially parentrated attention subscale score change (P \ 0.05). Conclusion: Both studies in two independent samples suggest association between MAOA polymorphisms and the improvement of ADHD symptoms with MPH treatment.

P-16-07 Pharmacotherapy of Attention Decit Hyperactivity Disorder in children with epilepsy A. Kesic*, A. Lakic, V. Milovanovic, P. Ignjatovic * Belgrade, Serbia Objective: The aim of this study was to evaluate clinical results, side effects and seizure control in children with ADHD and epilepsy, which are treated with OROS methylphenidate. Population studies suggest that the prevalence of ADHD in childhood epilepsy is betweene 12 and 17%.The treatment of ADHD in children with epilepsy, can become a challenge for doctors who are forced to prescribe drug combinations. Method: We have analyzed a group of fteen children with Attention Decit Hyperactivity Disorder and epilepsy (10 males and ve females), of the age between seven and fteen years. They were seizure-free at least six months, before we started treatment with OROS-methylphenidate. We have evaluated the efcasy of MPH (18 and 36 mg/day) using SNAP-IV scale. Digitalized EEG were recording every three months.The follow-up period for at least one year was one of the inclusion criteria. Results: The therapeutic effect of drug was monitored by clinical observation and SNAP IV scale, over a year.OROS MPH signicantly improved ADHD symptoms by lowering score on SNAP IV scale.In our group of patients, OROS methyphenidate was well tolerated. Some side effects, such as decrease in appetite and sleep disturbance, were mild and transient, and it occurs in 4 children. No seizures were observed in our group during the one year study period.

P-16-06 Monoamine oxidase a gene is associated with methylphenidate response in ADHD children: Results in two independent samples L. Yang*, Y. Chen, L. Liu, H. Zhang, Y. Wang * Beijing, Peoples Republic of China Objective: The efcacy of ADHD medications is suggested to be mediated by changes in dopaminergic and noradrenergic functioning. Monoamine oxidase A (MAOA) plays an important role in regulating catecholamine level in central nervous system. We hypothesized that allelic variation in MAOA contributes to inter-individual variation in clinical response to methylphenidate. Method: We studied the association between MAOA and methylphenidate response in two independent samples. (1) Ninety Han Chinese boys meeting DSM-IV criteria for ADHD were recruited. Immediate released methylphenidate treatment was given in titrated doses in order to achieve optimal response. Behavior changes were measured using the ADHD Rating Scale-(ADHD-RS) IV at baseline and after optimal doses were reached. The MAOA 30bp VNTR, T941G and C1460T polymorphisms were genotyped. (2) One hundred twelve ADHD boys were given Osmotic-Release Methylphenidate (OROS MPH) treatment. The dose was also titrated to optimal. The same behaviour rating scales were used to assess the response. Five polymorphisms were genotyped (rs5905859, rs2239448, rs3027400, rs1137070, rs3788862). Results: In the rst sample using immediate released methylphenidate, haplotype analysis revealed that some patients with the rare 3TC

P-16-08 Treatment adherence of osmotic release oral systemmethylphenidate in children and Adolescents with Attention Decit Hyperactivity Disorder H. Yoo*, B. Kim, A. Y. Son, C. Suh * Gui-Dong, Seoul, Republic of Korea Objective: The objective of this study was to evaluate the treatment duration and adherence of OROS methylphenidate for the treatment of ADHD. Method: 218 children with ADHD (10.52.73 years old) who had previously taken medications for ADHD and 632 drug naive children with ADHD (11.342.91 years old) were recruited. The dosage was adjusted according to the clinicians judgment. The SNAP-IV, CGI-S, CGI-I, and side effect rating scale were measured at every visit. Results: The medications which had been taken by the children were found to be ER-MPH, IR-MPH, and atomoxetine in order from most common to least common. The drug naive children were older, and more of them belonged to the inattentive subtype compared to those who had previously taken medications. The factors inuencing treatment adherence were other ADHD medications and change of the CGI. The presence of comorbidity was not signicant (p=0.058) but might have inuenced treatment adherence. Conclusion: In the current study, age, sex, family history of ADHD, subtypes of ADHD, pattern of treatment medications, and side effects


155 of the medication did not show any statistically signicant relationship with treatment adherence. On the contrary, other ADHD medications and change of the CGI were associated with treatment adherence. The presence of comorbidity might inuence treatment adherence. P-16-11 Effects of methylphenidate treatment on ROS formation in the blood of children with ADHD P. Heiser*, O. Sommer, A. Hoinkes, M. Rottinger, U. Hopt, A. Schmidt, E. Schulz, K. Hennighausen, H.-W. Clement * Freiburg, Germany P-16-09 Alterations of oral language in the Attention Decit/ Hyperactivity Disorder and correlation with stimulant treatment M. Periotto*, E. Barbante Casella, S. Pacheco, S. Branco, U. Reed * Sao Paulo, Brazil Objective: We studied the oral narrative in a task of recounting of story and the evolution after treatment with methylphenidate. Method: We investigated 36 children (aged seven to 14 years), and 34 normal controls, during performance in the narrative evaluation of the speech oral in task of recounting of history, pre and after treatment with methylphenidate. The inclusion criteria were: IQ [85 in the WISC test and to study in regular school. The points evaluated were: oral narrative speech; narrative speech in a task of story recounting. Results: The ADHD group had a mean of 8.83 (33.96%) sentences remembered and the control group 12.62 (48.54%)(p = 0.001). The ADHD group had a mean total errors of 5.75 versus 3.32 in control group.(p = 0.001). Regarding the type of error, the difference was signicant only for error of misinterpretation (p \0.001) (ADHD group 1.53, control 0.44). The analysis after the treatment was done only in the group with ADHD and it was observed a signicant increase in the number of sentences retold for children (p = 0.001). At baseline, the average sentence was retold of 8.83 (SD = 4.67) and after the use of stimulant, the average was 13.44 recounted sentences (SD = 4.79).There was no signicant difference in the performance of children between the assessment and reassessment in the categories of errors (segmentation, misrepresentation, substitution, ambiguous reference, adding ctitious, repetition), as well as the frequency of these errors. Conclusion: Memory of history improved with the pharmacologic treatment. Did not occur a decrease in the frequency and in the types of errors and we believe that was by the fact that it was not done a specic speech therapy. Objective: There are some hints of an increased oxidative stress level in patients with ADHD (e.g. increased lipid peroxidation). Oxidative stress is a synonym for enhanced reactive oxygen species (ROS). Cellular oxidative stress indicators are leucocyte, especially macrophages, formed from precursor monocytes and pollmorphonuclear leucocytes (PMN). Aim of our study was to analyze the formation of ROS in the whole blood and in PMN leucocytes after methylphenidate (MPH) intake in ADHD patients. Method: Blood was analyzed in 12 drug-naiv ADHD patients and 9 ADHD patients treated with MPH (between 6 and 12 years old). The rst blood probe was taken before the attitude on the medication and the second after the attitude. Blood sampling started at 10 a.m. (2 h after MPH intake) followed by measuring the formation of ROS in the whole blood and in isolated PMN obtained after Ficoll density gradients centrifugation. ROS detection was carried out by electron spin resonance spectroscopy using the spin label CMH (1-hydroxy-3methoxycarbonyl-2,2,5,5-tetra methylpyrrolidine). The responsiveness of ROS formation in PMN leucocyte was analyzed by stimulation with phorbol12-myristate13-acetate and inhibited by CuZn superoxide dismutase. Also the MPH concentration of the patients was measured in the serum. Results: The mean MPH concentration was 0.96 mg/kg. ROS formation in whole blood decreased signicantly from 108 3 nmoles O2/ml/min in the drug-naiv patients to 76 3 nmoles O2/ml/min in MPH-treated patients. The same decrease of ROS formation was observed in PMN leucocytes (drug-naiv patients: 33 6 nmoles O2/ min/106 cells, MPH-treated patients: 143 nmoles O2/min/106 cells). Conclusion: MPH reduces oxidative stress by a diminished formation of ROS in ADHD patients. This could be a reason why MPH may not lead to cell damage and is supporting the clinical observations that MPH is usually well tolerated.

P-16-10 A re-examination of acute tolerance, Tachyphylaxis and Hysteresis Loop in the Pharmacokinetics and Pharmacodynamics of immediate release methylphenidate in individuals with ADHD D. Quinn*, M. Denis, M. Cavanagh * Saskatoon, Canada Objective: To discuss the terms: Acute Tolerance, Hysteresis Loop and Tachyphylaxis. Acute Tolerance, Tachyphylaxis are frequently used to describe the rapid decrease in clinical response despite plasma levels being elevated. The term Hysteresis Loop is more appropriate. Method: 31 subjects (Children 7-12) were treated with either d-Methylphenidate (2.5 mg, 5 mg or 10 mg), dl-Methylphenidate (5, 10 or 20 mg) or placebo in crossover double blind clinical trial in an Analog Classroom Setting. Results: Data was collected over time measuring plasma level and using a clinical measure of response (PERMP). Data was analysed and graphed using a Bivariate correlation. Both compounds (d-Methlpenidate and dl-Methylphenidate were superior to placebo. Conclusion: Clinical response occurs faster than plasma levels and supports the concept of a Hystersis Loop.

P-16-12 Osmotic-controlled release oral delivery system Methylphenidate treatment reduces parental stress in children and adolescents with Attention Decit Hyperactivity Disorder in Korea H. Yoo*, J. M. Ahn, B. Kim, Y. J. Park * Gui-Dong, Seoul, Republic of Korea Objective: The purpose of this study was to investigate the parenting stress of parents of children and adolescents with Attention Decit Hyperactivity Disorder (ADHD) and to assess whether the parenting stress could be reduced by Osmotic-controlled Release Oral Delivery System (OROS) methylphenidate treatment. Method: 495 subjects (10.4 2.8 years of age, 391 (79%) males) with ADHD were recruited. Assessments including the Parenting Stress Index (PSI), ADHD Rating Scale (ARS) parent version, Beck Depression Inventory (BDI) for caretakers were conducted at baseline and after OROS methylphenidate for 8 weeks. Paired t-test and stepwise regression test were used to assess the effects of medication and the associated clinical factors on drug effects. Results: 342 (69.1%) subjects were combined type and 98 (19.8%) were predominantly inattentive type of ADHD. Signicant reduction was observed in the PSI scores between baseline and endpoint (P \ 0.001). The BDI and ARS changes were associated with the PSI


156 changes between pre- and post-medication, accounting for 20.1% and 10.0%, respectively (p \ 0.001). Conclusion: To conclude, this study result suggests that parents of children and adolescents with ADHD have greater parenting stress. The increased parenting stress of caretakers of children and adolescents with ADHD can be reduced by short-term drug treatment of ADHD. In addition, the improvement of parenting stress of by medication may be associated with the reduction of ADHD symptoms and parental depressive mood. * Munchen, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) is a frequent psychiatric disease also in adults. Deriving measurable cognitive endophenotypes of the behavioral impairments with experimental neuro-cognitive assessment promises to improve diagnosis, evaluation of treatment response, and disentanglement of genetic and environmental inuences. In a prior study we found signicant working-memory (WM) storage capacity reductions in unmedicated ADHD patients compared to normal controls. Method: In order to systematically specify the effect of medication on attentional components in adults with ADHD, we used an assessment based on Bundesens theory of visual attention (TVA). In an exploratory study we compared a group of adult ADHD patients on ADHD-specic medication with an unmedicated patient group and a demographically matched healthy control group. The TVA-based assessment provides four quantitative, mathematically independent parameter estimates that are highly sensitive even for subtle attention decits: visual perceptual processing speed (elements/s), WM storage capacity (number of elements), spatial distribution of attentional weights, and top-down control. All parameters are assessed with highly similar stimuli (letters) and response requirements (verbal report), imposing comparable demands on perceptual and motor skills. Performance is assessed in terms of accuracy at certain exposure durations instead of response latency, avoiding confoundation with motor dysfunction (e.g. hyperactivity). Results: WM storage capacity was signicantly higher in medicated than in non-medicated patients, but still signicantly worse compared to normal controls. Mirroring previous results, medication did not affect perceptual processing speed, spatial weighting and top-down control. Conclusion: Medication seems to ameliorate the WM storage capacity decit in ADHD to a certain degree, but not to a normal degree. Since no decits in speed and top-down control have been found using the TVA based assessment, the ndings of slow and variable performance in response-based tasks might rather reect impairments in later, motor response stages than impairments in perceptual information processing.

Friday, 27 May 2011, 14.3016.00 P-17 Pharmacological treatment: Adults I

P-17-01 Usage trends of ADHD medication by bipolar patients with attentional decits I. Szpindel*, R. McIntyre * Toronto, Canada Objective: To observe ADHD medication usage trends in bipolars with attentional decits and identify patterns that might aid in diagnosis and improve management. Method: Patients referred for attentional assessment and diagnosed with bipolar disorder in the greater Toronto Area between 2008-present were observed naturalistically. The full spectrum of bipolar disorder was considered along with both stimulant and Nonstimulant class medications indicated for ADHD use in Canada. Results: Bipolar patients not stabilized pharmacologically experience acceleration of their cycles across classes with all medications, and more pronounced with the more noradrenergic agents. Patients with sufcient pharmacological stabilization did not accelerate or destabilize. Unstable patients frequently reported signicant response or intolerable side effects at relatively low doses of medication. Subjective attentional improvements reported by these patients did not correlate with clinical assessment, were short-lived and episodic, and required escalating doses and frequent switches of medication. Many unstable bipolars had already developed, or showed a preference for, patterns of brief episodic medication use coinciding with switches to manic or hypomanic phases. Conclusion: Insufciently controlled bipolars using ADHD medication across classes risk destabilization and acceleration of their progressively neurotoxic underlying disorder. The more noradrenergic the agents, the more obvious and early the reaction. Sufciently stabilized bipolars appear protected from this effect. A pattern of escalating episodic ADHD medication dosing adopted by uncontrolled bipolars seemed consistent with self induction of manic switching during episodes of depression. Reported initial sensitivity to unusually low doses of medication likely represents a similar triggering of manic switch which is misinterpreted by the patient as emotional and cognitive improvement. Awareness of these distinguishing characteristics and behaviours may aid in the earlier identication and differentiation of bipolar patients from those comorbid with, or incorrectly diagnosed as, ADHD.

P-17-03 Long acting Methylphenidate improves cortical dysinhibition in adults with ADHD: A study with paired pulse Transcranial Magnetic Stimulation M. Schneider*, W. Retz, G. Gougleris, W. Verhoeven, J. Tulen, M. Rosler * Venray, The Netherlands Objective: Systematic evaluation of the effects of long acting methylphenidate (LA-Mph) on motor cortex excitability in adult patients with ADHD with the paired pulse transcranial magnetic stimulation (ppTMS) technique. Method: Thirteen right handed drug nave adult ADHD patients were included in this ppTMS study. Measurements took place before and under treatment with 30-54mg LA-Mph (daily dose). Statistical analyses were performed to investigate treatment effects and correlations with clinical symptomatology. Results: LA-Mph signicantly decreased the relative short intracortical motor inhibition (SICI) magnetically evoked potential (MEP) amplitude at 3ms interstimulus interval (conditioned/unconditioned MEP amplitude: 0.840.76 drug-free vs. 0.290.19 with LA-Mph; p=0.020). The relative intracortical facilitation (ICF) MEP amplitude at 11ms interstimulus interval (conditioned/unconditioned MEP amplitude: 1.510.92 drug-free vs. 1.790.95 with LA-Mph) was not signicantly increased. The decrease of the relative SICI MEP

P-17-02 Systematic parametric assessment of attentional dysfunction in medicated adult patients with Attention Decit Hyperactivity Disorder W. Schwarzkopf*, K. Hennig-Fast, U. Muller, T. Frodl, H. Muller, R. Engel, M. Riedel, H.-J. Moller, K. Finke


157 amplitude with LA-Mph correlated signicantly with the improvement of the psychopathological ADHD self-rating total scores (p=0.034) and hyperactivity/impulsivity subscores (p=0.029). These results show that in adult patients with ADHD, LA-Mph signicantly improves motor disinhibition, but has no signicant inuence on motor facilitation. Conclusion: LA-Mph might have differential stabilizing effects on motor hyperexcitability in adults with ADHD which correlates with the clinical improvements. These results are the basis for future pharmacological investigations of disturbed motor cortex excitability in adult ADHD. (PROs) when switched from a stable dose of Concerta (OROS-MPH) to the same dose of the generic Novo-Methylphenidate ER-C (MPHER-C) Method: A single centre, randomized double-blind cross-over trial was conducted in 20 adult patients with a primary diagnosis of ADHD. Patients were stable on OROS-MPH for at least 3 months before being randomized to receive either MPH-ER-C or OROSMPH in a two way cross-over design, after signing informed consent. Treatment periods were 3 weeks in duration at the patients current OROS-MPH dose, or mg-mg equivalent of MPH-ER-C. Patient-and physician-reported outcomes were assessed at baseline of each period and at the end of this study; analysis was conducted using a linear mixed effects ANOVA model. Results: Nineteen of the 20 enrolled patients were included in the efcacy analysis. The primary endpoint was, change over time in the Treatment Satisfaction Questionnaire for Medication- version II (TSQM-II) scores. Statistically signicant differences were observed between OROS-MPH and MPH-ER-C in the TSQM-II effectiveness (p=.04) and side effects (p=.03) subscales, which were also supported by changes in the Adult ADHD Quality-of-life Scale (AAQOL) and physician reported CGI-I and CGI-S. More adverse events were reported when treated with MPH-ER-C. Five patients withdrew upon switching to MPH-ER-C; one paitent withdrew consent. Conclusion: Patients treated with a stable dose of OROS-MPH were more satised in terms of efcay, side effects than those receiving an equivalent dose of the generic, MPH ER-C; this was also supported in the physician-reported CGI outcomes. All patients elected to return OROS-MPH at the conclusion of the trial. Although these treatments are deemed bioequivalent, this study shows clinically and statistically signicant differences in patient-and physician-reported treatment outcomes as well as patient discontinuation rates, which warrant further investigation.

P-17-04 Mood stabilization protocol mitigates risk in high-risk ADHD A. Ocana*, R. Rivers * West Vancouver, Canada Objective: Patients with ADHD can present with extreme academic, vocational and interpersonal impairment. The sum of which can be associated with enormous social costs. This is especially true among those with comorbid mood instability, such as Bipolar Spectrum Disorder; or comorbid disorders of reward regulation, such as substance use disorder or impulse control disorders. Thus a patient with ADHD and bipolar disorder, who has abused cocaine in the last year, would be conceptualized as ADHD plus Mood and Behavioural Instability (MBI). The object of this retrospective study was to review clinical outcomes in stimulant-treated patients with ADHD plus MBI or as we have termed it, high risk ADHD (HR-ADHD). Method: NorthShore ADHD clinic ( is a tertiary referral centre. In reviewing our clinical registry, 816 patients met the DSM IV-TR criteria for adult ADHD. Of these, 576 had at least one comorbid diagnosis, and 360 had HR-ADHD. All patients received a mood stabilization protocol which included strength-based counselling as well as coaching on diet, exercise and stress resilience. HRADHD patients underwent further mood stabilization with Lamotrigine (36.9%), Divalproate (6.4%), Topiramate (3.3%) or Lithium (1%). Prior to receiving stimulant medication, patients had to have 3 months recovery, documented by urine drug screen. Clinical outcomes were rated using the CGI. Results: The HR-ADHD groups baseline Global Assessment of Function (GAF) was 85-15; mean = 49.7; SD = 15.06. The mood stabilization protocol was successful, showing better than expected outcomes in stimulant treated patients, even in the group that included patients who were homeless and/or actively abusing substances (GAF\50). Of these, 79.8% had a positive response: Full remission, CGI=1 (28.9%); Near remission, CGI=2 (28.9%); Response, CGI=3 (22%). Mood stabilizing medications had a relatively low rate of adverse events (n=7) and mild-moderate allergic reactions (n=9). Conclusion: Because of the frequency of negative outcomes, patients with high risk ADHD, i.e. ADHD associated with comorbid mood or behavioural instability, may not receive treatment. A mood stabilization protocol can mitigate a signicant portion of that risk.

P-17-06 Comparative effects of Methylphenidate and Atomoxetine on AQT processing speed in ADHD Adults: Preliminary ndings N. P. Nielsen*, E. H. Wiig * Kbenhavn, Denmark Objective: To evaluate effects of treatment of ADHD adults with methylphenidate and atomoxetine on A Quick Test of Cognitive Speed (AQT) processing speed and efciency. Method: We administered the color, form and color-form naming tests to 13 ADHD adults (ages 17 to 41) and compared measures (sec.) without medication and after treatment with methylphenidate and atomoxetine. At baseline, ASRS-V1.1 ratings ranged from 22 to 56 (M = 40.33), indicating likely ADHD. Results: There were signicant differences in cognitive speed (F2,36 = 26.31; p = .000000) and processing efciency (F2,36 = 10.50; p = 0.0002) between pre- and post-treatment measures. Pre-medication, cognitive-speed (color-form) and processing-efciency (cognitive overhead) (M = 73.69 and 17.34 s.) were signicantly slower/larger than post-treatment with methylphenidate (M = 53.69 and 8.08 s.) and atomoxetine (M = 48.46 and 3.56 s.). Cognitive-speed and processing-efciency did not differ signicantly after treatment with methylphenidate (M = 53.69 and 8.08 s.) and atomoxetine (M = 48.46 and 8.23 s.). After medication with atomoxetine, ASRS-V1.1 ratings ranged from 11 to 36 (M = 23.56). Conclusion: Within the limitations of this study, ndings suggest that methylphenidate and atomoxetine affect cognitive speed and processing efciency similarly.

P-17-05 A randomised, double-blind cross-over, single-centre study to evaluate patient and physician reported outcomes on Concerta-Oros-Methylphenidate vs. the Generic NovoMethylphenidate ER-C A. Fallu*, F. Daboux * Sherbrooke, Canada Objective: The objective of the study was to evaluate adult ADAH (Attention Decit Hyperactivity Disorder) patient reported outcomes


158 P-17-07 The positive impact of methylphenidate in a sample of patients with Irritable Bowel Syndrome T. Freire Barbosa*, E. Barbante Casella * Sorocaba, Brazil Objective: Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders in the general population, affecting people of all ages. It is a chronic functional disorder of the intestines and is characterized by abdominal pain or discomfort, atulence and bloating associated with altered bowel habits. There is no specic exam to diagnose IBS and there is no single treatment established. After observing that some patients with Attention Decit Hyperactivity Disorder (ADHD) that presented signals and symptoms of IBS, which improved with the pharmacologic treatment of ADHD, and considering the fact that the catecholamines associated to ADHD also have a role in the control of the intestinal motility, we decided to study the correlation of these two conditions. Objectives: to review the pathophysiology of IBS and discuss the possibility of a positive impact of methylphenidate in IBS. Method: We studied nine patients, aged 5 and 59 years. All the patients had the diagnosis of ADHD and presented clinical symptoms of IBS. It was used Methylphenidate (MPH), initially in the dose of 0,5 mg/kg/day, and it was been readjusted individually, having as objective, the improvement of the picture of the ADHD. Results: Improvement was observed in all patients, in the ADHD and IBS symptoms. Conclusion: Although the pathophysiology of IBS is unclear, adds observations about relationship with central nervous system (CNS) maybe considered. Many of the neurotransmitters that found in the CNS have also been identied in the enteric nervous system (ENS), such catecholamines which modulate gastrointestinal motility, also controls the functioning of related cerebral circuits to the control of the attention, hyperactivity, impulsive behavior and executive functions; circuits these, that are modied in ADHD carriers. a driving simulator; two studies were conducted in cars in usual driving situations. All reviewed studies concluded that the use of MPH improved signicantly driving performance in patients with ADHD. In one study, OROS MPH signicantly improved driving conditions compared to placebo and to mixed amphetamine extended release salts. In all studies no signicant side effects of MPH were observed. Conclusion: A signicant improvement in driving performance after treatment with MPH was observed, both in male and female patients, and in teenagers and adults. Nevertheless, methodological limitations such as sample size, daily drug dosage and measurement of driving skills (simulators) should be considered. The literature on this subject is still scarce, making further studies necessary.

P-17-09 Does Biphentin have a signicant clinical impact on attentional networks in individuals with ADHD? K. Saliba*, U. Jain, R. Tannock * Milton, Canada Objective: To investigate the effects of pharmacological treatment on controlled attention in adults with Attention Decit Hyperactivity Disorder (ADHD). Method: This project forms one component of a collaborative largerscaled randomized controlled trial designed to evaluate effects of a long-acting medication (MLR methylphenidate, which is a widely used treatment for ADHD) on the driving performance of adults with ADHD. The project will enroll 30 adult participants with ADHD. Participants are recruited from the Adult ADHD clinic at the Centre for Addiction and Mental Health (CAMH), following a comprehensive diagnostic assessment to ensure eligibility based on pre-specied inclusion/exclusion criteria. Medication dose is optimized following study procedures prior to participating in my component of the project. Participants undergo a 48-hour washout period (from medication), prior to commencing the study protocols. Participants are then assessed under two conditions: placebo and their optimized dose of active medication, which are administered using randomized and multiple-blind procedures. The controlled attention measure is administered at the University of Guelph, where the driving simulator is located. Following a baseline practice of all measures, participants are administered either placebo or their optimized dose of active medication prior to completing the cognitive measure (the well-validated computer, Attentional Network Task [ANT], that assesses three separate neuronal networks - the alerting, orienting and executive functioning network) four times, at both assessment sessions. Results: Correlational and mixed between-within subjects analysis of variance will be conducted to test the hypothesis concerning: the effects of medication on controlled attention and ADHD symptoms. To date, 23 participants have completed the protocol, and the remaining 7 have been recruited and will complete the protocols over the next 1-2 months, allowing the data to be analyzed and the project to be completed prior to the conference. Conclusion: The economic costs of ADHD are substantial. This research will provide the rst empirical investigation of MPH effects on controlled attention in adults with ADHD.

P-17-08 Driving performance of patients with Attention Decit Hyperactivity Disorder (ADHD) after treatment with methylphenidate (MPH): systematic review of randomized controlled trials M. A. Gobbo*, M. Louza * Sao Paulo, Brazil Objective: To review randomized controlled trials (RCTs) on the effect of methylphenidate (MPH) in driving performance of patients with ADHD. Method: Search in PubMed, Lilacs and Cochrane databases, using the following terms ADHD, driving, methylphenidate. Inclusion criteria: RCTs. Exclusion criteria: case reports, reviews, observational trials. Results: Seventeen studies were found. After review, seven RCTs were considered for analysis. All patients were diagnosed according to DSV-IV criteria. All RCTs used a crossover design. Six studies were placebo controlled (one of these compared OROS MPH with mixed amphetamine extended release salts and placebo), one compared immediate release MPH with OROS MPH. Six studies were double-blind; one single-blind. In ve studies the sample size was smaller than 20 patients; the other two studies included respectively 35 and 53 patients. Drug dosage varied from 10 mg/day to 120 mg/ day of short-acting MPH and from 18 mg/day to 144 mg/day of OROS MPH. Three studies included both male and female patients; four, only male patients. Three studies evaluated teenager patients; four studies were conducted with adults. Five of the seven trials used

P-17-10 Predictive factors for more than 3 years duration of central stimulant treatment in adult ADHD: A retrospective, naturalistic study T. Torgersen*, B. Gjervan, H. M. Nordahl, K. Rasmussen * Trondheim, Norway


159 Objective: In spite of effective short-term central stimulant (CS) treatment of ADHD symptoms in adult ADHD, there is evidence for early discontinuation of the treatment in many patients. We wanted to study the duration of CS treatment in a Norwegian cohort of adult ADHD, and identify predictors for long treatment duration (C3 years). Method: The data were based on the medical records of a sample of 117 out of all 119 adult ADHD patients diagnosed over a period of 8 years in a specic catchment area, and treated with CS. A logistic regression model was applied to identify possible predictors for long treatment duration. Results: The sample was severely impaired in terms of comorbidity, educational achievement and employment. However, the median duration of CS treatment was 33.0 months. Use of extended release (ER) formulations of methylphenidate (MPH) predicted long treatment duration positively; OR 4.420 (1.875-10.419), while baseline antisocial personality disorder (APD) predicted long treatment duration negatively; OR 0.210 (0.085-0.518). Conclusion: This study showed that it is possible to treat severely impaired and highly comorbid adult ADHD patients with CS over years. The nding that ER formulations of MPH predict long treatment duration supports previous research, and it is important to show this association in naturalistic samples like the present. reduce the risk. This study is a double blind within subject controlled design using multilayer release methylphenidate (MLR MPH) at optimized doses in adult ADHD patients. A major component of this study is to assess the longtidudinal changes within the day using cognitive measures. Previous studies focus more on the on-task capacity in the evenings only and do not regard subject fatigue states after a long driving period. This would be akin to a long distance driver who must maintian greater vigilance. MLR MPH, a long acting psychostimulant, has not been investigated using this procedure but, as it uses the active primary ingredient, methylphenidate, it is likely to have comparable efcacy. Method: Thirty referrred patients selected from a major metropolitian city (Toronto) were recruited for this study and assessed at a University-based teaching-research hospital (Centre for Addiction and Mental Health) though the actual study was conducted at the University of Guelph. The subjects were randomized to the study drug versus placebo. The subjects would be put through a driving simulator and at regular intervals would be measured on various cognitive and clinical measures. The same protocol would be repeated with the other preparation on a successive weekend. Results: At the time of submission, all of the patients have been recurited for the study and the majority have completed the actual study procedures and, except for two patients, all have been optimized on their doses. The patients were typically dosed between 20-80 mg of MLR MPH which is consistent with the literature on this product. Conclusion: This is a complex study involving a long day of testing (starting early morning and ending after midnight) and is unique in the study design. It has already been established that psychostimulant medications are useful in on-task capacity but the uniqueness of the study design allows for a critical analysis of certain parameters that may be factors that make this a more compelling rationale for why it happens.

P-17-11 Relapse of comorbid substance use disorder during central stimulant treatment in severe adult ADHD T. Torgersen*, B. Gjervan, K. Rasmussen, H. M. Nordahl * Trondheim, Norway Objective: Central stimulant (CS) therapy is a cornerstone in treatment of ADHD. Substance use disorder (SUD) is a common comorbid disorder in adult ADHD and might complicate the remission of adult ADHD. Our objectives were to investigate the prevalence of relapse of SUD during CS treatment and to identify variables that could predict such relapse. Method: The collection of data was based on a naturalistic, retrospective approach using the medical records of a sample of 117 adult patients diagnosed with ADHD in a specic catchment area over a period of 8 years, and treated with CS. A logistic regression model was applied to identify possible predictors of relapse. Results: Most patients with comorbid SUD (58.5%) relapsed during CS treatment, and the relapses often led to termination of treatment. Younger age (p=0.039) and comorbid antisocial personality disorder (p=0.040) were positively related to relapse, while remission for more than 12 months (p=0.026) and living with a partner (p=0.015) were negative predictors. Conclusion: The clinician should treat comorbid SUD as a separate disorder, and try to obtain a stable and long remission period before introducing CS treatment for adult ADHD. CS treatment in patients with comorbid SUD requires multimodal intervention.

Friday, 27 May 2011, 14.3016.00 P-18 Pharmacological treatment: Adults II

P-18-01 Psychopharmacological treatment of ADHD patients older than 50 years - A pilot study M. B. Lensing*, P. Zeiner, S. Opjordsmoen * Oslo, Norway Objective: ADHD is a well-established diagnosis in children and adolescents. The condition can persist into adulthood. Short-term treatment with medication is found to be effective in most children, adolescents and younger adults. However, little is known about the effectiveness of treatment in adults over 50 years of age with ADHD. In this pilot study we therefore studied: 1) whether adults over 50 years of age ever had used medication for their ADHD and 2) if so, what did they report about treatment effects? Method: A short questionnaire survey was performed among members of the National ADHD patient organization in Norway. Subjects 50 years or older with ADHD were included. Subjects on long-term medication (the great majority with stimulants) were compared with those who had stopped treatment. Chi-square and independent t-tests were used in the statistical analyses. Results: The eligible number of participants was 251. A total of 153 (61.0%) answered the questionnaire, more females (58.8%) than males. The mean age was 55.8 years (SD 4.4), and the mean age when ADHD was diagnosed, was 50.3 (5.9) years. A majority (88.8%) had been treated with medication, and 71.9% were still on this treatment when entering the study. Subjects on medication reported

P-17-12 Driving risk in adult ADHD patients U. Jain*, K. Saliba, R. Yoon * Toronto, Canada Objective: Adult ADHD patients have driving risk and numerous studies have shown that the likely problems are related to executive functioning decits connected to the core symptoms of ADHD namely attention and impulsivity. ADHD patients have a higher rate of accidents, speeding infractions, and moving violations. Accumulated evidence points to a role using psychostimulant medications to


160 signicantly fewer symptoms of impairment with respect to hyperactivity (p=0.001), impulsivity (p=0.000), and inattention (p=0.000). They also reported better general health (p=0.023), better work capacity (p=0.038), better work motivation (p=0.003), and better ability to manage daily life activities (p=0.004). Conclusion: In adults with ADHD 50 years of age and older, treatment with medication seems to be in use and effective. Medication is associated with reports of signicant symptom reductions and improved daily functioning. Method: This multicentre trial enrolled adults (aged 1855 years) with ADHD on LDX (C6 months; 30-, 50-, or 70-mg/day nal dose at entry), with an ADHD Rating Scale IV with adult prompts (ADHDRS-IV) total score \22, and ratings B3 on the Clinical Global Impressions-Severity (CGI-S) scale. Following a 3-week open-label phase (OLP; LDX 30-, 50-, or 70-mg/day), subjects who maintained responder status were eligible to enter a 6-week double-blind RW phase (RWP) to continue on their OL LDX dose, or switch to placebo. The primary efcacy outcome was proportion of adults having ADHD symptom recurrence (C50% increase in ADHD-RS-IV score and C2 rating-point increase in CGI-S vs RWP baseline score). Safety/tolerability was also evaluated. Results: The OLP included 122 adults; 116 were randomized (LDX, n=56; placebo, n=60) and included in the efcacy analysis. At endpoint, a signicantly (P\0.0001) smaller proportion of adults taking LDX met criteria for ADHD recurrence and were withdrawn (8.9%; 5/56) versus placebo (75%; 45/60). Four subjects taking LDX and 26 taking placebo met ADHD recurrence criteria after 1 week of treatment in the RWP. At 2 weeks, 10 additional participants taking placebo and 0 taking LDX met criteria. During the RWP, 38.8% of 116 subjects (27 LDX, 18 placebo) had a treatment-emergent adverse event. Conclusion: Subjects receiving long-term LDX treatment demonstrated maintenance of efcacy versus placebo upon RW. ADHD symptoms tended to recur early following discontinuation of LDX in the RWP, mostly by 2 weeks. The LDX safety prole was consistent with previous studies and long-acting stimulant use.

P-18-02 A pilot study on the effects of nicotine on attention and concentration in students with adult ADHD symptomatology S. Sayce*, A. Burke * Johannesburg, South Africa Objective: The aim of this study is to explore the effects of nicotine on the attention and concentration levels young adults with Adult ADHD. Method: In order to meet the aims of this study, a quasi-experimental design was utilized. In order to investigate what the extraneous variables may be, a pilot study was conducted rst. A group of four participants were selected on the basis of their use of nicotine (in the form of a cigarette), and one for the use of a hookah pipe. In order to measure attention and concentration, the following three subtests on the CANTAB were selected: Motor Control Task, Rapid Visual Information Processing Test, and the Stop Signal Test. The participants were asked to refrain from using any nicotine products for a period of 12 h prior to the study. The CANTAB tests were administered, where after they were asked to smoke a cigarette. The literature indicates that nicotine that is inhaled starts affecting the brain within 10 20 s after inhalation. Based on this, the participants were required to retake the CANTAB test immediately after they stopped smoking. Results: The results of the pilot study indicated that there is a signicant improvement in attention, concentration and impulse control after inhaling nicotine. These results are, however, extremely tentative due to the small sample size. As the research is still continuing, more reliable data will be available in the near future. Important lessons were, however, learnt from the pilot study, which will be incorporated into future experiments. These include: Refraining from smoking for 12 h may be too excessive, and nicotine withdrawal may have an impact on the initial assessment. In future, participants will only be required to abstain for 4 h. Smoking a hookah pipe for 60 min is excessive, and 7 min (equal to smoking a cigarette) should be sufcient. A second post-test, 2 h after smoking will be done in order to assess long term affects. Conclusion: Results of this study may explain why adults with ADHD are prone to abusing nicotine products.

P-18-04 Long duration of efcacy of lisdexamfetamine dimesylate, the rst prodrug for Attention Decit Hyperactivity Disorder M. Gasior*, S. Wigal, T. Wigal, J. Gao, C. Richards * Wayne, USA Objective: To evaluate the duration of action of lisdexamfetamine dimesylate (LDX) in paediatric and adult subjects. Method: The duration of LDX effect was evaluated in children (612 years) and adults (1855 years) in one parallel-group and two crossover studies. In the former, children were randomized to LDX 30, 50, or 70 mg/day with forced titration, or placebo, for 4 weeks. Study visits occurred once weekly during the treatment phase. In the latter two studies, subjects were titrated to an optimal LDX dose (up to 70 mg/day) during a 4-week optimization phase, followed by a 2-week double-blind crossover (LDX 1 week, placebo 1 week). Children and adults were evaluated once weekly in a highly structured controlled environment (laboratory school or adult workplace environment); assessments were conducted up to 13 h postdose in children and up to 14 h postdose in adults. All statistical tests were 2-sided and performed at the 0.05 signicance level. Results: 230 of the 290 subjects randomized completed the parallelgroup study. Use of the Conners Parent Rating Scale-Revised: Short Form (CPRS-R) demonstrated that LDX was effective throughout the day (i.e. from the rst observation [10a.m.] until the nal observation [6p.m.]). Of the 117 paediatric subjects randomized, 111 completed the laboratory school study. LDX was effective from 1.5 to 13 h postdose based on results for the SKAMP deportment (behaviour) subscale (SKAMP-D), attention subscale (SKAMP-A), total SKAMP score and PERMP scores. Of the 127 subjects randomized, 103 completed the adult crossover study. LDX was effective from 2 to 14 h postdose based on the PERMP. Conclusion: In all three studies, the efcacy of LDX allowed for coverage into the evening hours for children and adults, as measured by behavioural and performance measures, respectively.

P-18-03 Maintenance of efcacy of lisdexamfetamine dimesylate in adults with Attention Decit Hyperactivity Disorder: randomized withdrawal design M. Gasior*, M. Brams, R. Weisler, R. Findling, M. Hamdani, M. C. Ferreira-Cornwell * Wayne, USA Objective: To evaluate maintenance of efcacy of lisdexamfetamine dimesylate (LDX) using a double-blind, randomized withdrawal (RW) design in adults with ADHD on stable treatment. The RW design minimizes time off active treatment and is recommended by the European Medicines Agency.


161 P-18-05 Metadoxine - a novel non-stimulant extended-release drug for treating adhd I. Manor*, Y. Daniely, D. Meggido, R. Yamin, A. Weizman * Tel Aviv, Israel Objective: Metadoxine (pyridoxol L-2-pyrrolidone-5-carboxylate), an ion-pair salt of pyridoxine and pyrrolidone carboxylate, is approved in some countries for use in the treatment of acute and chronic alcohol intoxication. Our pre-clinical studies suggest that Metadoxine affects the Serotonin receptor family and modulates hyperactive behavior. These and additional ndings led us to propose a therapeutic role for Metadoxine in ADHD. Method: A 40-person adult (32.1 6.9 years) ADHD study has been conducted in our clinic. All subjects were dosed with a single 1400 mg dose of Extended-Release Metadoxine (ER-Met). Subjects were diagnosed with ADHD using DSM-IV criteria, and according to international standards. Subjects were tested before and 90 min after dosing using the computerized Test of Variables of Attention (TOVA). Results: Among others, the TOVA ADHD score increased from a mean of -4.9 to a mean of -1.8 (SE=2.1, p\0.001), and response time variability increased from a mean of 68.9 to a mean of 86.5 (SE=9.5, p\0.001). In WAIS-R, the correct symbol identication test score increased from a mean of 34.7 to 37.9 (SE=1.6, p\0.001) and the symbol search score increased from a mean of 74.6 to a mean of 81.8 (SE=2.5, p\0.001). All subjects reported minimal to no side effects. Conclusion: An extension trial in a similar population (n=10) established the sustained effect of ER-Met using similar endpoints, with consistent improvement shown at both the 4 h and 7 h time points. A 6-week Phase IIb study (multi-center, randomized, doubleblinded parallel placebo-controlled) in 120 subjects is now ongoing in order to further establish ER-Met safety and efcacy in this indication. Conclusion: ADHD is a highly prevalent disorder with signicant functional impact that often persists into adulthood. There is very little data comparing different stimulant treatments. Although the current observational ndings have limitations, they will undoubtedly contribute to increasing our understanding of the treatment of ADHD.

P-18-07 Pharmaceutical treatment of Attention Decit Hyperactivity Disorder (ADHD) in adults an overview of available studies and the medical situation in Germany based on a health technology assessment D. Benkert*, K.-H. Krause, J. Wasem, P. Aidelsburger * Sauerlach, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) is a mental disorder. An established form of therapy is using stimulants medications, most commonly, containing Methylphenidate as the active ingredient. However, in Germany this ingredient is not approved for adults suffering from ADHD. In the following Health Technology Assessment, the situation of studies regarding adult ADHD as well as available medical care, are discussed and viewed from different perspectives Method: In August 2009, a systematic literature search was performed in relevant scientic databases to the efcacy and costeffectiveness of the medical treatment of ADHD in adults as well as the ethical, social and legal aspects in regard to society and care. Results: Nineteen studies fulll the inclusion criteria: nine randomised controlled trials, ve meta-analyses, three economic studies and two studies relevant to legal aspects. Studies show pharmacutical treatment to be signicantly efcient in treating adult ADHD, especially for methylphenidate, amphetamine, dextroamphetamine and bupropion - as compared with placebo in patient-relevant endpoints. The average annual medical expenses for an adult with ADHD were between 1,270 and 1,619 Euro. The legal issues related to ADHD, generally, revolve around the use of stimulant medication, since stimulants fall under the category of narcotics. Particularly the legal aspects of stimulant use in regard to driving, traveling, performing military service and doing competitive sports must be considered. From societys perspective, a growing acceptance of drug-treatment for adults with ADHD is to be expected in the healthcare policy environment. For example, on the Internet pages of the ADHD information portal quick tests and knowledge tests on the topic ADHD can be conducted. Conclusion: An early start of pharmacological treatment of ADHD is economically and politically highly relevant because of the social disadvantages, high risk of developing other mental disorders and high costs for society.

P-18-06 The effect of OROS methylphenidate and long-acting amphetamine salts on cognitive tasks in adults with Attention Decit Hyperactivity Disorder: An open trial with blind placebo control comparison T. Simon*, M. Bilodeau, M. Beauchamp, R. Elie, P. Lesperance, S. Dubreucq, J.-P. Doree, S. V. Tourjman * Montreal, Canada Objective: To compare the effect of different stimulant medications on cognitive tasks in adults with Attention Decit Hyperactivity Disorder (ADHD). Method: Following a clinical trial with ADHD subjects, participants were clinically stabilized on long acting stimulant medication between August 2009 and January 2011 at the Centre Hospitalier Universitaire de Montreal and the Fernand-Seguin Research Center. Thirteen adults with ADHD without signicant comorbidity were treated sequentially with OROS methylphenidate (Concerta) and long-active mixed amphetamine salts (Adderall-XR). Once stabilized at optimal dosage, subjects completed subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) assessing spatial working memory, attention and inhibition. Results were then compared to those obtained from fteen subjects treated with placebo during the initial double-blind study. Results were analysed using a 3 9 3 MANOVA. Results: Preliminary results will be presented. The expected result is a greater improvement on the CANTAB tests with stimulant medications compared to placebo. The improvement with the two stimulant medications might show differences on specic CANTAB tests.

P-18-08 Pharmacological treatment for ADHD in adults: The Italian reality B. Plattner*, E. Duregger, A. Conca * Bolzano, Italy Objective: In January 2010 the Department of Psychiatry in Bolzano/ Italy opened the rst Italian ADHD center for adults. The real challenge were and still are legal restrictions in prescribing off-labeldrugs even if the evidence for their efciency exists. Method: We report two cases in which the conditions of legal and nancial restriction demonstrated an important clinical impact as well


162 as clinically relevant pieces of information where obtained under alternative pharmacological regimes. In the rst case the legal contest was the determining one to switch from Methylphenidat to Bupropion. Patient A, male, age 21 was diagnosed with ADHD in his rst decade. Medication was changed from Methylphenidat to an increasing dose rate of Bupropion until reaching 450mg/d. Medication was taken at 13:00 to reach maximum plasma levels while the patient was attending evening school. He works out 2h/d, attends group therapy and weekly personal coaching. Patient B, male, age 20, was diagnosed with ADHD as an adult after having experienced severe problems in school and in diverse relationships. He was initially treated with Bupropion as monotherapy in normal dosage. Due to a partial response (positive impact on nicotin and alcohol consumption) comedication with Methylphenidat was successfully implemented in a gentleman agreement with the pharmacist. Results: Patient A reported equal concentration ability with Methylphenidat retard and Bupropion. Initial hypersensivity to external stimuli decreased rapidly. Bupropion yielded not the same result in Patient B so that comedication with Methylphenidat was deamed necessary. In both cases the response was of clinical relevance and increased the social functioning and stable occupational setting as well as stable relationships. Conclusion: Legal restrictions severly hamper state of the art treatement of adult ADHD patients in Italy and demand a change in professional and political attitude regarding this mental illness. diagnosed with co-morbid GA. Analysis involved the two treatment groups (stimulants and non-stimulants). Detailed analysis of the relationship between ADHD symptoms, anxiety symptoms, and functional impairments scores before and after treatments utilizing the repeated measures multivariate analysis of variance (MANOVA) with will be presented. Conclusion: Both stimulants (amphetamine salts, and atomoxetine, are effective in reducing disability in adult ADHD patients suffering from comorbid GAD, and both were overall well tolerated.

P-18-10 Individualized dosing with OROS Methylphenidate to optimize treatment in adults with Attention Decit Hyperactivity Disorder B. Schaeuble*, H. L. Starr, R. B. Armstrong, Y.-W. Ma, S. Ascher * Neuss, Germany Objective: To evaluate efcacy and safety of individualized dosing of OROS MPH in adults with ADHD. Method: Randomized, double blind, placebo controlled parallel group study including adults with ADHD with an AISRS score [24. Individualized daily dose (OROS MPH 18, 36, 54, or 72 mg or matching placebo) was determined with a goal of AISRS score \18 during a 4-week dose adjustment period; patients then maintained their dose for 14 days. Changes in AISRS scores (the primary outcome) from baseline to nal visit were analyzed using ANCOVA. Results: Of 341 patients in the intent-to-treat population (OROS MPH, 169; placebo, 172), 162 (47.5%) were female. Mean age was 35.8 years. Percentages of patients with each nal OROS MPH dose were 18 mg: 13.6%, 36 mg: 23.1%, 54 mg: 24.3%, and 72 mg: 39.1%. Mean (SD) baseline AISRS scores were 37.8 (6.94) for OROS MPH and 37.0 (7.51) for placebo. The OROS MPH group had signicantly greater improvement than the placebo group in AISRS scores (17.1 [SD=12.44] vs. 11.7 [SD=13.30], P\0.001). Adverse events reported by C10% of patients were headache, dry mouth, and decreased appetite in the OROS MPH group and headache in the placebo group. Of the randomized subjects, 8/178 (4.5%) in the OROS MPH group and 5/179 (2.8%) in the placebo group withdrew because of adverse events. One serious adverse event occurred in the placebo group. No deaths occurred. Conclusion: Individualized dosing of OROS MPH with the goal of symptom remission resulted in greater ADHD symptom reduction than placebo treatment.

P-18-09 Functional impairments of adult ADHD patients with or without co-morbid generalized anxiety before and after treatment with stimulants or non-stimulants: A Comparative naturalistic study S. Mousa*, A. Gabriel * Calgary AB, Canada Objective: Substantial proportion of patients with ADHD may suffer from comorbid anxiety. The main objective is to examine and compare functional impairments in adult ADHD patients with or without Generalized Anxiety Disorder (GAD), treated with stimulants or nostimulants. Method: Consenting adult ADHD patients (n= 88) participated in this open label naturalistic study. Of the total number of patients (n = 62, 70%) had signicant comorbid anxiety symptoms (HAM-A [ 7). There were (n = 57, 65%) treated with stimulants (amphetamine salts or lisdexamfetamine dimethylate) and (n = 31, 35%) treated with the non-stimulant atomoxetine. All those suffering from GAD failed to respond to 8 week trials of SSRIs, or SNRIs prior to the adjunctive treatment with stimulants or atomoxetine. The primary effectiveness measure were the Sheehans disability scale, and the WEISS functional impairment rating scale self-report (WFIRS-S). Other scales included adult ADHD self report scale (ASRS-v1.1) symptom checklist, the Clinical Global Impression severity subscale (CGI-S), Hamilton anxiety scale (HAM-A). Baseline measures prior to the treatment with stimulants and atomoxetine were compared to those at 4, 8, and at 12 weeks of treatment. Monitoring for pulse, blood pressure and weight changes was carried out at baseline and at endpoint. Results: All patients completed this open label naturalistic study. There was signicant and robust resolution of symptoms of all effectiveness measures, including the symptoms of anxiety, as shown by changes from baseline in ASRS-v1.1, HAM-A, and CGI at 8 weeks in patients treated with stimulants or with atomoxetine. Also there was signicant reduction in disability scores on both the clinician rated Sheehans disability scale and the self report WFIRS-S scales at 12 weeks. However patients without comorbid anxiety were less impaired at both baseline and at 12 weeks than patients who were

P-18-11 Oros methylphenidate and patient-reported work-related outcomes in adults with Attention Decit Hyperactivity Disorder B. Schaeuble*, S. Ascher, Y.-W. Ma, H. L. Starr * Neuss, Germany Objective: To assess patient-reported work outcomes in adults with ADHD. Method: Double-blind, placebo-controlled, dose titration study of OROS MPH in adults with ADHD (1865 years). Subjects were randomly allocated to 6-week treatment with placebo or OROS MPH. Doses were initiated at 18 mg/d with weekly 18-mg increases to a total AISRS score of less than 18 or maximum dose of 72 mg/d. Efcacy outcomes included the investigator evaluated AISRS and the Endicott Work Productivity Scale (EWPS) which is a 25-item, selfreport questionnaire that assesses feelings and behaviors at work that affect productivity and efciency. Low scores indicate low negative impact on work productivity and efciency. Results: 341 patients were included in the ITT population (OROS MPH, 169; placebo, 172). Mean (SD) baseline AISRS scores were 37.8


163 (6.94) for OROS MPH and 37.0 (7.51) for placebo. The OROS MPH group had signicantly greater improvement than the placebo group in AISRS scores (17.1 [SD=12.44] vs. 11.7 [SD=13.30], P\0.001). Mean (SD) baseline values for EWPS were 46.2 (17.1) and 44.7 (19.6) for OROS-MPH and placebo group respectively. The LS mean changes from baseline to endpoint for the EWPS were 18.2 (OROS group) and 11.7 (placebo group). The LS mean change difference between treatments was 6.5 points, (nominal p=0.008). Adverse events reported by C10% of patients were headache, dry mouth, and decreased appetite in the OROS MPH group, and headache in the placebo group. Of the randomized subjects, 8/178 (4.5%) in the OROS MPH group and 5/179 (2.8%) in the placebo group withdrew because of adverse events. One serious adverse event occurred in the placebo group. Conclusion: Treatment with OROS MPH improved self-reported feelings and behaviors contributing to work productivity and efciency, important components of health and productivity management. OROS MPH was generally safe and well tolerated. suggest that Neurofeedback offers similar results as the standard drug treatment in the improvement of ADHD symptoms.

P-19-02 Determining the effectiveness of reality therapy on reducing depression amongst mothers with children aficted with Attention Decit Hyperactivity Disorder M. Darini*, P. Azizi khereshki, H. Davoodi * Tehran, Iran Objective: Attention Decit Hyperactivity Disorder (ADHD) is the most common neuro-behavioral disorder in childhood. And in order to improve social and emotional interactions of these children who suffer from ADHD a great deal of psychological interventions are required from which one of the most inuential programs is parent mass education.The objective of this study is to determine the efciency of mass education program of reality therapy on reducing depression (ADHD) amongst mothers. It should be mentioned that the adopted sampling method is multi-stage cluster sampling and the selected subject group for this research is consisted of mothers who have children aficted with ADHD and are residence of Tehran. Method: In this procedure 24 of the individuals who gained higher average scores in one Beck depression questionnaire -21 questionswere randomized in to two groups of 12 individuals, one as control group while the other as experimental group. Both groups received mass reality therapy through eight 2 h sessions. Both groups were tested and evaluated two times (pre-test, post-test). Results: The study of results obtained from analysis of covariance using statistical-tests veries the efciency of mass reality therapy in reduction of depression amongst mothers with children aficted with ADHD. Conclusion: With regard to the effectiveness of reality therapy in comparison with other therapeutic approaches, it is strongly recommended to the mothers who own children contracted ADHD to consider this approach for their children.

Friday, 27 May 2011, 14.3016.00 P-19 Non pharmacological treatment: Children and adolescents I
P-19-01 Neurofeedback and standard pharmacological intervention in the improvement of Attention Decit Hyperactivity Disorder symptomatology: Preliminary ndings V. Meisel*, G. Garca-Banda, E. Cardo, M. Servera, P. Aggensteiner, T. Perez, J. Picardo, I. Moreno * Palma de Mallorca, Spain Objective: Many studies have shown that Neurofeedback could be an alternative treatment for Attention Decit Hyperactivity Disorder (ADHD). However, this intervention has not been commonly recognized as an efcacious treatment for ADHD due to the important methodological limitations that many of these studies have. We present preliminary data of a randomized, controlled, and open study that aims to determine the efcacy of Neurofeedback compared to standard pharmacological intervention for the treatment of ADHD. Method: This project is a multicentric study (University of Seville and Univesity of Balearic Islands) that evaluates the level of improvement of ADHD symptomatology with the following assessments: pre-treatment or baseline assessment, 3 assessments during treatment, post-treatment and 2 follow-up assessments. These assessments included several behavior rating scales completed by teachers and parents. The data presented here refers to 8 participants (7 -12 years old), and their pre-treatment and post-treatment assessments. Neurofeedback training was conducted over a period of 20 weeks with 2 sessions per week, using an Atlantis II 2 9 2 Brain Master. The training consisted in supressing Theta (4-8 Hz) while increasing Beta (12-20 Hz). Results: As expected, the pharmacological intervention group improved in 10 of the 12 evaluated variables. The improvements on inattention according to mothers and teachers, and hyperactivity according to teachers,were almost statistically signicant. On the other hand, participants in the Neurofeedback group also improved in 10 of the 12 assessed variables. The improvements on the functional impairment measures and hyperactivity for fathers, inattention for mothers, and reading and reading comprehension for teachers were almost signicant. Conclusion: Although these results are not signicant, both treatments show a tendency of improvement. Theses preliminary ndings

P-19-03 Effect of music training and movement on redusing the symptoms of attantion decit hyperactivity disorder M. Esteki*, Z. Atashkar * Tehran, Iran Objective: The present study is conducted to investigate the effect of music training and movement on decreasing the symptoms of Attention Decit Hyperactivity Disorder. Some studies show that music therapy for children with Attention Decit Hyperactivity Disorder can improve their cognitive skills such as attention and memory, and play an important role to decrease the impulsivity behavior. Rhythmic movement for harmonic and regularity that they have can affect on perception and attention of the children with hyperactivity disorder. Method: Memory test, attention test and Leiter-R questionnaire are used at this study. The present study is experimental with pre-test and post test method and control group. Statistical population is all and boys at the age of seven ten with Attention Decit Hyperactivity Disorder referred to clinics of saveh city. The size of session was 50 and the sample size was 20 that selected randomly from clinics and divided into 2 group experimental and control groups. For training music, Orff method was used. Therapy was for 15 session. T Test and covariance analyze used to analyze the information. Results: Results indicated the music training and movements have effect on decreasing the symptoms of Attention Decit Hyperactivity


164 Disorder so music along with movement can be used to decrease the symptoms of this disorder at school and home. Conclusion: Music and movement play an important role in training and treatment in ADHD. These are enjoyable work for children. So it is better to use it for treatment of childeren. period and becoming more efcient in dealing with time-wasters; organization of the studying space, including personalized courses in language, English and art therapy and assigning a personal tutor. Results: The center offers support for all learning disabilities, such as dyslexia, dyscalculia and dysgraphia. The center is run by professionals from academia, a center manager who is a learning disabilities expert, a psychologist who specializes in diagnosing and treating learning disabilities, an occupational therapist, an expert in handwriting, organization for studying and sensory processing related difculties, an assistance technologies expert and student tutors. Each student with a learning disability and/or attention decit disorder arriving in EIC is assigned a personalized assistance package to suit his/her unique needs. Conclusion: The EIC model has been recognized by Israels Ministry of Education and EIC centers are to be nowadays found in a few postprimary schools.

P-19-04 Changes in omega 3/6 fatty acid plasma proles in a randomized placebo-controlled study in children and adolescents with ADHD M. Johnson*, J.-E. Mansson, S. Ostlund, G. Fransson * Goteborg, Sweden Objective: Background: A small number of studies have examined fatty acid proles in plasma or red blood cells in children with ADHD and controls suggesting that children with ADHD have lower Omega 3 blood levels and higher n-6/n-3 ratios than controls. Objective: Assess baseline levels and changes in plasma fatty acid proles in children and adolescents with ADHD, participating in a placebocontrolled study with Omega 3/6 supplementation, and relationships between fatty acid measures and treatment response. Method: 75 children and adolescents aged 8-18 years with DSM-IV ADHD were randomized to 3 months of Omega 3/6 (Equazen eye qTM) or placebo, followed by 3 months of open phase Omega 3/6 for all. Plasma fatty acids (n-3, n-6, n-6/n-3 ratio, EPA and DHA) were measured at baseline, 3 and 6 months. Results: Subjects with a clinically meaningful reduction of ADHD symptoms (more than 25%) at 3 or 6 months were classied as 3-month responders or 6-month responders. At baseline, there were no signicant differences in mean n-3, n-6, n-6/n-3 ratio, EPA or DHA across the active and placebo group or across responder and non-responder group (but the 6-month responders tended to have a higher baseline n-6/n-3 ratio). The 0-3 month changes in these parameters were signicantly greater in the active group (p\0.05). The 6-month responders had signicantly greater changes than non-responders in n-3 at 3 months (increase) and in n-6/n-3 ratio at 3 and 6 months (decrease). Conclusion: Omega 3/6 supplementation had a clear impact on plasma fatty acid levels in the active group. A signicant correlation was found between treatment response and plasma fatty acid changes. The most pronounced shifts were seen in the n-6/n-3 balance.

P-19-06 Creativity training effects upon concept map complexity of children with Attention Decit Hyperactivity Disorder (ADHD): An experimental study K. Alkahtani* * Riyadh, Saudi Arabia Objective: To extend the knowledge about creative thinking among children with Attention Decit Hyperactivity Disorder (ADHD) via investigating the effects of creativity training upon concept mapping prociency. Method: A pretest-posttest control group design was used. In order to ensure that concept mapping is a familiar technique to all participants (students aged 9-10 years and diagnosed as having ADHD), they all were given a training session in concept mapping. Next to that, they were asked to complete a concept map (CM) and Torrance Tests of Creative Thinking (TTCT) as a pre-test measure. They then were assigned to either experimental or control group, and the experimental group was given creativity training. Finally, all participants completed a second CM and the TTCT as a post-test measure. Results: The post-test scores for the two groups were signicantly different on the TTCT (t=3.450, P=0.001) and on the CM (t=6.690, P=0.0001) indicating that the participants who received creativity training displayed signicantly higher post-test scores at the 0.01 level compared to the control group. A strong positive correlation was also found, for the pre-test scores was (r=0.961, P\0.0001) and for the post-test scores was (r=0.878, P\0.0001). This correlation shows a signicant relationship at the 0.01 level between the students scores on the TTCT and CM in both the pre-test and the post-test. Conclusion: Maps of the students in the experimental group point to a deep learning and understanding which resulted from the change in their learning strategies. They used different thinking skills and learning strategies to read, understand, and map the text. The maps constructed by those students reected changes in their conceptual understanding which was evidenced by a higher number of concepts and cross-links. Therefore, they should not be excluded from having the opportunity to develop their potential of being creative personnel.

P-19-05 Empowerment and Insight Center for students with learning disabilities and ADHD O. Tykochinsky*, A. Frishman Shetrit * Hod Hasharon, Israel Objective: Empowerment & Insight Center (EIC) was established at the Kibbutzim College of Education in order to assist and empower students with learning disabilities and ADHD. Each year, EIC assists 330 Kibbutzim College of Education B.Ed students. EICs vision is to offer our students the opportunities to realize their intellectual and personal potential and develop their unique skills, so that they may contribute in the eld of education. Method: The center follows the Human occupational model, which focuses on three components: the persons components, the component of the occupation and the components of the environment. The goal is to promote a level of participation and success in studying with minimal effort and with maximum concentration in studying. The center offer students aid in the following areas: improving occupational skills, including learning accommodations and assessment accommodations; time planning and organization, which includes a monthly and weekly planning, getting organized during the exam

P-19-07 Cognitive behavioral therapy in the treatment of children with Attention Decit Hyperactivity Disorder L. F. Coelho*, M. C. Miranda, D. L. F. Barbosa, S. Rizzutti, M. Muszkat, S. M. M. Palma, F. Rosangela, F. Dias, O. F. A. Bueno * Sao Paulo, Brazil


165 Objective: The cognitive behavioral therapy (CBT) is the most studied modality of non-medicated treatment in patients with Attention Decit Hyperactivity Disorder (ADHD). However there are no CBT records to be used in groups, which could be useful for health centers. To analyze the efciency of a CBT group protocol in the treatment of the behavioral and cognitive symptoms in children with ADHD. Method: A CBT program for the treatment of children with ADHD was elaborated containing 20 two-hour sessions, being 40 min with the parents and 1 h and 20 min with the children. The used techniques address: psycoeducation, parents training, routine elaborations, token economy, planning, auto-instruction, problem-solving and an exercise in social abilities. The protocol was applied in a group of ve ADHD boys, with average age of 9,5. It was used methylphenidate LA 20mg during the treatment. The pre and post treatment evaluation was composed by the following cognitive and behavioral instruments: DSM-IV criteria, Continuous Performance Test (CPT), ve subtestes from Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Results: It was held a qualitative analysis of the scores in the scales answered by the teachers in which it was veried that has decrease of the hyperactivity manifestation, attention and anxiety at school, increasing the socialization capacity, behavioral regulation and metacognition. In the parents scales it was noticed the decrease of the internalizing and externalizing scores. About the cognitive aspects there was an improvement in all attentional and working memory performance. Conclusion: A group of ve children will be included and will be reevaluated in March, 2011, so the relevant conclusions to this study, which means the improvement of the cognitive and behavioral symptoms, will be submitted together with the current data. Objective: Group-therapy for adolescents with AD(H)D are not established in the treatment standardized. Barklay described a pro gram in 2009. In 2010 Sprober investigate a SAVE cognitivebehavioral group-therapy program at the University of Ulm. Helinger, Philippsen and Ebert developed a cognitive-behavioral grouptherapy with young adults at the University of Freiburg. Method: The scope of our therapy approach with adolescents with AD(H)D is an interactive focus. As a result of the symptoms of AD(H)D, problems themselves come along with others. Moreover children, adolescents and adults are often not noticed their own symptoms. With reference of systemic, interactional-analytical and cognitive-behavioral elements of group-therapies we carried out 8 sessions. We worked with two therapists and used media like movies, homework, reciprocal observation, describing and correcting each other. We tried to drew attention the symptoms into the therapyinterventions. Therefore the patient should take the role of the therapist or change their perspectives. But to generalized signicance of situations into the therapy to real daily problems was very difcult for adolescents and superimposed by the dysfunctions of AD(H)D. Our study population include adolescents with severe youth psychiatric problems. We integrate all patients with co-morbid disturbing. Exclusion criteria were acute addiction, autism spectrum disorders or criminal trials. Results: From May to September 2010 we realized 10 sessions. All participants were motivated to continue and want to prolonged the therapy after 8 sessions. 3 months after nish the therapy, we invited the adolescents and their parents. We discussed the intervention, whether there was an effect or not, and, what works from the point of view of the youth and their parents or were dysfunctional. Education about AD(H)D in adolescence, structuring and self-management strategies were useful, but interactive interventions like breaks, group-works and role-playing sustainable, because the youth noticed their own thoughts, emotions and pattern of reaction during reections of role-playing or reciprocal descriptions. Conclusion: Up to now we cant give a prognosis, whether our approach of a group-therapy with adolescents lead to reduction of symptoms in daily routine. Below study results show an impression of positive side effects like self organisation regarding the sessions in our hospital, contacts with the others outside the sessions. Interactive interventions show possibilities the youth to involve into the therapy. It should be useful strategies to motivate youth persons with AD(H)D to tackle with their own problems.

P-19-08 An experiential-based psychotherapeutic plan for Attention Decit Hyperactivity Disorder in children G. Cucu-Ciuhan* * Pitesti, Romania Objective: The paper presents the results of a controlled study that had the purpose to test the efciency of a complex experiential-based psychotherapeutic plan for the treatment of ADHD. Method: This psychotherapeutic plan combines metaphorical scenarios adapted for therapeutic intervention in small groups of hyperactive children with special groups of professional optimisation organised for the teachers of these children. The subjects were 40 children diagnosed with ADHD, combined type. Results: One-way ANOVA showed that there is a signicant difference between the four groups on each criterion (p \ .05). Bonferoni Post-hoc multiple comparisons tests showed that this difference is due to the mean scores for the control group, signicantly different from the experimental groups. Conclusion: Results show that group experiential psychotherapy leads to a signicant global behavioural progress in the case of children diagnosed with ADHD. Teachers participation in a professional optimization group leads to a signicant behavioral progress of children in their class diagnosed with ADHD.

P-19-10 Treatment of ADHD in affected mothers and children a randomized controlled multicentre trial: Patient enrolment and basic characteristics of the study sample T. Jans*, C. Jacob, K. Hennighausen, E. Graf, M. Rosler, S. Haenig, E. Sobanski, L. Poustka, M. Colla, R. Burghardt, A. Philipsen * Wurzburg, Germany Objective: The objective of our randomized controlled multicenter trial is to evaluate whether the treatment of maternal ADHD improves the efcacy of a behavioural parent training for childrens ADHD. Method: 144 mother-child-pairs - both affected by ADHD according to DSM-IV - were treated or are currently under treatment at ve study sites in Germany. Mothers were randomized to cognitivebehavioural group psychotherapy plus open methylphenidate treatment or to control treatment (supportive counselling). After 13 weeks of treatment of the mothers behavioural parent training is administered to all mother-child-pairs on a weekly basis for 12 a period of weeks. The primary endpoint of the trial refers to the change in the childrens externalizing symptoms from baseline to week 26 (after parent training).

P-19-09 InterActIVE: An approach of group-therapy for adolescents with AD(H)D T. Krause* * Munchen, Germany


166 Results: Last patient out will take place in May 2011. Therefore, outcome data will not be open to the study group until June 2011. At the time of abstract submission data clearing was still under progress with respect to screening and baseline data. Data on patient enrolment and basic characteristics of the study sample will be presented. Conclusion: To our knowledge our study is the rst randomized controlled trial on a combined treatment of ADHD in affected mothers and children (CCT: ISRCTN73911400, source of funding: German Federal Ministry of Education and Research - BMBF 01GV0605). Conclusion: Results indicate that sustained attention performance of children with ADHD will improve with computer-based attention training.

P-19-15 What changes in preschoolers with ADHD symptoms after a 14 week parental intervention: Preliminary results A. Azevedo*, M. J. Seabra-Santos, M. F. Gaspar, T. Homem, S. Leitao * Coimbra, Portugal

P-19-13 Children with ADHD attended outpatient clinic and day care program: The impact of psychosocial intervention A. Al Ansari* * Manama, Bahrain Objective: Evaluation of the effectiveness of psychosocial intervention in comparison to the usual outpatient management. Method: Design: Retrospective/cross section design. Method: Children aged 5-16 years, received DSM IV ADHD diagnosis and spend at least 4 weeks of treatment including medication for the years 2006-2009 constitute the study sample, outpatient (n=20), Day care (n=15). A blind investigator reviewed patient clinical notes and documented evidence of changes in clinical symptoms. The investigator interviewed therapist/nurse for their assessment of degree of improvement. The unit social worker contacted or visited mothers for the same. Results: The two groups didnt differ on sex distribution, parents education, social class and source of referral. More children from day care group were from non-intact family (P=.036). Mothers reported marked improvement among both groups. Blind investigator and therapist/nurse found more improvement among those received more intense psychosocial intervention (P=.018). Conclusion: Cases attended day care service had more psychopathology compared with those from out patient clinic. The staff and blind investigator reported better improvement among children attended the day care program. This indicates that difcult ADHD cases benet more from an intense psychosocial intervention in addition to medication.

P-19-14 Effects of computer base of attention training on sustain attention performance in children with Attention Decit Hyperactivity Disorder S. Bakhshi*, E. Pishyareh, F. Behnia, V. Nejati * Tehran, Iran Objective: The aim of this study was to investigate the effect of computer-based attention training in children with Attention Decit Hyperactive Disorder. Method: Eighteen children with Attention Decit Hyperactive Disorder were selected by multi-stage cluster random sampling from Tehran psychiatry and occupational therapy clinics. Children in experiment group received ten 1 h sessions computerized attention training while the control waiting list group did not received any treatment. Before and after training all participants assessed with continuous performance test and parent form of conners rating scale. Results: Results showed signicant improvement in sustained attention performance (p=0/000) and impulsivity (0/021) in the experiment group. Mean reaction time did not show any signicance alterations. Also signicant improvements were seen in conners total score (p=0/ 000), learning problems subscale (p=0/003) and, hyperactivity index (p=0/00).

Objective: With the increase of preschoolers diagnosed with ADHD, and the cautious recommended in the use of pharmacological treatment in young children (Sonuga-Barke et al., 2006), psychosocial interventions that include parent training hold promise as a treatment tool for this age (Webster-Stratton & Reid, 2010). The purpose of this study is to evaluate the efcacy of the Incredible Years Basic Parent Training Program (IY; Webster-Stratton, 1989) in a sample of Portuguese preschoolers with ADHD symptoms. Method: 42 participants between 3-6 years of age scoring above the borderline or clinical cut-off points on the ADHD markers of the Strengths and Difculties Questionnaire (SDQ; Goodman, 1997), Werry-Weiss-Peters Hyperactivity Scale (WWP; Routh, 1978), or Parental Account of Childs Symptoms (Taylor et al., 1991). Families were randomly allocated to either an IY intervention group (IG; n=22) or a waiting-list control group (CG; n=20). Measures were administered in both groups at baseline and 6 months later. Intervention: IY was delivered in groups of 9-12 parents, through 14 weekly sessions by experienced group leaders. Pre-post results of two primary outcome measures (SDQ, WWP) were analyzed, and Nonparametric Tests (Wilcoxon, Mann-Whitney) were used. Results: Regarding the IG, results from the pre-post comparison indicate: signicant differences in the level of parent-reported overall difculties (p=0.040) and ADHD behaviours (p=0.025). There were no signicant differences in the pre-post comparison of the CG; nor between groups, either on pre or post results. However, when comparing the groups according to the amount of change that occurred from the pre to the post test, results indicate a signicant difference in the WWP (p=0.043) after intervention. Conclusion: Results must be carefully interpreted taking into account the small sample size. Nevertheless, preliminary results suggest that in the short term (6 months), intervention was associated with more positive outcomes for children, as reported by parents after IY, suggesting that this could be an effective intervention for preschoolers with ADHD symptoms. To clarify the intervention impact, future studies must include: larger randomized samples; different informants; secondary outcome measures (parenting skills; parent-child interaction) and extension of the follow up to a broader period of time.

Friday, 27 May 2011, 14.3016.00 P-20 Non pharmacological treatment: Children and adolescents II
P-20-01 Cognitive rehabilitation using Pay Attention! Program in children with ADHD D. Barbosa*, M. C. Miranda, M. Muzskat, S. Rizzutti, S. M. M. Palma, O. F. A. Bueno * Sao Paulo, Brazil


167 Objective: In ADHD - that has great negative impact in the daily therapeutic intervention becomes necessary. Pay Attention! A Childrens Attention Process Training Program intends to treat the difculties of sustained, selective, alternating and divided attention (Sohlberg & Mateer, 1989 and 2001). Than, this study described the efcacy of the intervention program using Pay Attention! analyzing cognitive and behavioral symptoms before and after treatment. Method: In the rst phase of the study, 10 children (M=9,86; SD=2,45) were assessment by medical criteria for ADHD and a neuropsychological battery was performed. The second phase contained the training using Pay Attention! in 20 individual sessions accomplished once a week. In the third and last phase, the efcacy of the program was analyzed by comparing results on neuropsychological tests and behavioral scales before and after the intervention, using the following measures: Conners Continuous Performance Test (CCPT), Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Children were medicated with methylphenidate during the treatment and their families participated of a parents orientation program in group. Data were analyzed by Wilcoxon test. Results: The analysis of the results showed signicant better performance in some attention measures, like: CCPT: (Clinical% Z=2,49; p=0,013), (Omissions Z=2,54; p=0,011), (HitRT Z=2,80; p=0,005), (HitRTSE Z=2,80; p=0,005), (Variability Z=2,80; p=0,005), (HitRTBlock Change Z=2,59; p=0,009), (HitRTISI Change Z=2,39; p=0,017), (ResponseStyle Z=2,19; p=0,028). There were also differences in BRIEF (BehavioralRegulation Z=2,12; p=0,034) and CBCL (AggressiveBehavior Z=1,955; p=0,051). Conclusion: The results indicate better speed and orientation of the attention and behavioral adjustment. Than, basis on this study is possible establishing that the attentional training using Pay Attention! has possibility to show efciency for the ADHD treatment. daily activities and academic situations. More success, less failure, and nally more positive evaluations led to a decrease in aggression, anxiety and other behavioral problems in general among the children in this study.

P-20-03 Effects of combined treatment on Turkish children diagnosed with Attention Decit Hyperactivity Disorder: A 12-month follow up study E. S. Ercan*, A. Kutlu, S. Durak, U. Akyol Ardic * Izmir, Turkey Objective: The aim of this study was to investigate the effects of combined treatment on children diagnosed with Attention Decit Hyperactivity Disorder (ADHD). Method: After careful screening, 67 children (55.8%) diagnosed with ADHD ? oppositionaldeant disorder (ODD) and 53 children (42.2%) diagnosed with ADHD ? conduct disorder (CD) were included in the study. Treatment consisted of ongoing medication (methylphenidate) management and a parent-training program that continued for 12 months. Children were assessed in multiple domains by multiple sources of information at baseline and at the end of the 1st, 6th and 12th months by parent- and teacher-completed the Turgay Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S), Conners Parent Rating Scale (CPRS), and Conners Teacher Rating Scale (CTRS). Mother-child relationship was assessed by the Parental Acceptance and Rejection Questionnaire (PARQ). Results: Combined treatment was effective in reducing the ADHD, ODD, and CD symptoms. Analyses of the data revealed that medication, rather than parent training, was responsible for the improvements both in the symptoms and in the mother-child relationship. Conclusion: The results of the study, in line with the Multimodal Treatment Study of Children with ADHD (MTA) ndings, highlighted the role of stimulant medication in the long term treatment of ADHD.

P-20-02 The effectiveness of using Perceptual-Motor Practices on behavioral disorder among ve to eight year old children with Attention Decit Hyperactivity Disorder F. Dehghan*, E. Pishyareh, F. Behnia, N. Amiri, M. Safarkhani * Tehran, Iran Objective: The present study investigates the effectiveness of using perceptual-motor skills on the decrease in behavioral disorders of ve to eight year old children with ADHD. Method: In this quasi-experimental study, 26 ve to eight year old children with ADHD referred to four occupational therapy centers were randomly divided into an experimental and a control group. Research instruments included Parents Rating Scale (CPRS-48), Child behavior check list (CBCL), Bruninks Oseretsky Test of Motor Prociency (BOMT). After the intervention, which included a six week perceptual-motor practice, mothers were asked to ll out the behavioral checklists again. BOMT was used for post-intervention assessment. Results: At the end of the intervention period all motor component scores (gross movements, ne movements, upper limb speed and dexterity and total score) showed signicant improvement. Behavioral disorders (anxiety, social problems, attention problems, aggressive behaviors and others) also showed signicant improvement. In addition, children in the control group showed signicant improvement in ne movement and BOMT total score, as well as a decrease in aggressive behaviors and anxiety. Conclusion: The improvement of motor skills in children in this study appears to have resulted in a feeling of competency as well as

P-20-06 A study of combined treatments in cognitive and behavioral symptoms of children with ADHD M. Miranda*, M. Muszkat, S. Rizzutti, L. F. Coelho, D. Barbosa, O. Bueno * Sao Paulo, Brazil Objective: The aim of this study is to analyze the benets of multimodal treatment of Attention Decit Hyperactivity Disorder (ADHD), so: a) analyzes the effects of isolated treatments (use of methylphenidate) and combined treatments to the use of medication as cognitive-behavioral therapy (CBT), family intervention and cognitive training in cognitive and behavioral symptoms of children with ADHD. b) also discuss current cognitive training techniques for attention and working memory training. Method: Forty ADHD- diagnosed children aged 7-14 were divided into 4 groups to be subjected to the following procedures: the children are assessed by neuropsychological and clinical criteria of ADHD and after exclusion criteria are randomized into four treatment groups: group 1 - children only make use of methylphenidate long-acting medication; group 2 - methylphenidate and training of attention using Pay Attention!; group 3 - methylphenidate and working memory training; group 4 - methylphenidate and cognitive-behavioral group.


168 All groups received family intervention. Children are evaluated pre and pos-treatment by the following instruments: DSM-IV criteria, Continuous Performance Test (CPT), ve subtestes from Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Results: Outcomes in terms of efcacy of the interventions are being analyzed in relation to performance on neuropsychological tests and behavioral scales before and after intervention (nished March, 2011), which will enable us to objectively analyze the efcacy for both cognitive and behavioral symptoms Conclusion: The results of this study and discussion of these aspects will help acquire new knowledge of techniques and instruments for intervention ADHD children. P-20-07 Effectiveness of guided parental self-help for parents of children with ADHD: An interim report on the study sample L. Mokros*, N. Benien, M. Dopfner * Koln, Germany Objective: The present study is based on positive results of two pilot studies about the efcacy of guided parental self-help (GPSH) for parents of children with ADHD. Parents receive manuals with contents based on a German self-help book (Wackelpeter und Trotzkopf) and additionally a biweekly counselling telephone call. About 200 parents are included in the program. The objective of the presentation is an interim analysis of the sample-characteristics. Method: About 200 parents of 6-12 year old children with ADHD are investigated in a one-group pre-post design. Physicians from private practices across the whole county enrolled parents with a diagnosis of ADHD. Results: The sample was analyzed on ADHD-symptoms as well as socio-demographic factors, sex, age, and residential area at study entry. As expected a high proportion of the patients were male. A high variance regarding symptom-severity could be detected. Conclusion: Preliminary ndings of GPSH are promising. Yet, more research is needed to provide GPS for parents of children with ADHD in a broader context. P-20-10 Eye movement and cognitive training in children with Attention Decit Hyperactivity Disorder A. Orylska*, J. Sarzynska, H. Lubanski * Warsaw, Poland Objective: The aim of the research is to examine the effectiveness and gain deeper knowledge of the attention and memory training combined with neurofeedback in children with Attention Decit Hyperactivity Disorder (ADHD), age 10-15 . Method: Half of the participants of the research is underaging 3-5 times per week up to 20 sessions of cognition functions training (namely the memory and attention training: Memory Updating Spatial, Multielement Visual Tracking). The remaining half shall undergo sessions on EEG-biofeedback with special emphasis on C3-C4 and Fp1-Fp2 spots/points. To estimate the effectiveness of the training and its impact/effect on the performance of attention, the participants is examined pre and post tests (control attention and inhibit measure) with the ANT attention test this test involves examination using the eye-tracker which provides information whether patients suffering from ADHD have a specic pattern of eyeball movement and whether the proposed training can affect this pattern. Results: We assume that the cognitive functions training combined with sessions on the EEG-biofeedback is improved the performance of attention. Conclusion: Attention and memory training could potentially have positive impact on patients functioning in society and family. The adoption of eye-tracker testing shall allow to verify the hypothesis that the cognitive training may affect the way in which ones brain functions.

P-20-11 Attention training in children with Attention Decit Hyperactivity Disorder J. Sarzynska* * Warsaw, Poland Objective: The aim of the research was to examine the efciency of the attention training in children with Attention Decit Hyperactivity Disorder (ADHD) Method: Children aged from 8 to 12 years were divided into two groups the rst clinical group comprised of 20 children with diagnosed ADHD, the second consisted of 40 healthy children. All the subjects undergone 10 training sessions, during which they performed a series of especially designed computer tasks testing their resistance to distractions. To verify the effectiveness of the training as well as to examine its effect on attention and other cognitive functions, the subjects performed D2 attention tests and Raven Progressive Matrices Test for children before and after the training sessions. Results: As a result in children from both the clinical and the control group a statistically signicant improvement in performance of the attention test was observed. Furthermore the children from the clinical group improved their performance in the intelligence test. Conclusion: It may indicate, that functioning of attention does not have a direct effect on the performance in the intelligence test, but the limitation of vulnerability to distractions in children with ADHD helps them to cope with this type of tasks. Moreover, training of cognitive functions might improve the performance of patients with ADHD in school and social life.

P-20-12 Incredible years parent training program in ADHD: Parents attendance and satisfaction M. J. Seabra-Santos*, M. F. Gaspar, A. Azevedo, T. Homem, M. Pimentel * Coimbra, Portugal Objective: Although parent training programs have proven effective in the reduction of ADHD symptoms in preschoolers, a major concern is how to engage and retain parents in such programs which, in turn, are conditions of their effectiveness. The purpose of this study is to analyse the experience with the use of the Incredible Years Basic Parent Training Program (Webster-Stratton, 1989, 2001) in Portugal. Method: Subjects: 97 parents of preschoolers, who participated in the Incredible Years Program (IY). Some of the IY groups comprised parents whose children dont have any known risk factors (nonclinical groups NCGs, n=46 parents); other groups were attended by parents whose children were above the borderline or clinical cut-off points on the ADHD markers of the Strengths and Difculties Questionnaire, Werry-Weiss-Peters Hyperactivity Scale, or Parental Account of Childs Symptoms (clinical groups CGs, n=51 parents). Intervention: The IY was delivered in groups of 8-12 parents, through 12-14 weekly sessions. The attendance rates and levels of satisfaction regarding the program and its different methods (e.g. explanations given by group leaders, DVDs, discussion in group, role-play) and strategies trained (e.g. play, praise, ignore, clear commands, time-out) were analyzed and the Student t test was used to compare groups. Results: The high attendance rates observed in both groups are associated with the facilitating conditions offered to parents (e.g. babysitting provided to children, snacks in the middle of sessions). The


169 high levels of satisfaction observed are discussed in discussed in terms of some specic characteristics of the program (e.g., clear contents, group leader skills, supportive and non-evaluative relationship with group leader and other group members). When compared to parents of NCG, parents of CG consider more useful the use of role-play in group sessions and the strategy of time-out, which may be attributed to the specic difculties they face when interacting with their children. Conclusion: Regarding attendance rates and satisfaction levels, the IY Program is a good choice to use with families of Portuguese preschoolers with symptoms of ADHD. of the most difcult children in local schools in a combined health/ education collaborative initiative. Method: After working out issues of implementing wraparound in the local scene, children who were unable to be managed within local schools despite maximum behaviorual support, were referred through the schools to the Edwrap team. Data gathering, assessment, planning, implementation and evaluation of outcomes then took place over variable periods of time.. The parents were key players and involved at each stage of the process from assessment to plan development and consistency in management across life domains was a key feature overall Results: 186 children were referred from Oct 2006 - June 2010, and 149 accepted into the process: 48 of those accepted did not enter the process. 40 had entered and transitioned on and another 36 remain within the current workload and are ongoing. 6 are long term clients with ongoing issues. Others moved from the area or withdrew from the service. More than 80% had a diagnosis of ADHD plus comorbidities. 80% were male. The mean age was 8.6 years with range of 5 - 14 years. 58% were reintegrated with the education process within 6 - 15 months, and tranistioned back to normal support within their schools. SDQ data (strengths and difculties questionnaire) shows improvement overall with signicant variability from child to child. Fewer days lost from school and fewer adverse events were documented. Conclusion: Implementing a contextualized wraparound process has proved successful in a combined health/education collaborative process for this most difcult group of children in local schools. Reengagement with education has been achieved in the majority most of whom have ADHD, and other measures of improvement including fewer adverse events at school are evident. It has proved exible in allowing for signicant variation in the implementation of plans and focusing on individualized outcomes. While there have been signicant issues in contextualizing wraparound process to the Australian scene, the outcomes for this group of children has been very good, although access to further funding especially for behavioural interventionists would assist the process further.

P-20-13 Comparison of effectiveness of three treatment methods for adolescents with Attention Decit Hyperactivity Disorder (ADHD) and executive function disorder (EFD): A phenomenological study R. Weaver* * Wayland, USA Objective: The objective of this phenomenological study was to evaluate and compare the effectiveness of three short-term nonmedical treatments of adolescents with ADHD and EFD. Method: The three methods of treatment were: Cognitive Dichotomy Therapy (CDT), a cognitive treatment method, Systems of Fair Exchange (SOFE), a behavioral treatment method, and Self Advocacy Method (SAM), an educational/communication treatment method, all of which have been developed and utilized at the Weaver Center by this examiner over the last two decades. The method employed 12 families with students considered to be underachieving by parents and teachers. Students were controlled for social/economic class, age, intellect, diagnosis, medicine usage and given eight weekly treatment sessions of one of the three treatment methods. Results: The results indicated that the three methods were described as signicantly improving the young adults and parents condence, health, self-esteem, optimism of future, reduction of stress within the family and increase of academic productivity. The SOFE provided the most immediate positive results, however following the study without monitoring and continued therapy demonstrated the briefest positive effect. The CDT had a moderately positive effect with a modest duration of benet. SAM demonstrated the most positive and the longest lasting benet. Conclusion: The conclusions indicated that behavioral interventions had the quickest response time and did not endure because of its initial effectiveness, CDT had a signicant benet on independence and autonomy and was useful in sustaining behavioral change, and the most enduring therapy was SAM, as it included individual education regarding strengths and liabilities of having such diagnoses, behaviorally practiced compensatory strategies, and communication skills. These individuals became more independent and empowered when they advocated for themselves successfully. These methods showed promise for reducing adjustment co-morbidities.

Friday, 27 May 2011, 14.3016.00 P-21 Non pharmacological treatment: Adults

P-21-01 Micronutrients reduce stress and anxiety in adults with ADHD after a 7.1 earthquake A. P. Julia Rucklidge*, A. Boggis, J. Johnstone, R. Harrison * Christchurch, New Zealand Objective: The Objective was to study the role of nutrition, (in the form of Micronutrient supplementation), in the recovery from the emotional responses associated with experiencing a 7.1 earthquake, in a population of adults with ADHD. Method: The 7.1 earthquake occurred in the context of ongoing trials of New Zealand adults with ADHD taking a micronutrient supplement (EMP?). The earthquake provided an opportunity to use a real-life stressor to compare mood, anxiety and stress responses of adults with ADHD who were and were not taking the micronutrient supplement at the time of the earthquake. We expected that those participants who were consuming the micronutrients at the time of the earthquake would show a stronger emotional recovery compared with a sample of adults with ADHD not taking micronutrients. Thirty-three adults with ADHD were assessed twice following the earthquake using a measure that had also been completed prior to the earthquake (baseline). Seventeen were not taking micronutrients at the time of the earthquake (control group), 16 were (micronutrient group).This time period was characterised by intensive after-shock activity with on-going heightened arousal and

P-20-14 To utilise wraparound process in a combined health/ education initiative (EdWrap) in the management of children presenting with major behavioural/learning problems in local schools N. Wooleld*, W. Chan, P. Cooper * Wamuran, Australia Objective: To evaluate the outcomes of implementing a contextualized wraparound process when this was utilized in the management


170 sleep disturbance in the general population. Necessary Ethics approval was acquired. The measure used was The Depression Anxiety and Stress Scale (DASS) which is a 42-item questionnaire which assesses an individuals current severity of symptoms relating to depression, anxiety and stress with well established psychometric properties.Statistical measures used included MANOVA, Paired sample t tests and Independent sample t tests (two-tailed) . Results: While there were no between-group differences one week post-quake (Time 1), at two weeks post-quake (Time 2), those taking micronutrients reported signicantly less anxiety and stress than those not taking micronutrients (effect size 0.69). These between group differences could not be better explained by other variables, such as baseline measures of emotions, gender, ethnicity, socio-economic status, intelligence, age, ADHD type, or co-occurring disorders. Further, while there was no signicant change from baseline to Time 2 for the control group (effect sizes ranged from 0.11-0.45), there were signicant changes in all areas assessed for the micronutrient group (effect sizes ranged from 0.73-1.01). Conclusion: The results suggest micronutrients may increase resilience for individuals with ADHD to ongoing stress and anxiety associated with a traumatic event and are consistent with a growing body of evidence supporting micronutrient use as a tool in treating mental health problems. Method: Six adult ADHD patients from the Toronto area received a novel therapy adjunctive to medication and CBT between 2009-2011. Entitled Narrative Schema Realignment, the technique is introduced at time diagnosis and continued through CBT. The method relies on patient identication with culturally universal and psychologically derived narrative archetypes and where the patient is cast as hero of their own evolving epic narrative. The diagnosis and negative schema align with the role of villain. A familiar redemption story arc is then chosen or created by the patient as a framework to progressively guide away from negative schema and into positive realignment through therapy. Results: Based on subjective reports, and compared subjectively to similar patients not offered the technique, more consistent subjective improvements were reported and were achieved in fewer sessions. Improvements in self esteem and self condence were the most commonly reported benets. One patient had difculty initiating the technique due to poor insight and difculty aligning with a known storyline or character. This patient responded well when asked to create an original story and character instead. Conclusion: Narrative Schema Realignment represents a potentially useful CBT adjunct to for adults with ADHD who are prone to negative schema development and the resultant maladaptive behaviours and distortions. Some of the advantages may include enhancement of the therapeutic alliance through the experience of shared narrative, the establishment of a framework conducive to speculation and role play, the ability to recontextualize aspects of the psychotherapeutic or CBT experience into a more appealing or engaging experience for patients with ADHD who are particularly responsive to novelty, external structure, and activation of interest provided by this technique. This promising technique would therefore benet from a study design involving a greater number of patients, a matched control with a sham adjunct, and formal measures of progress.

P-21-02 First results of the COMPAS group (Comparison of Methylphenidate and Psychotherapy in adult ADHD study) E. Graf*, S. Matthies, M. Colla, S. Gro-Lesch, T. Jans, E. Sobanski, B. Alm, A. Philipsen, M. Huss, B. Kis, M. Roesler * Freiburg, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Given this background, there is great need for an effective treatment of adult ADHD patients. Method: Therefore, our research group has conducted a rst controlled randomized multicenter study on the evaluation of disordertailored DBT-based group program in adult ADHD compared to a psychopharmacological treatment. Between 2007 and 2010, in a fourarm-design 433 patients were randomized to a manualized dialectical behavioural therapy (DBT) based group program plus methylphenidate or placebo or clinical management plus methylphenidate or placebo with weekly sessions in the rst twelve weeks and monthly sessions thereafter. Therapists are graduated psychologists or physicians. Treatment integrity is established by independent supervision. Primary endpoint (ADHD symptoms measured by the Conners Adult ADHD Rating Scale) is rated by interviewers blind to the treatment allocation (Current Controlled Trials ISRCTN54096201). The trial is funded by the German Federal Ministry of Research and Education (01GV0606) and is part of the German network for the treatment of ADHD in children and adults (ADHD-NET). Results: First results on baseline data including socio demographic and clinical characteristics including co morbid disorders of the whole study population are presented.

P-21-04 The effects of the French Version of the community parent education program for families of preschoolers with behaviour problems: A pilot study N. Leblanc*, L. Ben Amor, P.-A. Desmarais, L. Archambault, R.-C. Duval, P. Bouchard, J. Martel, M. Simoneau * Quebec, Canada Objective: To evaluate the effects of the French version of the COPE on child behavior problems, parenting competence, and parent-child attachment. Method: Families of children, 3 to 5 years old, were recruited via community health service centers. The COPE consisted of 10 weekly 2-hour sessions, including homework assignment and review, watching videotaped vignettes and identifying common parenting errors, discussing potential solutions, and modeling and role playing strategies. The topics for each session were: (1) praise and attending, (2) rewards, (3) planned ignoring, (4) transitional warnings, (5) whenthen statements, (6) planning ahead, (7) point systems, (8) time out, (9) time out from reinforcements-loss of privileges, and (10) problem solving. An activity-based social skills program was conducted for children during parenting sessions. Child behavior problems were measured using the Child Behavior Checklist 1.5-5. The Parenting Stress Index was used to assess parenting variables. Parents completed these questionnaires before and after the program. T-tests were used to compare pre and post mean scores, with p \ 0.01. Results: A total of 25 parents (72% mothers) and 18 children (77.8% boys) participated in the study. A highly signicant improvement in sleep problems (p = 0.009) and attention decit/hyperactivity problems (p = 0.005) was observed in children. Parents reported feeling

P-21-03 The hero with a million faces: Narrative schema realignment in adult ADHD I. Szpindel* *Toronto, Canada Objective: To introduce a narrative based psychotherapeutic adjunct for accelerating and enhancing schema reconstruction and CBT for the adult with ADHD.


171 more competent (p = 0.005), less isolated (p = 0.001), and less depressed (p \ 0.001); thus globally less stressed (t(17) = 3.40, p = 0.002). They also indicated high levels of satisfaction with the COPE. Conclusion: Psycho-educational interventions may be an important tool to improve behavior problems in preschool children. to enable health care workers from various professional backgrounds to accompany and coach ADHD individuals according to particular needs in various areas of life. Results: The presented university based 12 months qualication program adresses health care workers and therapists from various professional provenance (social workers, teachers, psychologists) who want to acquire specic knowledge and professional skills in order to be able to particularly support the ADHD individuals conduct of life. The curriculum includes broad basics of etiology, diagnostics, differential diagnosis, fundamentals of treatment approaches, and deep insight into various training programs. Emphasis is put on transition from adolescence to adulthood, on important aspects of social law and on the acquisition of supervised individual coaching experience. The respective modular courses will be held and supervised by renowned experts from medicine, psychology and social sciences. Conclusion: With the decided professional qualication as an ADHD coach, potential participants will be put in a position to accompany individuals along their paths of life and encourage their particular decisionmaking and responsibility as an essential part of multimodal treatment.

P-21-05 A randomized controlled study of a manualised cognitive behavioral treatment for medicated adults with ADHD B. Emilsson*, G. Gudjonsson, J. F. Sigurdsson, G. Baldursson, H. Olafsdottir, E. Einarsson, S. Young * Reykjavik, Iceland Objective: The primary aim of this study was to measure the efcacy of a novel CBT programme for medicated adults with ADHD. The primary outcome measures were ADHD symptoms and severity. Secondary outcome measures were anxiety, depression, emotional control, social functioning and antisocial behaviour. In light of positive results of earlier studies on CBT for this population it was hypothesised that those who received the psychological treatment would show signicantly more improvement on the selected outcome measures than those who did not. It was also hypothesised that this effect would be maintained at follow-up. Method: This study was conducted at an outpatient clinic at the Landspitali National University Hospital of Iceland. 54 medicated adults with ADHD and residual symptoms were randomly allocated to an experimental (CBT/MED) treatment condition (n = 27) and a treatment as usual (TAU/MED) control condition (n = 27) that did not received the CBT intervention. The outcome measures were obtained before treatment (baseline), after treatment and at three month follow-up, and included self-reports and ratings by independent assessors. To adjust for differences at baseline an analysis of covariance (ANCOVA) was conducted for each of the dependent variables measuring differences between the conditions in time. Results: Signicant treatment effects were found on measures of ADHD symptoms and antisocial behaviours at the end of treatment with medium to large effect sizes. Signicant and large treatment effects were noted on all the measures at follow-up. Conclusion: The results give support for the growing evidence for the effectiveness of CBT interventions for adults with ADHD. Further, the results demonstrate that the psychological treatment has an additive effect over and above medication alone and improves functions associated with impairment. Further studies on psychological treatments for adults with ADHD are needed.

P-21-07 ADD & loving it?! And The new media that transforms psychoeduction in ADHD U. Jain*, R. Green, A. Green *Toronto, Canada Objective: ADHD is the most common childhood psychiatric disorder and one of the most common adult afictions yet there are two groups that are difcult to reach: the 13-25 year olds and the ADHD spouses. The website, and the documentary ADD & Loving It?! were specically created to reach the public and, by default, this target audiance. The rst step to any treatment program is to rst educate the client. Method: The multimedia strategy uses a new media tool called Edutainment: education through entertainment. The authors are experts in this eld both in terms of previous work and professional credentials. The task was to create information that was presented with humor, hope and credibility. The rst step was to review existing sources of information. The second step was to create a proposal and have it funded and produced. The third step was to see if the target audiance was reached. The method was to have a membership system and to determine if we were a) reaching our core age demographic and b) how long were they on the site (a very good indication of acceptance and likely learning). Results: Both the site and the documentary are award-winning and highly visible. PBS launched the documentary to 89 stations in the US with over 3000 viewings reaching 98% of the US population. Hits to the website in December 2010 were over 100K and the demographic in question was a signicant component of that group. Conclusion: Websites have global appeal and as English is the worlds language for science and information, it is not surprising that the reach of this website has been Global. In Google searches, it ranks high. This is the new wave of information dissemination. What we know as psychoeducation will have changed.

P-21-06 Multimodal treatment and coaching in ADHD development of an advanced training program P. Greven*, J. Irmscher * Berlin, Germany Objective: Attention decit disorders can no longer be regarded as solely childhood or adolescent disorders. Large numbers of adults still suffer substantially from ADHD symptoms that cause considerable difculties for themselves and their family and social environment but also constitute a notable burden for professional elds, health care and welfare systems. Method: In order to minimize the negative impact of symptoms in the course of ADHD, a variety of training programs have been developped to support individuals, families and health care workers according to requirements during multimodal treatment. It is obvious though that for some individuals there is a need for specic and continuous coaching beyond that. The presented program is designed

P-21-08 ADHD adults incidence of personality disorder and response to treatment with Methylphenidate F. Reimherr*, J. L. Olsen, B. Marchant, R. J. Robison, C. Pommerville, E. D. Williams, C. Halls * Salt Lake City (UT), USA Objective: Personality disorders (PD) are frequently identied in adults with ADHD.1 This study reassesses the incidence of


172 personality disorder and the treatment response based on the severity of personality disorder symptoms in adult ADHD. Method: 113 subjects who met DSM-IV-TR and/or Utah criteria for ADHD were entered in one of two placebo-controlled crossover trials of methylphenidate.2,3 No attempts were made to include or exclude patients based on personality disorder. PD diagnosis was determined by the clinician using all available information including self-report questionnaires and the SCID-II interview. Subjects were categorized as those with no PD (PDnegative), one PD (PDpositive) and with two or more PDs (PDplus). Symptom severity was measured with the WenderReimherr Adult Attention Decit Disorder Scale (WRAADDS.) Results: 43% were PDnegative, 32% PDpositive and 25% PDplus. Among patients with personality disorders, 16% of subjects had a PD in cluster A, 42% in cluster B, 63% in cluster C and 18% had other PDs. Compared with others, PDplus subjects had higher baseline levels of ED (p\.001). Subjects experienced a signicant treatment effect for the total WRAADDS (d=0.9, p\.001). The PDplus subjects did not show a signicant treatment effect (d=0.3, p=.61) in contrast with PDnegative (d=0.9, p=.002) and PDpositive (d=1.5, p=.004) subjects. This pattern was replicated for the symptom areas of attention?disorganization, hyperactivity?impulsivity, and emotional dysregulation. The interaction between treatment and PD group was signicant for emotional dysregulation (p=.05), but not for the total WRAADDS (p=.062). Conclusion: 57% of subjects with ADHD had a personality disorder. PDplus subjects did not have a signicant treatment response while PDpositive and PDnegative subjects experienced large and signicant treatment effects. The interaction between treatment and PD group was only signicant for the symptoms of emotional dysregulation. This suggests that extensive personality disorder symptoms might limit treatment response to methylphenidate alone in ADHD adults. extradimensional shift (IES: set shifting) and spatial working memory (SWM) promised to be useful for subtyping ADHD children. The best diagnostic validity is to be gained in children between 8 and 10 years, whereas lower rates of diagnostic hits in younger children are revealed. Conclusion: Combining executive functioning questionnaires and respective neuropsychological tasks seems to be a promising way to identify ADHD subtypes and thus, may enable us to reliably differentiate fuzzy kids from those with a clinical diagnosis of ADHD. Even more so, diagnostic reliability increases considerably when merging parent behaviour questionnaires and actual test performance (i.e., the CANTAB subtests SOC, IES, SWM).

P-22-02 ADHD or bipolar disorder-survey of cultural differences in diagnosis between Germany and the USA G. C. Teschke* * Berlin, Germany Objective: The purpose of the study was to see, if there are differences in the perception of ADD/ADHD between German and USAmerican child- and adolescent psychiatrists. Method: A clinical vignette of an 18 years old male youth presumably suffering from AD/ADHD was sent to a randomly chosen sample of 425 German and 350 US-American child psychiatrist with the request as to the most likely diagnosis and the option of an alternative diagnosis. Results: A return rate of 185 of 650 (28,5%) was obtained (125 recipients could not be located). ADD/ADHD was, according to expectations, the most frequently chosen diagnosis (51.7 of the Germans and 42.7% of the Americans opted for it). Surprising was that 22.7% of the Americans opted for bipolar disorder, whereas in Germany nobody considered this likely. The Americans made up for this by seeing ADD/ADHD far more often as an alternate diagnosis, thus reecting a seeming ambivalence about or interchangeability of these two diagnoses. This difference was statistically highly signicant. Conclusion: The results of this study suggest that there is a discrepancy in the perception of ADD/ADHD on both sides oft he Atlantic; whereas inGermany ADD/ADHD is seen as a monolithic disorder, in the USA it is considered overlapping with bipolar disorder. The reasons for these differences are unclear and need to be explored.

Saturday, 28 May 2011, 14.3016.00 P-22 Diagnosis: Children and adolescents II

P-22-01 Just fuzzy kids or ADHD-kids? Diagnostic utility of questionnaires and PC-tests tapping executive functions for ADHD subtyping M. Schoe*, L. Kaufmann, D. Kloo * Linz, Austria Objective: The main aim of the present study is to examine the diagnostic utility of (i) the German version of the Behaviour Rating Inventory of Executive Functions (BRIEF) and (ii) selected PC-supported tasks of the Cambridge Automated Neuropsychological Test Battery (CANTAB) for differentiating subtypes of Attention Decit Hyperactivity Disorder (ADHD). Method: Potential performance differences on executive functions are compared between elementary school children with the clinical diagnoses of ADHD (n = 33) and aged matched controls without ADHD (n=41). Upon using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, 14 ADHD children could be classied as inattentive, 7 as hyperactive-impulsive and 12 as combined. Moreover, parent information about executive functioning is available for all kids. Results: Findings revealed signicant correlations between all BRIEF scales and subscales and the standard symptom questionnaire for ADHD as provided in DSM-IV. Hence, the latter results closely match the ones reported for the English-language version of the BRIEF. Furthermore, the CANTAB subtests stocking of cambridge (SOC: tapping planning abilities), intra-

P-22-03 The development of screening scales for Attention Decit Hyperactivity Disorder (ADHD) in Thai children and adolescents age 3-18 years C. Pornnoppadol*, V. Piyasilp * Bangkok, Thailand Objective: To develop reliable and valid screening scales called Thai Attention Decit Hyperactivity Disorder Screening Scales (THAI ADHD SS) to screen for Attention Decit Hyperactivity Disorder (ADHD) among Thai children and adolescents age 3-18 years. Method: Thai ADHD SS are newly developed screening scales comprised of 3 versions including Preschooler (age 3-5 years), Child (age 6-12 years) and Adolescent (age 13-18 years) versions. Each version contains 30 items assessing hyperactive-impulsive symptoms (item 1st -15th) and inattentive symptoms (item 16th-30th). The reliability of Thai ADHD SS was evaluated by item analysis, twoweek test-retest and inter-rater reliability assessment as well as internal consistency measurement. Area under curve (AUC) of


173 receiver operating characteristic curves (ROC curves) was measured to help select the appropriate cut-off point. Diagnostic Interview for Children and Adolescents (DICA)-ADHD section was used as a gold standard to determine the ADHD diagnosis. Sensitivity, specicity, positive and negative predictive value were analyzed to determine the criterion validity. Exploratory and conrmatory factor analyses were also performed to assess the construct validity. Results: Fifteen thousand three hundred sixty subjects (4,608 children, 8,064 parents and 2,688 teachers) participated in this study. All versions of Thai ADHD SS have shown an excellent internal consistency. Cronbachs alpha coefcient ranged from 0.94 0.98. Two-week testretest reliability conrmed the scales stability. Pearsons correlation coefcient (r) ranged from 0.70 - 0.88 (mean = 0.80, p\0.001). When used separately, at T-score [ 61, Thai ADHD SS - self report, parents report and teachers report form- have an AUC of 0.64 (95% CI = 0.56-0.71, p\0.01), 0.74 (95% CI = 0.68-0.79, p\0.001) and 0.61 (95% CI = 0.55-0.67, respectively and have fair sensitivity (0.57 0.63) and specicity (0.49 0.55). When used altogether, at T-score[61, Thai ADHD SS - self report, parents report and teachers report formrevealed good sensitivity (0.90) and specicity (0.88). Factor analysis conrmed that Thai ADHD SS contain two domains including hyperactivity-impulsivity domain and inattentiveness domain. All items have loading factors of more than 0.4. Conclusion: Thai ADHD Screening Scales are reliable and valid screening scales for ADHD and are useful for further clinical or epidemiological study related to ADHD especially when Self-report, Parents report and Teachers report form are used altogether. P-22-05 Is DSM-IV based ADHD self report scale valid and reliable tool for 8 years children? E. Ercan*, E. S. Ercan, R. Kandulu, E. Uslu, C. Aydin * Izmir, Turkey Objective: The current study investigates whether self-reports of children provide reliable and valid information concerning ADHD. For this purpose, we developed Ercan DSM-IV Based ADHD Self Report Scale for elementary school children based on the 18 DSM-VI ADHD symptoms. Method: The validity and reliability of the Ercan DSM-IV Based ADHD Self Report Scale was evaluated in an epidemiologic sample of 171 s grade students (89 ADHD; 82 controls). In the rst stage of the study, 1500 2nd grade students has been screened for the presence of ADHD by using DSM-IV based ADHD Scale. All positive screened students (86) and one-to-one matched controls (except one missing case) were evaluated with a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School-Age ChildrenEpidemiologic Version (K-SADS-E), and all diagnostic decisions made by using best estimate procedure. After the diagnostic evaluation 89 subjets has been classied as ADHD and 82 non-ADHD. Results: Ercan DSM-IV Based ADHD Self Report Scale scores of diagnostic group and the control group were compared and the signicant difference was found between the groups. Item-total correlations and Cronbach-alpha coefcient was calculated to evaluate the item quality and the internal reliability (.85 for attention decit and .84 for hyperactivity-impulsivity subscale). Conrmatory Factor analysis was conducted for studying validity of the scale. A logistic regression analysis was performed using scales on the Ercan DSM-IV Based ADHD Self Report Scale as predictors of membership in the two groups (ADHD vs. non- ADHD). Logistic Regression showed that attention decit subscale classication percentage is 69.4 and the hyperactivity subscale classication percentage is 64. Conclusion: These results suggest that the Ercan DSM-IV Based ADHD Self Report Scale is reliable and valid tool for diagnostic and screening purposes.

P-22-04 Reliability and validity of turgay DSM-IV based disruptive behavior disorders rating scale teacher and parent forms E. S. Ercan*, E. Ercan, R. Kandulu, E. Uslu, C. Aydin * Izmir, Turkey Objective: The aim of the study is to evaluate the reliability and validity of Turgay DSM-IV Disruptive Behavior Disorders Rating Scale in an epidemiologic sample of Turkish elementary school children. Method: 1500 2nd grade students from zmir, Turkey has been I screened for the presence of ADHD by using DSM-IV based ADHD Scale. All positive screened students (86) and one-to-one matched controls (except one missing case) were evaluated with a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children- Epidemiologic Version (K-SADS-E), and all diagnostic decisions made by using best estimate procedure. The validity and reliability of the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale Parent and Teacher Forms was evaluated in this study sample of 171 subjects. Results: Item-total correlations and Cronbach-alpha coefcient were calculated to evaluate the item quality and the internal consistency reliability of the scales. Conrmatory Factor analysis was conducted for studying validity of the scales. The internal consistency reliability of the scales was found to be quite high (.92 and .91 for parent form; .97 and .96 for teacher form). Logistic Regression Analysis of Turgay DSM-IV Based Disruptive Behavior Disorders Rating Scale Teacher and Parent Forms revealed that %87.6 correctly classied the diagnostic group, and %91.5 correctly classied the control group. Conclusion: These results suggest that the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale teacher and parent forms are reliable and valid for diagnostic and scanning purposes.


174 P-22-06 Prevalence of Attention Decit Hyperactivity Disorder in school-aged children of a poor Brazilian community M. Arruda*, M. V. Moura-Ribeiro, J. H. Golfeto, M. E. Bigal, G. Polanczyk * Ribeirao Preto, Brazil Objective: To estimate the prevalence of ADHD in a representative community sample of Brazilian school-aged children, as well as to compare the Mental Health Status of children with and without ADHD. Method: Children from 5-12 years (n = 1,856) were recruited at the public school system (36.7% of the total population of children from 5-14 years living in this city). Parents and teachers were completed the Swanson, Nolan and Pelham Questionnaire - version IV (SNAPIV), a rating scale that lists all 18 symptoms of ADHD according to the DSM-IV. General psychopathology was assessed with the validated Brazilian version of the Child Behavior Checklist (CBCL/418). Results: The overall point prevalence of ADHD was 6.1% (95% condence interval [CI] = 5.0-7.2); it was signicantly higher in children older than 9 years-old (7.6%, relative risk [RR] = 1.9, 95% CI = 1.1-3.2), in boys (7.7%, RR = 1.7, 95% CI = 1.1-2.4) and in those coming from lower social classes (9.1%, RR = 2.2, 95% CI = 1.2-4.0). The RR of CBCL scores in all dimensions, with the exception of withdrawn, were signicantly higher in those with ADHD versus controls. Conclusion: This study assessed large sample of school-aged children from a poor community in Brazil. The detected prevalence is in accordance with estimates found in diverse settings, with different cultural and social characteristics. Children with ADHD were found to be signicantly impaired in several domains of mental health. Health care providers and educators should be adequately prepared to identify and provide medical and educational support to children with ADHD. P-22-08 The latent class analysis of subclinical ADHD symptoms in parent and teacher report A. Kobor*, A. Takacs, R. Urban, V. Csepe * Budapest, Hungary Objective: Previous studies have suggested the importance of dimensional and categorical approaches in understanding Attention Decit Hyperactivity Disorder (ADHD). The high prevalence rate of attention problems in nonclinical samples further indicates the need for identifying subtypes with milder symptoms. Moreover, the role of multiple informants is of high importance when symptom severity is at evaluation. Method: The Hungarian version of Strengths and Difculties Questionnaire (SDQ), suitable for rapid screening of childhood behavioral problems, has been used. The SDQ data were collected both from parents and teachers of 383 and 391 children (age = 8-13 years) of a non-referred sample, respectively. A latent class analysis was applied to the items of the Hyperactivity scale of both versions of the questionnaire. One to six class models were estimated for boys and girls separately. Only those participant who had ratings from both informants (n = 272) were included in the cross-informant analyses, in which the equivalent or similar classes across informants were identied. Results: Based on t indices and interpretability, a 3-class solution for parental report and a 5-class solution for teachers report were optimal. For girls, again, a 3-class solution was the most appropriate for parents, and a 4-class solution for teachers. The parental latent classes included a non-symptomatic class, a severe combined class, a mild combined class for boys, and a mild impulsive-inattentive or combined class for girls. However, the teacher classes found were somewhat more elaborated and matching more or less with the parental classes. Conclusion: Our results promote the dimensional approach. The subgroups identied by behavioral ratings, could be accessible in further studies aiming to explore a more detailed cognitive neuropsychological prole of ADHD with subclinical variants. These distinct phenotypic groups are useful in diagnosis, treatment, neuroscientic and genetic research. Conclusion: The ADHD disorder founded in these children appeared in connection with some environmental factors, but a deeper investigation is needed for studying all these factors, in addition to others (psychological, socio-economical, and nutritional) ones.

P-22-07 Impact of the environmental factors on the Attention Decit Hyperactivity Disorder in Moroccan children F.-Z. Azzaoui*, H. Hami, A. Ahami * Kenitra, Morocco Objective: The objective of this study is to evaluate the Attention Decit Hyperactivity Disorder (ADHD) in urban, periurban and rural schooled children living in Gharb plain (North-West of Morocco), and to study the relationship between this neurobehavioral disorder (ADHD) and the quality of environment. This region is one of the most important agricultural and industrial regions of the Kingdom. Unfortunately, it suffered from the increase of different polluting human activities (metallic pollution) which expose the population, especially children to serious neurobehavioral problems. Method: The study was realized in 129 children, aged 6 to 8 years.Two questionnaires are used; one based on the DSMVI to evaluate ADHD and another about quality of the environment of children. Results: The obtained results had shown that the important percentage of ADHD was found in the rural school (33%) and that was signicant correlations between this disorder and the consumption of well water (p\0.05), the storing condition of water (p\0.01) and the PICA syndrome (p\0.05).

P-22-09 Neuropsychological proles of adolescents with childhood Attention Decit Hyperactivity Disorder F. Cuhadarolu, G. Evinc*, T. Cak, G. Dinc, Z. Tuzun, C. Esra * Ankara, Turkey Objective: The aim of this study is to examine the neuropsychological -namely, WISC-R (Wechsler Intelligence Scale for Children Revised) and Stroop- proles of adolescents diagnosed as ADHD in childhood. Method: 45 adolescents admitted to the Child and Adolescent Psychiatry outpatient clinic of a University Hospital and diagnosed as ADHD when they were 7-11 years of age and a group of 28 adolescents without ADHD at the same age range and interviewed in the


175 same year were evaluated 6 years later and were compared. All participants were evaluated using Schedule for Affective Disorders and Schizophrenia for School Aged Children- Present and Lifetime Version (K-SADS-L), Wechsler Intelligence Scale for Children (WISC-R), and Stroop test. Results: In the study group 75.6% of the adolescents were still diagnosed as ADHD. WISC-R and Stroop results of adolescents having a continuing diagnosis of ADHD and control groups (adolescents who were remitted of ADHD and those who never had a diagnosis of ADHD) were signicantly different on coding and object assembly. Adolescents who had an ongoing ADHD had signicantly lower scores on two subscales of WISC-R, namely, digit span and object assembly., and had signicantly longer completion time and correction number on the fth card of STROOP test compared to the adolescents who exhibited remission at the second assessment and the ones who never had ADHD. Conclusion: This was one of the few studies investigating the ADHD children in adolescence and also the only study carrying this investigation on a multidimensional level. According to the results of this study it can be suggested that neuropsychological decits may be predictive for the ongoing ADHD diagnosis and they are helpful instruments for decision of the diagnosis and treatment however they can not be the only criterion.

Saturday, 28 May 2011, 14.3016.00 P-23 Diagnosis: Adults

P-23-01 Comorbidity, attachment and identity in adolescents with childhood Attention Decit Hyperactivity Disorder F. Cuhadaroglu Cetin*, H. T. Cak, G. Senses Dinc, Z. Tuzun, G. Evinc, E. Cop * Ankara, Turkey Objective: To examine the psychiatric status, attachment styles and identity in adolescents diagnosed as Attention Decit Hyperactivity Disorder (ADHD) in childhood. Method: This retrospective cohort study includes the reevaluation, 6 years after the diagnosis, of 45 adolescents between 13-17 years old with ADHD in comparison to 28 adolescents of the same ages with nonADHD psychiatric disorder. All participants were given K-SADSL, Sense of Identity Assessment Form and Relationship Scales Questionnaire. Results: The continuity of ADHD in adolescence was 75.6%. Comorbid psychiatric disorders were signicantly higher, the most common being anxiety disorders, oppositional deant disorder and conduct disorder. Comorbidity rate in the ADHD group was higher in adolescents with a RR of 3.3 (95% CI). Dismissing attachment pattern was relatively high in the ADHD group but a signicant difference regarding attachment styles or identity status was not found between the groups. Conclusion: Adolescents with ADHD are under greater risk for comorbidity compared to children with ADHD and the controls. There is no signicance of attachment styles or identity status. These ndings stress the high morbidity associated with ADHD in adolescents and support the importance of early recognition of this disorder for prevention and early intervention strategies in children with ADHD.

P-22-10 Comparison of behavior descriptions between ADD/ ADHD diagnosis and innovators using Kirtons AdaptionInnovation (KAI) theory C. Winton Brodeur*, C. Ritzen Kem * Gainesville, USA Objective: The purpose of this study is to look for an association between behaviors manifested and used to diagnose ADHD and behaviors manifested in Cognitive (problem solving) style using Kirtons Adaption-Innovation theory and the KAI Inventory Tool. Method: Compared the behaviors identied in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as published by the American Psychiatric Association (APA) and behaviors consistently manifested by different problem solving styles using Kirtons Adaption-Innovation Theory. Completed a pilot study on 100 formally diagnosed adult ADD/ADHD subjects. Used an online survey to identify participants formal diagnoses and additional variables including demographics, family history, and prescribed medications. Completed Kirtons Adaption-Innovation (KAI) Inventory on each participant to identify individual problem solving style. Completed the Myers Briggs Type Indicator (MBTI) focusing on Intuitive (N) and Perceiving (P) results for triangulation purposes with the KAI. Results: Statistical Analysis: A distribution comparison of the results with the general population (derived from several studies) will be provided along with the means and standard deviation to complete the data support of expectation. The case is especially strong as the KAI theory gives a very clear expected result with which results are clearly in accord. Narrative Results: Although general population usually falls in a normal bell curve for both KAI and MBTI results, the subjects in this study fell almost entirely on the innovator side of Kirtons Adaption-Innovation Continuum, and in the intuitive (N) and perceiving (P) side of the MBTI sixteen cell personality preference grid. The results of the pilot show that there is a strong correlation between those formally diagnosed with ADHD and Innovation. Behaviors identied by APA are closely aligned with behaviors manifested by innovators. Conclusion: Results support the need for a larger population study and increased training strategies based on KAI theory.

P-23-02 Are there differences between patients and close relatives evaluating retrospectively Attention Decit Hyperactivity Disorder (ADHD) psychopathology in childhood? A study using the short version of the Wender Utah Rating Scale (WURS-k) J. Buchli - Kammermann*, R.-D. Stieglitz * Basel, Switzerland Objective: ADHD persists in adulthood, and shows a prevalence of approximately 4%. To diagnose adult ADHD there needs to be a proven onset of symptoms in childhood. The German short version of WURS with 25 items provides valuable information to identify ADHD psychopathology during childhood retrospectively. ADHD should be recognised as a valid psychological disorder as it is, and the WURS-K plays an integral role in the complex diagnostic process. A cut-offscore above 30 in the WURS-k predicts a strong tendency for ADHD symptoms starting in childhood. However, only a very few studies have analysed the relationship between patient memories and those of close relatives concerning remembering the difculties the patients had during childhood. The aim of this study is to evaluate the symptom overlap, or differences between the two informants. Method: All patients passed through an ADHD diagnosis process consisting of clinical instruments by two psychologists from the adult ADHD consultation of the psychiatric outpatient department (University Hospital Basel). A sample of N=100 adults was evaluated with the following instruments: ratings scales (ADHD-SB, CAARS-R, -D; Rosler et al., 2008a) and a structured clinical interview: (WRI; Rosler


176 et al., 2008a). Additionally, symptomatology in childhood was assessed with the WURS-k by the patients and close relatives. For both informants each of the 25 WURS-k items were analysed in terms of frequency. Results: First results show a symptom overlap between both informants for some of the 25 WURS-k items. There were certain groups of symptoms where differences were registered. Conclusion: We recommend using WURS-k especially for adult patients. Valuable input by close relatives could complete the ADHD diagnosis in adulthood, in case that WURS-k scores of the patient is below the cut-off-score. N=358), the Beschwerdeliste (B-L, N=155), the Fragen zur Lebenszufriedenheit (FLZ, N=155) and the General Depression Scale (ADS, N=155). Results: The results of the psychometric properties, the convergent validity and the discriminant validity will be presented on the congress.

P-23-05 Quality rather than quantity of symptomatic criteria for the diagnosis of adult ADHD I. Szpindel*, A. Turgay

P-23-03 A screening scale for adult Attention Decit Hyperactivity Disorder: Sensitivity, specicity and cut-off score data of Turkish form ASRS S. Dogan*, B. Oncu, G. Varol-Saracoglu * Tekirdag, Turkey Objective: Altough Attention Decit Hyperactivity Disorder (ADHD) has historically been known as a childhood disorder, it is currently recognised as a lifelong disorder in many cases and associated with severe morbidity and disability. Diagnosis of adult ADHD is clinically based and rests on a thorough clinical interview, in conjunction with results from symptom rating scales and supplemental information about the patients childhood from parents or siblings. These article presents sensitivity, specicity and cut-off score data of Turkish Form Adult ADHD Self-Report Scale (ASRS-v1.1) . Method: Sample of the adult ADHD group comprised of 30 patients at the Ankara University Psychiatry Department. Sample of the control group comprised of 282 undergraduates at the Namik Kemal University, Tekirdag. All participants completed the Turkish ASRS, and Structured Developmental History Questionnaire (SDHQ). Results: Turkish version of ASRS has a high level of sensitivity (73.3%) and specicity (92.3%). Additionally, our result showed that ASRS has 37 cut-off score. Conclusion: With this study, we found that ASRS is a higly sensitive and specicic enstrument. Its cut-of score is 37. ASRS screener is very helpfull in community surveys and primary care screening. Besides, it can be self-administered easily and quickly might make it a useful secondary measure to include in clinical studies.

* Toronto, Canada Objective: To calculate symptom frequencies in a sample of adult ADHD patients administered an additional validated general psychopathology screen at time of diagnosis, and to identify the most frequently occurring symptoms and compare them in frequency to those associated with DSM-IV and ICD-10 diagnostic criteria for adult ADHD. Method: A sample of 297 adults from Toronto diagnosed with ADHD by psychiatric evaluation, employing structured clinical interviews and validated, standardized rating scales, received additional assessment at time of diagnosis by Gadow-Sprafkin General Psychopathology Screening Scales. Averaged frequency percentages for each Gadow-Sprafkin symptom were calculated retrospectively and ordered. Symptoms corresponding to DSM-IV and ICD-10 diagnostic criteria for adults with ADHD were identied and compared in frequency to remaining symptoms. Results: The following were the most common symptoms, occurring in greater than 80% of cases and in descending order: Sense of underachievement 92.3%, intolerance of boredom 88.8%, multitasking 87.2%, distractibility 87%, difculty sustaining attention 86.5%, inability to reach potential 83.5%, time mismanagement 83.3%, impatience 83.3%, chronic procrastination 81%, search for high stimulation 80.8%, difculty organizing tasks 80.5%. These correspond to only four of the nine DSM-IV and ICD-10 ADHD inattentive criteria which instead includes these lower frequency symptoms from our sample: losing items 62%, forgetfulness 70.5%, inattention to detail 70.5%. Symptoms associated with impulsivity were observed in relatively low frequencies of 57.8%63.95%. Conclusion: Current DSM and ICD symptomatic criteria for the diagnosis of adult ADHD may be lacking in quality rather than in quantity. Rather than lowering the minimum symptom threshold for the adult diagnosis, a more suitable symptom list might more effectively be adopted. Moreover, the qualities of these symptoms suggest that impulsivity is overrepresented while executive dysfunction is underrepresented and may indicate which low frequency items derived from child presentations might best be substituted by which high frequency executive symptoms.

P-23-04 Psychometrics of the German short version of the Brown ADD scales C. Hauinger*, U. Ruhl, I. Hach * Gottingen, Germany Objective: The Brown Attention-Decit Disorder Scales are a widely used instrument for screening adult patients. This study sought to evaluate a German short form of the Brown-Attention-Decit Disorder Scales (BADDS-K). These scales are used in a screening and follow-up measurement of symptoms of Attention Decit Hyperactivity Disorder (ADHD) in an outpatient population. It is expected that psychometric properties will permit the usage of a short form in screening and follow-up measurement. Method: 987 patients from mixed settings, enrolled in an ongoing study were asked to complete the BADDS-K. 710 also completed the short version of the Wender Utah Rating Scale (WURS-K), 274 the Connors Adult ADHD Rating Scales (CAARS-S), 318 the Adult ADHD Self-Report Scale V1.1 (ASRS) and 202 the German selfrating behaviour questionnaire (ADHS-SB). For the mental health status they also completed the Symptom Checklist-90-R (SCL-90R,

P-23-06 Developing a South African self-report ADHD questionnaire A. Burke*, T.-L. Austin * Johannesburke, South Africa Objective: In a pilot study on the use of self-report questionnaires as an aid to identify and diagnose adult ADHD, it was found that current self-report questionnaires may not be reliable or valid for use in the South African context. In this study an attempt is made to design a more relevant self-report questionnaire.


177 Method: In the pilot study 402 undergraduate Psychology students responded to an online survey in which they completed the Internal Restlessness Scale, Current Symptoms Scale, the Wender-Utah Rating Scale and the Adult ADHD Self-report Scale. An exploratory factor analysis was performed on the data to extract key symptoms that could be included in a self-report questionnaire. Results: The factor analysis yielded 7 factors. From this items were identied and included in a newly constructed questionnaire. The new questionnaire is similar to existing questionnaires as it covers items that retrospectively assess symptoms of childhood ADHD, and also covers items on current symptoms of ADHD. It differs from other questionnaires in that it includes a wider variety of symptoms, and is also structured in such a way that it covers behavioural, cognitive and emotional aspects of ADHD. Cronbachs alpha was calculated to determine the reliability of the Brief Symptoms scale, which was .933, which is satisfactory. Conclusion: As stated by McGough and Barkley (2004) there has been no scientic basis to support that the six out of nine symptoms, as required by the DSM-IV-TR, is applicable to adults. Furthermore, one of the frustrations with the DSM-IV classication of ADHD is that it does not quantify the intensity of symptoms, and leaves this problem up to the diagnostician to decide whether a symptom appears both frequently and seriously enough to warrant attention. In line with this argument Kent and Craddock (2003) comment on how much still remains to be learned regarding the development of symptoms into adulthood as some symptoms do appear to alter in their severity over time, for example hyperactivity. The scoring system in the questionnaire addresses both these issues as it allows for items to be scored both as the number of symptoms present, as well as the frequency of such symptoms. formal and informal discussions were found helpful by most participants. Conclusion: A training program for physicians to help them diagnose and treat adults with ADHD is feasible and effective. It requires didactic input, specialist mentorship and support and a combination of formal and informal case discussions and consultations.

P-23-08 Psychometric properties of the ASRS in a general population: ndings from the ChiP-ARD study H. Caci*, V. Oliveri, K. Dollet * Nice, France Objective: The mean worldwide prevalence of ADHD in the general population is estimated at 5.48% of school-aged children (about 800.000 individuals in France) and at 3.40% of adults (about 2 millions of individuals in France). Despite this, ADHD remains underdiagnosed in many countries. There are numerous reasons, among which we have identied the lack of validated scales. In France, clinicians and researchers cannot rely on normative data to interpret scale scores like the ASRS for adults. The ChiP-ARD study was designed to collect normative data in a random sample of pupils of the general population and their parents. Here we present the psychometric analyses of the Adult ADHD Self-Report Scale (ASRS). Method: Public schools were randomly selected in the city of Nice (south of France). The study addressed classes from last year of kindergarten (at least 5 years old) to last year of college. Teachers who agreed to participate in this study included up to 4 children: each of them was provided with a randomly drawn letter of the alphabet and selected children in the alphabetical order. Upon signed agreement of their parents, children were anonymously included in the study. Parents returned a booklet containing the ASRS. Results: 702 children were included and 844 booklets were returned by their parents (ratio = 1.20). Out of them, 784 ASRS were complete (92.89%). The total, inattention and hyperactivity scores are reliable (Cronbachs alpha = 0.85, 0.82 and 0.78, respectively) and independent of age and gender. With regard to the 6-item ASRS, 9 adults are screened positive for ADHD (1.15%). The structure of the ASRS was assessed by both exploratory factor analysis and conrmatory factor analysis (i.e. bi-factor model). Conclusion: The French version of the ASRS is a valid assessment of ADHD symptoms in adults. Norms can be derived with respect of age and gender. Study founded by the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2009):, record 09-APN-02.

P-23-07 Developing programs for physicians to diagnose and treat adults with ADHD J. Sadek*, L. Hechtman, L. Jerome, U. Jain, M. Weiss, D. Smith, A. Vincent * Halifax, Ns, Canada Objective: In 60% of children with ADHD, there will be continued impairment in adulthood. The National Co-morbidity Survey established the prevalence of ADHD in adults as 4.4%. It is likely that the demand for service will continue to rise. However, at this point, less than 12% of patients have been able to obtain services even at the primary care level. Therefore, a program for physicians to enable them to diagnose and treat ADHD across the lifespan is crucial Method: A program has been developed by CADDRA (Canadian ADHD Resource Alliance) through collaboration with 12 experts in the eld of ADHD. Forty-seven general physicians participated in the initial rounds of the program and provided feedback. The program focused on a small group, patient-centered interactive approach. The four session program (one month apart) consisted of didactic presentations, video clips, case presentations and a review of participants own cases. Didactic material included; epidemiology, etiology, diagnosis, differential diagnosis, co-morbidities, impairment and treatment. Twenty-four video clips on assessment, symptoms, impact, impairment, treatment, co-morbidities were reviewed at various points in the program. Expert assistance by phone was available to participants between sessions to enable them to actually diagnose and treat patients. Results: The majority of physicians who participated reported changes in their practice that translated into diagnosing more frequently, starting to treat patients with ADHD, referring less and following up their patients. Some physicians reported more condence in their ability to diagnose and evaluate co-morbidities. Real cases, interaction with the expert presenter and the combination of

P-23-09 Neural basis of decision making and reward: Disentangling euthymic patients with Bipolar disorder from adults with ADHD A. Ibanez*, A. Petroni, H. Urquina, M. Cetkovich, T. Torralva, F. Torrente, S. Baez, S. Strejilevich, M. Sigman, A. Lischinsky, F. Manes * Buenos Aires, Argentina Objective: Attention Decit Hyperactivity Disorder (ADHD) in adults, as well as the bipolar disorder (BD) share several DSM-IV criteria and present high rates of comorbidity.Both disorders present problems in everyday decision making. Nevertheless, previous decision making studies has shown inconsistent results. The goal of this work is to assess decision making with different tasks (behavioral as


178 well neural correlates) of decision making in adult ADHD, BD a group of controls. Method: 13 ADHD patients, 13 BD patients and 25 controls (matched for age, sex and years of education), were assessed.We considered the Iowa gambling task (IGT), a modied version of a simple task of rational decision making under risk (RDMUR, Fernandez-Duque & Wifall, 2007; Judgment and Decision Making), and a rapid-decision gambling task (RDGT) witch elicit neurophysiological process (ERPs) involved in rapidly evaluation of motivational impact of events and in guiding choice behavior (Gehring, et al., 2002, Science). In order to assess the relation of decision making tasks and individual differences we include a multivariate analysis between ERPs and the groups neurocognitive prole. Results: No relevant differences on decision making assessed with neuropsychology (IGT and RDMUR) were observed between groups. Compared to controls, only last blocks of IGT (4 and 5) in BD group showed a tendency to select risky cards. Nevertheless, the RDGT assess with ERPs shown signicant differences. Feedback error related negativity (fERN) distinguished between monetary win and losses in control group. In ADHD and BD, fERN did not discriminate between win and loss. Consistently with those result, analysis of source location (Brainstorm) evidenced reduced responses of anterior cingulated cortex (ACC) to monetary reward/ punishment in ADHD and BD. Moreover, late neural processing related to reward magnitude (P3) was impaired in both, ADHD and BD. Important differences were observed between those disorders regarding neuropsychological prole and multivariate association to decision making results. ADHD showed a pattern of impaired reversal learning and non-exible responses to negative feedback. Those impairments were associated to clinical prole of impulsivity and hyperactivity. BD showed an abnormal sensitivity to feedback and an enhanced neural response to the magnitude of the reward (irrespective of the outcome -win or loss-). Those patterns were associated to memory performance and to psychopathological measures of depression and anxiety. Conclusion: Our data suggest that neurophysiological paradigms are well suitable for assessing objective measures of those everyday impairments of decision making in ADHD and BD. Finally, our results in ADHD and BD are discussed in the framework of models of reward processing and ACC. mothers of the ADHD group were found to have statistically signicant higher scores in all sub-scales compared with the control group (p \0.05). Results of the comparison of the fathers of both groups, all of the sub-scale scores of the fathers in the ADHD group, except the overall total sub-scale score of the sum of 3 subscale scores were found to be statistically higher than the control group (p\0.05). Conclusion: Higher rates of the symptoms of ADHD in parents of children with ADHD may indicate that these people experienced problems with themselves, partners and children, and in social life. For this reason, it will be useful for more effective progression of this process to take into account the evaluation of the parents for adulthood ADHD and related co-morbid psychiatric conditions during the evaluation and the treatment period of children.

P-23-11 Evolution of the CADDRA Canadian ADHD practice guidelines - user interface rationale U. Jain*, M. Weiss, L. Hechtman, D. Smith, D. Quinn, G. Farrelly, J. Sadek, A. Vincent * Toronto, Canada Objective: The Canadian ADHD Resource Alliance (CADDRA) was founded in 2005. One of its mandates was to create user-friendly, evidence-based, practice guidelines for clinicians working with ADHD across the lifespan. Since rst published ve years ago, the Canadian ADHD Practice Guidelines (CAP-Guidelines) have evolved over three editions. Method: The underlying objective was to provide every clinician with equal access to practice-based, evidence or consensus-based information in order to facilitate a competent and standardized assessment of ADHD in children, adolescents and adults. This required that the Guidelines were: a) accessible for free (including all the rating scales); b) downloadable; c) translated into both ofcial languages (English and French); d) user-friendly; e) comprehensive; and f) written so that the common practice issues of the clinician were addressed. Results: The CAP-Guidelines contain the most widely-used, freelyaccessible instruments of assessment and treatment for ADHD in Canada. The latest edition is available simultaneously on the CADDRA website ( and in print format in a binder to allow for new and updated material to be easily inserted over time. The newly-developed CADDRA ADHD Assessment Toolkit enables physicians to standardize the assessment and treatment process and is the cornerstone of CADDRA primary practitioner training programs. The CADDRA website is in the top ten of ADHD results, suggesting an international presence. Conclusion: The CAP-Guidelines are being translated into ve major languages and will have a global reach. What most distinguishes these Guidelines from others is their user-friendly interface, their online/ print strategy which allows for timely updates and revision, and their evidence-based approach. Clinicians want more than just information: they want to know it is reliable, practical and current. The CAPGuidelines provides all of the above.

P-23-10 The symptoms of Attention Decit Hyperactivity Disorder in the parents of the children with ADHD S. Simsek*, C. Gokcen, E. Fettahoglu * Antalya, Turkey Objective: Studies concerning ADHD have shown that this disorder has a high rate of familial transmission and its heritability rate varies between 55-92 percent. In this study, we aimed to investigate the features of ADHD seen in the parents of the children with ADHD. Method: Our study included parents of 34 children with ADHD aged between 6 and 17, for the control group, parents of 34 children aged 6-17 with no referral history to the Childrens Mental Health Clinic, with excluded diagnoses of ADHD and Disruptive Behavior Disorder (DBD) were enrolled in this study. To investigate whether the parents had the symptoms of ADHD, an Adult Attention Decit Hyperactivity Scale was given to parents of both groups. Results: There is no statistical difference (p[0.05) between age and the educational level of the parents in the patient and control groups. Results of the comparison of the sub-scale scores of the Adult Attention Decit Hyperactivity Scale showed that the

P-23-12 Criterion validity of an Attention Decit Hyperactivity Disorder (ADHD) screening list for screening ADHD in older adults E. Semeijn*, M. Michielsen, H. Comijs, A. Beekman, D. Deeg, S. Kooij * Amsterdam, The Netherlands


179 Objective: To measure Attention Decit Hyperactivity Disorder (ADHD) in older adults, a screening instrument validated in the older population is needed. This study evaluates an ADHD screening list for adults, developed by Barkley on its usefulness in a populationbased sample of older adults. The predictive value of the ADHD screening list is investigated in the Dutch population. Method: Data were collected within the Longitudinal Aging Study Amsterdam (LASA). In a two-phase epidemiological design the criterion validity of the ADHD screening list was tested against a Dutch structured diagnostic interview based on the DSM-IV criteria (DIVA 2.0). At Phase 1, 1.494 older adults (61-95 years) were assessed with the ADHD screening list. In Phase 2, 234 older adults participated in the diagnostic interview. Sensitivity and specicity were determined using a ROC-curve with a cut-off score of 6 as suggested for adults by Barkley. Test-retest reliability was calculated using Spearmans rho. Results: With a cut-off score of 6, sensitivity and specicity were respectively 19.1% and 95.3%. Optimal sensitivity (61.9%) and specicity (74.2%) was reached with a cut-off score of 3 and an AUC of 75%. The test-retest correlation was 57%. Correlation between a positive screening on the ADHD screening list (cut-off C 6) and a DIVA diagnosis was 7%. Conclusion: Preliminary analysis on the data shows the ADHD screening list has limitations in its ability to adequately identify ADHD from non-ADHD in older adults in a population-based sample. P-24-03 Written production characteristics of children with Attention Decit Hyperactivity Disorder ` A. Mies*, E. Jurado, A. Fornieles, M. Quintana * Bellaterra, Spain Objective: This study analyses the text production abilities of students with ADHD and students without that disability, through evaluation of different aspects, such as planication, cohesion, causal conections and achievement of written text end, almong others. The purpose was to determine if there are any signicant differences between the study group and control group and between the different sub-types of ADHD. Method: Various studies show that stories by students with ADHD also make fewer references to the achievement of an end and include many causal connections between the ideas and unity of the text. (Soriano, 2008).Other authors emphasize that children with ADHD product shorter narrative and descriptive texts (Pedron and Cornoldy (2007) and have difculties in text categories, especially in coherence superstructures and syntactic cohesion (Gallardo, 2007). The sample involves 44 boys and girls between the ages of 8 and 10, 22 of them with ADHD and 22 in the control group. The participants go to state and public schools with State funding in the Metropolitan Area of Barcelona. All participants ` were assessed with TALEC (Test danalisi de lectura i escriptura ` en catala, Cervera, M. et al.) which includes various reading and writing sub-tests. Data process has been carried out using the SPSS-12.0 statistics kit. Pearson correlations, T-Test and ANOVA have been applied. Results: Main results show that the difference between the levels obtained between ADHD and Control groups is signicant (0.088), with higher scores for the control group. We also nd signicant differences in the majority of text evaluation categories. Conclusion: We conclude that there is evidence of the need to implement differential learning strategies and improvements in written texts by children affected by ADHD among the different subtypes and those who have learning difculties.

Saturday, 28 May 2011, 14.3016.00 P-24 Co-morbidity: Children and adolescents III
P-24-01 A clinical study of temperament, phenomenology and psychosocial factors in child and adolescents of disruptive behaviour disorders M. Bhatia*, V. Agarwal, P. Kumar, D. Verma * Delhi, India Objective: Children with disruptive behavioral disorders (DBD) have various factors behind their presentation such as temperament,intelligence & psychosocial factors.Systemic study of these factors is likely to delineate them as spectrum disorder or as a distinct entity. AIM-To clinically study phenomenology,temperament,psychosocial factors,comorbidity and parent handling style. Method: The study sample included patients aged 6 to 16 years in child and adolescent psychiatric OPD of CSMMU, Lucknow. All the patients were screened for ODD or CD & who screened positive were included in the study. TOOLS Semi structured Performa K-SADS-PL by Kaufman et al. Parent Interview schedule by W.H.O. Interview Schedule for Children by W.H.O. Temperament Measurement Schedule by Malhotra Parent Handling Questionnaire by Malhotra The following Statistical tools were used- Mean Standard Deviation t test for independent samples Chisquare test Fishers Exact Probability Test. Results: 69 patients, ODD (N=48) and CD (N=21),fullled the inclusion criteria.Mean IQ was 92.CD groups had statistically significant higher number of patients with presenting complaint of Indulges in ght (p\0.001).Lying, bullying and cruelty to animals were most commonly found symptoms in the CD group. ADHD was the most common co-morbidity diagnosis found in the both the groups. Conclusion: ODD and CD seem to be a spectrum disorder.

P-24-04 Performance evaluation of children with ADHD in reading/writing and math skills with Academic Performance Test - APT F. F. Dias*, M. C. Miranda, L. F. Coelho, S. Rizzutti, S. M. M. Palma, M. Muszkat, R. Fgaro, O. F. A. Bueno * Sao Paulo, Brazil Objective: Attention Decit Hyperactivity Disorder is considered an important educational, social and health problem. It is characterized by motor, perceptual, cognitive and behavioral disturbances that impair a childs learning, including neuropsychiatric disorders, which result in compromised quality of life. The aim of this study was to evaluate, in children with ADHD, the results of the Academic Performance Test (APT). Method: We evaluated 25 children and adolescents aged 6 to 12 years diagnosed with ADHD, who were submited to several clinical and neuropsychological assessments to determine: level of intelligence, diagnosis, Attention Decit Disorder, neuropsychologica l prole (memory, attention, executive functions and visual spatial abilities) and achievement in reading, writing and math. The APT is a psychometric instrument that aims to offer an objective evaluation of core capacities for academic performance.


180 Results: Learning difculties, studied here, most of them were in writing and reading, where the performance of children in general was below the average for the level of education in which they were. Conclusion: Due to the number of children with ADHD identied with learning difculties, believed to be necessary evidence, to be held in schools, projects for dissemination and intervention to help children with difculties in school subjects. Only then can we help to reduce the school failure of these children. Since both the literature as empirical data, such as those presented in this paper show how the coexistence of this disorder can affect the quality of life of children, it is believed that the benets would not only improve their skills in school, as also, the quality of life. specically investigates the relationship between home environment and reported sleep disturbances Method: The study was conducted at the Child Psychiatry Unit, All India Institute of Medical Sciences, New Delhi, India. Twenty clinically referred children (aged 6-11, and medication naive) were assessed for ADHD using Conners Parent/Teacher Rating Scale, and Conners Global Index-Parent version. The children underwent subjective assessment of sleep disturbances using Pediatric Sleep Questionnaire, Child Sleep Habits Questionnaire, Epsworth Sleepiness scale, Screening Questionnaires for Restless Leg Syndrome and Obstructive Sleep Apnea. Sleep parameters assessed were bedtime resistance, sleep onset difculties, night awakenings, restless sleep, sleep duration, difculty in morning awakening, excessive daytime sleepiness, parasomnias and sleep disordered breathing. A semi structured interview was conducted to elicit home environment and sleeping arrangement for the child. Results: In India children usually sleep in parents bedroom and are awake participating in late night activities which include watching TV and socializing. Parents reported that they observed bedtime resistance in their children. 30% of children with ADHD had enuresis and would talk during sleep. 5% had night terrors and 10% had seizures. Family members found it difcult to cope up with the sleep difculties of the child Conclusion: In India family environment and sleeping arrangement contributes to sleep resistance, and difculty in morning awakening. About 5-30% of children were found to have sleep disturbances.

P-24-05 Differences in brain dynamics of ADHD children with and without comorbidity of learning disability P. Adibpour*, S. Farahibozorg, N. Sadoughi, R. Rostami, M. Ahmadlou * Tehran, Iran Objective: Since ADHD is highly probable to co-occur with Learning Disability (LD), differential diagnosis of the two conditions seems to be crucial both for accurate pathology assessment and selection of effective treatment. The aim of the present study is to explore whether nonlinear dynamic analysis of brain through EEG can be used to differentiate ADHD children from those with LD comorbidity. EEG dimensional complexity is a representative of brain functioning complexity which is related to the number of independent variables needed to describe the dynamics of brain and central nervous system. Therefore in this study, EEG dimensional complexity is used to show differences of brain dynamics between ADHD children and those with LD comorbidity. Method: The subject group consisted of 31 ADHD children (mean age=8.671.49 years) and 29 sex matched with LD comorbidity (mean age=9.171.77 years). The EEG signals were recorded using 19 channels, according to 10-20 international protocol, for 4 min with sampling rate of 256 Hz during eye-closed resting condition. Correlation Dimension (CD) was computed, using Grassberger-Procaccia algorithm, to quantify dimensional complexity of EEGs. Averaging CDs of all EEG channels located in each brain region (frontal, right and left lateral, parieto-occipital, and central) resulted in CD of that region. Statistical evaluation of results was performed using one-way ANOVA in regional scale, nding out how different the two groups are. Results: The primary difference was found in frontal area (p-value 0.0047) followed by meaningful differences in left and right lateral and parieto-occipital areas (p-values: 0.018, 0.029, and 0.049, respectively). ADHD group showed higher complexity both regionally and overall brain. Conclusion: Reduced dimensional complexity of EEGs in the comorbid group compared to ADHDs could be attributed to more decient synchronization and activity of the brain networks involved in learning in the comorbid patients.

P-24-08 Comorbid autism and ADHD: Parent stress and coping D. Hamilton*, J. Whelan * Fitzroy, Australia Objective: The study aimed to: examine the prevalence of comorbid ADHD in children with autism spectrum disorder (ASD); determine the effect of comorbid ADHD on self-reported depression, anxiety and stress in parents of children with ASD; and examine possible between-group differences in coping strategies adopted by parents in stressful situations. Method: 171 parents of children with autism completed an online questionnaire which included the 21-item Depression, Anxiety, Stress Scale (DASS; Lovibond & Lovibond, 1995) and two sets of 16 items taken from The Cope (Carver, Scheier and Weintraub, 1989), a measure of coping strategies adopted in stressful situations, each set preceded by a description of either a changeable or unchangeable situation involving an autistic child. Results: 39 children (22.8%) had a comorbid diagnosis of ADHD. The age difference between children with and without ADHD was not signicant (t=1.40, p=.16). Presence of ADHD did not predict levels of parental depression, anxiety, or stress. Parents with or without a child with ADHD did not differ in their use of coping strategies (all p[.05). Many parents in both groups were found to be severely depressed, and the majority were also found to have severe anxiety. Higher levels of depression predicted low use of emotion-focused coping in a changeable situation as well as lower levels of problemfocused coping in both types of situations. Anxiety also predicted higher levels of both styles of coping. Parents higher in depression were less likely to use to either coping strategies in dealing with stress, while parents higher in anxiety were more likely to use both coping styles. Conclusion: Previous ndings on the prevalence of comorbid ADHD in autistic children were supported.The presence of ADHD does not increase parental psychological distress, nor does it affect the use of coping strategies. Coping strategy use was related to levels of anxiety and depression.

P-24-06 Sleep disturbances in children with Attention Decit Hyperactivity Disorder A. A. Joseph*, M. Mehta, R. Sagar, G. Shukla * New Delhi, India Objective: The present study aims to examine sleep disturbances in children with Attention Decit Hyperactivity Disorder (ADHD). It



Saturday, 28 May 2011, 14.3016.00 P-25 Co-morbidity: Adults II

P-25-01 ADHD and axis I disorders

persistence of ADHD symptoms into adulthood. In the present study, we systematically analyzed comorbid anxiety and depression in a sample of adult ADHD outpatients in order to estimate the incidence of these disorders in an undiagnosed patient population.

P-25-03 ADHD and axis II disorders U. Ruhl*, C. Hauinger, I. Hach * Gottingen, Germany Objective: Already in Childhood, comorbidities between AD(H)D and axis I disorders exist, e.g. social behaviour disorders. In terms of epidemiology as well as in developmental psychopathology the question comes up, if and which of the comorbid disorders continue to exist in adulthood. As a consequence, the question arises, if AD(H)D exists in adulthood or if the symptomatic can be explained by other mental disorders. This subject matter, that is also important for the treatment strategies, is not yet sufciently researched by empirical studies. Method: Since 2005, a standardized diagnostic (DIA-X, questionnaires to different mental health disorders) takes place at the beginning of a therapy in the Therapy- and Counselling Centre of the University of Goettingen. Within this process, patients ll out a screening for Attention Decit Hyperactivity Disorder (ADHD-SB, Rosler et al.). Patients who were screened positive will be invited to an ADHD-specic diagnostic where they complete performance tests (FAKT, WCST, WIT) and ADHD-specic questionnaires (BADDSK, WURS-K, CAARS). Results: 580 patients took part in the standardized diagnostic. Thereof 212 patients took part in the ADHD-specic diagnostic.First analyses show that there is a high comorbidity between ADHD and major depression or anxiety. Conclusion: Further results will be presented on the congress. I. Hach*, C. Hauinger, U. Ruhl * Nurnberg, Germany Objective: Results of studies in childhood show that patients with ADHD feature a higher risk for developing a personality disorder. During childhood, the question of the differential diagnoses between ADHD and personality disorder is marginal. In adulthood on the opposite, this question gets a higher importance. E.g. the emotional instability is on the one hand part of the ADHD and on the other hand of the borderline personality disorder. Method: Since 2005, a standardized diagnostic (DIA-X, questionnaires to different mental health disorders) takes place at the beginning of a therapy in the Therapy- and Counselling Centre of the University of Goettingen. Within this process, patients ll out a screening for Attention Decit Hyperactivity Disorder (ADHD-SB, Rosler et al.). Patients who were screened positive will be invited to an ADHD-specic diagnostic where they complete performance tests (FAKT, WCST, WIT), ADHD-specic questionnaires (BADDS-K, WURS-K, CAARS) and the structured clinical interview for personality disorders (SCID-II). Results: 580 patients took part in the standardized diagnostic. Thereof 212 patients took part in the ADHD-specic diagnostic. Conclusion: Results will be presented on the congress.

P-25-02 Comorbid mood and anxiety disorders in adult ADHD patients D. Meshkat*, A. Kutzelnigg, C. Eckert, A. Konstantinidis, S. Kasper * Vienna, Austria Objective: ADHD is a highly heritable neurodevelopmental syndrome with signicant lifetime risk for psychiatric comorbidities. Several psychiatric conditions are signicantly more common in patients with ADHD than in control subjects. Method: To evaluate the incidence of comorbid affective disorders, patients with adult ADHD who were rst seen at the outpatient clinic of the Department of Psychiatry and Psychotherapy were evaluated for symptoms of major depression, brief recurrent depression, bipolar depression and anxiety disorders. Patients aged between 18 and 75 years were included into the study. Both ADHD symptoms and symptoms of comorbid psychiatric conditions were evaluated according to DSM IV TR criteria. So far, from February 2007 until December 2010, 383 patients (224 males and 159 females) were included into the study. Results: The mean age of the patients at diagnosis was 33,3 years for males (range: 18-75) and 35,8 years for females (range: 18-64). Affective disorders were most frequently diagnosed as current comorbid conditions in our patients and occurred in 37% of the patients in our sample. Of these, 17% had minor depressive episodes, 14% had major depressive episodes and 6% were diagnosed with bipolar disorder. 21% of our patients were diagnosed with one or several comorbid anxiety disorders. Conclusion: Most adults with ADHD are not diagnosed properly and therefore remain untreated although they are usually diagnosed and treated for comorbid psychiatric disorders. Furthermore, the presence of psychiatric comorbidities may be one factor that inuences the

P-25-04 The accompaniment of inattention with daily excessive sleepiness among individuals with attention decit disorder or Attention Decit Hyperactivity Disorder S. Shirataki*, S. Moriyasu, Y. Idehara * Kobe, Japan Objective: To investigate the appropriateness of hypothesis on the developmental milstones in attention function; reexive attention, alerting attention, orienting attention, and executive attention. But, the reexive attention is at moment a focus of discussion. The authors hypothesis is that the reexive attention has certainly a pivotal role in the early infants in whom attention is possible only in the state of wakefulness and impossible when this wakefulness is changed into sleep state. Therefore, we may expect one type of inattention in affected children or adults can be caused by the distorted neurophysiological system which concern with sleep and wakefulness alteration or maintenance of wakefulness state. Method: Using detailed symptoms analysis, the ADHD RS-IV Japanese Version, and Continuous Performance Test for randomly chosen patients with inattention, all subjects were diagnosed with Attention Decit Disorder (ADD) for 5 adults individuals (age range from 20 to 42 yrs) and Attention Decit Hyperactivity Disorder (ADHD) for 5 children (age range from 12 to 14 yrs). Furthermore, all these individuals were found to be affected by the daily excessive sleepiness. The routine EEG recordings were undertaken to investigate whether subjective sleepiness in these individuals can be objectively conrmed or not in EEG by the presence of slow wave sleep activities. Results: It was conrmed that all adults individuals with ADD and all children with ADHD are accompanied by daily excessive sleepiness, and also conrmed that this sleepiness is not a subjective feeling, but, it was objectively demonstrated by the dominant slow wave sleep


182 activities in the EEG recordings which were undertaken at around 10 am in the morning. Conclusion: High frequency accompaniment of inattention with daily excessive sleepiness among individuals with ADD or ADHD can be understood easily when we take into account that the rst attentional milestone is grounded on the Brainstem Activating Reticular System which closely related with the sleep and wakefulness alterations or wakefulness maintenance. Method: To assess the existing scientic literature the medical and psychological databases such as PsychInfo and Medline were searched. Using Google the combination of ADHD and Sports addiction was assessed. Several experts in sport psychology and psychiatry were interviewed. Results: There are some rare case reports and only one open study on ADHD and sports addiction. In the open eld of the Internet there exist several self help groups and chat communities on the topic. The experts consider sports addiction as a possible explanation for massive hyperactive behaviour of individuals and postulate more systematic research. Conclusion: Addictive behaviour in Sports should be considered as a possible comorbid behavioural pattern in ADHD-patients with massive hypermotoric symptoms and a possible explanation for lack of treatment success. On the other hand, systematic research could distinguish between the numerous protective aspects of sports for ADHD-patients and the possible risc for some vulnerable individuals.

P-25-05 Sleep in adults with Attention Decit Hyperactivity Disorder (ADHD) of the predominantly inattentive (ADHD-I) and combined (ADHD-C) subtypes R. Yoon*, U. Jain, C. Shapiro * Toronto, Canada Objective: To determine the nature and frequency of sleep disturbances in adults with Attention Decit Hyperactivity Disorder (ADHD) Method: This is an observational study of sleep in ADHD patients, using questionnaires designed to assess daytime sleepiness, sleep quality, alertness, circadian preference, and fatigue. Results: Approximately 90% of patients with ADHD report either excessive daytime sleepiness or poor sleep quality, suggesting that a very large percentage of patients with ADHD suffer from sleep disturbances. Because we wanted to determine whether daytime sleepiness is attributed to poor sleep quality, we assessed correlations between daytime sleepiness and sleep quality. While there is no correlation between daytime sleepiness and sleep quality, there is a correlation between sleep quality and fatigue. This suggests that quality of sleep does not necessarily result in daytime sleepiness but, rather, gives rise to the experience of fatigue. This is important from a clinical perspective, because it implies that fatigue, rather than daytime sleepiness, is a marker of sleep disturbances. It also raises questions about the experience of sleepiness: if sleepiness is not associated with sleep quality, is sleepiness a pathological condition rather than a symptom of sleep disturbances? It is important to note that although the ndings of the subjective data are interesting, studies in childhood ADHD have revealed that subjective data do not necessarily correlate with objective data. As a result, even though about 90% of ADHD patients are found to suffer from signicant daytime sleepiness or poor sleep quality, such ndings may not coincide with data collected through objective methods such as polysomnography (PSG), a diagnostic tool used to collect objective sleep data. We are currently collecting sleep data with PSGs to objectively assess sleep disturbances in ADHD. Conclusion: Given the high incidence of sleep problems in ADHD, we believe that understanding sleep in ADHD will lead to better understanding of the complexities of ADHD and, consequently, to the development of alternative and effective treatment options.

P-25-07 Personality traits in a small sample of adults with ADHD: Evaluation with temperament and character inventory, revised (TCI-r) and the NEO-Personality Inventory, revised (NEO-PI-R) C. S. Miguel*, M. Klein, M. A. Gobbo, M. A. Silva, L. C. Monteiro, T. M. Alves, M. Louza * Sao Paulo, Brazil Objective: To evaluate personality traits of adults with ADHD using the Brazilian versions of the Temperament and Character Inventory-revised (TCI-r) (Cloninger and Goncalves 2010) and the NEO Personality Inventory, revised (NEO-PI-R) (Costa and McCrae 2007). Method: Six adult subjects (4 men, age: 41.5 14.5 years) with ADHD (according to DSM-IV criteria) fullled both the NEO-PI-R and the TCI-r in two different occasions to avoid fatigue. All had at least 10 years of formal education. They did not fulll criteria for personality disorders. Means and standard-deviations (absolute scores) of the 5 main factors of the NEO-PI-R and the 7 main scores of the TCI-r were compared with normative Brazilian data using onesample T-test from SPSS version 14. Results: Persistence (a Temperament dimension) and Self-Directedness (a Character dimension) of the TCI-r were signicantly lower than the population mean. In the NEO-PI-R, Neuroticism was signicantly higher than the normative data and Concientiousness was signicantly lower than the population mean value. Conclusion: Both in the TCI-r and the NEO-PI-R differences in dimensions were observed in comparison with the normal population. These dimensions describe some of the clinical characteristics, symptoms and functioning of ADHD patients. References: Costa PT, MacCrae R. NEO PI-R: Inventario de Personalidade Neo revisado e Inventario de cinco Fatores Neo Revisado NEO-FFI-R (versao curta). 1st Ed. Sao Paulo: Vetor, 2007. Goncalves DM, Cloninger CR. J Affect Disord. 2010;124(1-2):126-33.

P-25-06 Sports and movement addiction in adolescents with ADHD - is this an existing differential diagnosis? Review of the literature in sports psychiatry O. Bilke-Hentsch*, M. Schmelzle * Berlin, Germany Objective: Sports Psychiatry is an emerging eld both in clinical and public interest. Scientic literature is sparse and hitherto concentrates on psychiatric disorders of athletes such as anorexia in runners and gymnastics or use of illegal substances in doping. In the context of severe motoric hyperactivity in ADHD-patients there may be clinical reason to see movement or sports addiction as a concept to explain specic features.

P-25-08 Emotional empathy and suicidal ideation in adult ADHD E. Gleichgerrcht*, F. Torrente, T. Torralva, F. Manes, A. Lischinsky * Buenos Aires, Argentina Objective: To determine the relationship between emotional empathy and suicidal ideation in adults with Attention Decit Hyperactivity Disorder (ADHD) Method: Forty patients diagnosed with ADHD were grouped according to whether or not they reported suicidal ideation (SI) on the corresponding item of the Beck Depression Inventory. Empathy was


183 assessed with the Interpersonal Reactivity Scale (IRI), including emotional empathy (empathic concern and personal distress subdomains) and cognitive empathy (perspective taking). Patients and their closest relatives also completed questionnaires on aggressive behavior, depression, anxiety, impulsivity, and quality of life, among others. Results: Compared to patients reporting no SI (no-SI-ADHD, n = 23), ADHD patients who reported SI (SI-ADHD, n = 17) exhibited signicantly increased levels of personal distress (U = 96.0, p \ .01) in the absence of signicant differences on empathic concern (p = .32) or perspective taking (p = .94). SI-ADHD patients also exhibited signicantly higher scores on childhood inattention (p = .03), depression as perceived by relatives (p = .025) and by themselves (p\ .001), apathy (p = .02), and anxiety (p = .012 for state, .019 for traits). Quality of Life was signicantly reduced in SI-ADHD (p = .05), with particularly low scores on global impression of life quality (p \ .01). In fact, personal distress, but not empathic concern, correlated signicantly with quality of life. Conclusion: Adult ADHD patients who exhibit suicidal ideation may have decits in the regulation of emotional empathy, leading to increased personal distress. This, in turn, seems to be associated with a poorer quality of life, accompanied by a wide array of psychiatric symptoms. Measuring different aspects of emotional empathy in ADHD patients can provide insight into the emotion regulation disturbances that characterize this population. Regression). Hyperactivity/Impulsivity could be correctly classied by differences in speech-rhythm: in the free-speech-task with 76.8% and 79.2% in the counting-task (log. Regression). The analysis of the voice quality correctly classied 65.1% of the subjects in the free speech task and 76.2% with the vowel/a/(log. Regression). Conclusion: These results indicate strong evidence for the possibility of an objective measurement of inattention and hyperactivity via the voice analysis of certain acoustical properties in the speech of ADHD-patients. In the near future we aim to 1. Verify our results on a larger sample. 2. Differentiate the ADHD-voice parameters from other Axis-1 disorders. 3. Finally we will investigate ADHD-subjects with comorbidities in order to differentiate ADHD-markers and those of comorbidities intra-individually.

P-26-02 Can quantitative EEG (QEEG) measures be used as objective indices in the diagnosis of Attention Decit Hyperactivity Disorder (ADHD) in adults? Preliminary study in a Hungarian clinical sample of adults with ADHD V. Simon*, P. Czobor, L. Tombor, S. Papp, S. Komlosi, B. Kakuszi, B. Szuromi, L. Balogh, A. Angyalosi, D. Kovacs, I. Bitter * Budapest, Hungary Objective: The diagnosis of ADHD lacks objective measurement tools and indices. A growing body of literature suggests that children with ADHD show an increase in EEG spectral power in the low frequency bands compared to healthy controls. However, there is a relative lack of such quantitative EEG (QEEG) data in adults with ADHD. Objective of this study was to investigate the association between symptoms of ADHD and power spectral indices of the QEEG in adults with ADHD; further, to test whether adults with ADHD are distinguishable from healthy controls along these QEEG measures, including absolute power and cordance. Method: Thirty adults with the DSM-IV diagnosis of ADHD and 30 matched control subjects were included in the study. Resting state, high-density EEGs were recorded using the BioSemi System (BioSemi, the Netherlands) from a 128 channel scalp montage, band-pass ltered (between 0.05 and 70 Hz), and digitized at 1024 Hz. Epochs with blinks and eye movements were rejected ofine. Absolute and relative power was calculated from epochs of 2500 ms duration for the major EEG frequency bands including delta, theta, alpha and beta, respectively. Cordance was computed according to a three-step algorithm including (a) the computation of re-attributed power, (b) normalization across electrode sites; and (c) summation of the z-scores for absolute and relative power. ADHD symptoms were evaluated based on the Conners Adult ADHD Rating Scale (CAARS) subscales scores for the analysis. Results: Preliminary results of this study indicate a signicant (p\0.05) association between symptoms of ADHD, as measured by the CAARS subscale scores, and absolute power, as well as a signicant (p\0.05) difference between the ADHD and control groups in absolute power and cordance. Conclusion: Preliminary ndings of this study suggest that QEEG may be used to differentiate adults with ADHD from healthy control subjects.

Saturday, 28 May 2011, 14.3016.00 P-26 Biomarker candidates

P-26-01 The voice of ADHD - vocal acoustic biomarkers in ADHD D. Langner*, J. Langner, L. Gentschow, P. Kunze, E. Ahlers, M. Colla * Berlin, Germany Objective: The study aims to detect vocal acoustic biomarkers for the main symptoms of ADHD, inattention and hyperactivity/impulsivity, based on the analysis of acoustical properties in the speech of adult patients with ADHD. This study is part of the ADHD Voice-Analysis project, granted by the German Federal Ministry of Economics and Technology (ZIM-KF2247401AK9). Method: We analyzed the high quality recordings from 161 subjects. The sample consisted of 77 adults drug-naive patients diagnosed with ADHD and no comorbidities (subtypes: inattentive =34, combined =37, hyperactive = 6) and 84 healthy controls. Each participant was voice-recorded for about ve minutes with a headset microphone. The participants were asked to a) speak freely three minutes and report on any chosen, emotionally neutral, topic, b) count from 1-10, c) read a given phrase, d) produce different vowels and consonants. We analyzed the voice quality and the speech rhythm. The speech rhythm was analyzed with rhythm-oscillograms, a new method of analysing periodicities as fundamental aspects of speech-rhythm (J. Langner, 2002). The voice quality was analyzed via subtle timbre-analysis, originally developed for the music-analysis, and now also in operation of speech-analysis, patented by J. Langner in 2003. Results: The analysis of the voice quality showed signicant results for both symptoms, inattention and hyperactivity/impulsivity. Inattention was correctly classied with speech-rhythm: in the freespeech-task with 73.6% and 72.0% accuracy in the counting-task (log. Regression). The sound-analysis of the voice quality performed even better detecting the subjects: in the free-speech-task with 71.5% correct classication and 79.9% using the sound of the vowel/a/(log.

P-26-03 An electroencephalographic biomarker separated patients with Attention Decit Hyperactivity Disorder into two subgroups with signicantly different clinical proles S. Snyder*, T. Rugino, M. Hornig, B. Daviss, E. Tsai, T. Lock, G. Marsella, R. Davis, R. Scheffer, R. Williams, K. McBurnett * Boulder, Colorado, USA


184 Objective: Methods are needed to support clinical integration of potential biomarkers for Attention Decit Hyperactivity Disorder (ADHD) in a manner that augments the clinicians evaluation. We investigated the use of an electroencephalographic (EEG) biomarker to separate patients with ADHD into two test-result subgroups, and we assessed clinical utility by evaluating these subgroups for clinically meaningful differences. Method: Investigators conducted a multi-site, double-blinded, clinical cohort study. Recruits were 364 children and adolescents, ages 6.0017.99 years, consecutively presenting with attentional and behavioral concerns to 13 clinical sites in geographically distinct regions of the US. ADHD was determined prospectively by a best estimate diagnosis requiring reviews of comprehensive clinical data sets by 3 independent diagnosticians. An EEG biomarker collected under double-blinded conditions was used to separate patients with ADHD into 2 test-result subgroups: 1) EEG-positive (standardized theta/beta ratio greater than a predened cutoff); n=101, and 2) EEG-negative; n=89. Results: As compared with the EEG-positive subgroup, the EEGnegative ADHD subjects were signicantly more likely to have the following clinical features: psychiatric disorders that could lead to ADHD exclusion (odds ratio, OR=2.0), medical or neurological conditions known to mimic ADHD (OR=9.5), uncorrected vision or hearing problems (OR=2.3), history of no improvement (OR=8.5) or adverse events (OR=3.9) on ADHD medications, presentation with a primary concern of aggression (OR=2.0) or anger (OR=4.1), satisfactory academic and intellectual performance (OR=4.1), and evidence of dissatisfaction with ADHD diagnosis (OR=7.7). Conclusion: EEG test-result subgroups of ADHD patients had signicantly different clinical proles with potential impact on ADHD diagnosis and management. The EEG-negative subgroup was more likely to have complicating conditions that may require further evaluation before clinicians should accept ADHD as the primary diagnosis. p= 0.00. In our study, stop-signal delay (SSD) was set as variable and dependent on subjects performance. A signicant SSD difference between the unaffected 4q13.2 and controls was found, t(65)= 2.50, p= 0.02), characterized by a larger SSD in the 4q13.2 group. Conclusion: Locus 4q13.2 might be acting as a protective factor in ADHD-unaffected family members, enhancing their inhibitory control as exhibited with the electrophysiological marker N200. Our ndings suggest the need for further analyses to evaluate the feasibility of using inhibitory control as an endophenotype in this particular ADHD isolate.

P-26-05 Investigation of brainstem dysfunction in ADHD - ABR changes and medication effects S. Nielzen*, J. Kallstrand * Lund, Sweden Objective: To assess brainstem integrative mechanisms by means of Auditory Brainstem Response (ABR) in medicated and unmedicated adult patients with ADHD. Method: Thirty unmedicated and 16 medicated patients with ADHD were compared with 72 healthy subjects with respect to their brainstem responses to complex sound stimulation. Data were analyzed by means of multivariate statistics. Results: Signicant aberrations were found in unmedicated patients predominantly at the levels of pons and thalamus. Medicated patients showed the same tendencies but the deviations were substantially reduced. Conclusion: Subcortical networks are affected in ADHD. Furthermore, the ABR technique is well suited for assessment of such deviances and the possibility of controlling medication is opened by this method.

P-26-04 Examining the feasibility of N200 as an endophenotype candidate in a genetic isolate of familiar type ADHD N. Trujillo-Orrego*, M. A. Garcia-Barrera, C. B. Holroyd, D. A. Pineda * Victoria, Canada Objective: An unanswered question in ADHD research regards the relationships between genetic variations and behavior, possibly addressed with the examination of endophenotypes. N200 is a robust electrophysiological marker for inhibitory control. This study examined N200 as an endophenotype candidate for inhibitory control in familiar type ADHD. Method: The sample was selected from an ADHD family study previously conducted in Antioquia (Arcos-Burgos et al. 2004). Linkage analyses identied 31 affected and unaffected subjects for this study, grouped into 4 subsamples: affected/unaffected and linkage loci 4q13.2/11p15.5. A sample of 59 subjects conformed our control group. Inhibitory control was examined using Stop-Signal Task (SST), and brain-electrical activity was recorded. N200 peak amplitudes in success and fail no-go trials were then calculated and examined within the region of interest. A mixed-design repeated measures ANOVA was used to examine statistical differences between groups. Results: We found an interaction effect for successful and fail conditions between unaffected 4q13.2 and controls, F(1, 64)= 4.50, p= 0.04. No other interactions were found. Post-hoc analyses showed that peak of amplitude for the N200 varied according to accuracy; specically, a signicant reversed pattern was found, characterized by larger N200 amplitude for success trials in controls, and a lesser amplitude in the 4q13.2, despite similar accuracy rates, t(66)= 3.59,

P-26-06 Alterations in the function of hypothalamic-pituitarythyroid axis in children with psychiatric disorders M. Dabkowska* * Bydgoszcz, Poland Objective: Thyroid abnormalities have been associated with Attention Decit Hyperactivity Disorder (ADHD) and with other childhood psychiatric disorders. Some type of thyroid dysregulation can contribute to ADHD. Attention decit disorders are a frequent manifestation of resistance to thyroid hormone (RTH). Resistance to thyroid hormone is caused by mutations in the hormone-binding domain of the human thyroid hormone receptor b gene. Resistance to thyroid hormone was associated with impaired function in the parts of the brain that are active in paying attention to and processing what we are trying to listen to. Other parts of the brain went into hyperactivity in an attempt to compensate. The goal of this study was to determine the relationships between thyroid hormone concentrations and psychiatric diagnosis in children, especially with ADHD. Serum TSH measurement is the most diagnostically sensitive test for detecting mild (subclinical), as well as overt, primary hypo-or hyperthyroidism in ambulatory patients. Serum TSH, fT3, fT4 was determined in 42 patients (30% girls, 70% boys), mean age 14 years, diagnosed with ADHD, anxiety disorders, psychoses and ODD. Method: We examined 42 children referred to a clinic ambulatory for different psychiatric problems, measuring their thyroid stimulating hormone (TSH), fT3, fT4 levels and correlating them with diagnostic and descriptive information. The function of hypothalamic-pituitarythyroid axis was measured by means of the Architect TSH (Abbott Laboratories) chemiluminescent microparticle enzyme


185 immunoassay (CMIA) for the quantitative determination of serum TSH, fT3, fT4. Results: In 30% children was noticed alterations in the function of hypothalamic-pituitary-thyroid axis, the half of this group had abnormalities in level of fT3. The data showed that it was the more subtle functional abnormalities rather than gross pathologic ones. Conclusion: Selective screening for thyroid dysfunction of children with psychiatric disorders, especially Attention Decit Hyperactivity Disorder appears to be justied. Method: Color (C), form (F) and color-form (CF) naming were administered to 32 ADHD adults pre- and post-treatment and 32 controls. Results: Cognitive speed (F2, 90 = 71.95; p = .000000) and processing efciency (F2, 90 = 42.77; p = 0.000000) differed signicantly between ADHD adults pre- and post-medication and controls. Cognitive-speed and processing-efciency were signicantly reduced in ADHD adults pre-medication (M = 69.31 and 13.81 s.) compared to controls (M = 47.63 and 3.56 s.) and in ADHD adults pre-medication (M = 69.31 and 13.81 s.) compared to postmedication (M = 46.25 and 3.16 s.). These measures did not differ between ADHD adults post-medication and controls. Applying failcriteria for cognitive-speed ([60 s.) yielded 75% sensitivity and 100% specicity and for processing efciency ([?6 s.) 88% sensitivity and 81% specicity. Combining fail-criteria yielded 94% sensitivity and 84% specicity. Conclusion: Preliminary ndings suggest that AQT cognitive-speed and processing-efciency measures may be used to screen adolescents/adults for ADHD.

P-26-07 The objective measurement of the activity in Attention Decit Hyperactivity Disorder children M. Dabkowska*, T. Pracki, D. Pracka * Bydgoszcz, Poland Objective: Motor hyperactivity is one of the core symptoms in ADHD. These children have serious problems with the control of their moves, with the adjustment of the move strength to the situation, with the limitation of moves in social situations that require calm behavior. The utterances of people with ADHD are accompanied by numerous hand gestures. The hyperactivity is particularly visible in case of younger patients, but the increased motor readiness still remains in adult life, negatively inuencing social functioning.The purpose of this work was the objective actigraphic evaluation of movement at children with ADHD (Attention Decit Hyperactivity Disorder) in relation to the evaluation of symptom intensication according to parents (ADHD-RS IV) and a medical qualication to a subtype of ADHD (DSM IV TR). Method: The motor activity of a child was evaluated by means of an actigraph - Actiwatch 4 produced by Cambridge Neurotechnology Ltd. The motor activity was calculated from 72 h, from 2-minute consecutive measurement periods typical of chronobiological examinations. There was isolated time of daily and night activity, there was determined the time (an hour out of twenty-four hours) of peak maximum motor activity (cosine peak).The investigated group consisted of 37 children (32 boys, 5 girls). Results: The total scoring of the ADHD RS-IV scale above the 90 percentile (93 and 98), which shows undoubted ADHD diagnosis, was noted in case of 72% of children, and equal to the 90 percentile or above the 80 percentile in case of 28%. There were not observed any differences in the activity between the group of children with recognizes ADHD combined subtype and the group of children with recognized ADHD predominantly inattentive subtype.There was not observed any difference in the intensity of average scoring of the ADHD RS-IV scale at boys in comparison to girls.More serious attention disorders occur in case of children, who in later hours have the maximum activity intensity. The scores of items evaluating the hyperactivity and impulsiveness did not correlate with the results of activity measurement. Conclusion: The results of actigraphic measurement did not correlate with the evaluation of the activity intensication according to parents.

P-26-09 Use of a virtual classroom in a french population: a comparative study between children with ADHD and control children S. Bioulac*, S. Kedziora-Lallemand, P. Philip, C. Fabrigoule, M. Bouvard * Bordeaux, France Objective: Use of virtual reality tool is interesting for the evaluation of Attention Decit Hyperactivity Disorder (ADHD) patients. The virtual environment offers the opportunity to administer controlled task like the typical neuropsychological tools, but in an environment much more like standard classroom. The aim of this work was to compare performances of ADHD patients and controls at an attentional task embedded in the context of a virtual classroom, with a focus on the evolution of performances over the blocks of trials. Method: Design and methods: 36 boys (7 to 10 years of age) comprising 20 ADHD subjects and 16 controls completed the virtual classroom task. We compared ADHD performances between control performances through the ve successive blocks of the virtual classroom. We also compared attentional performances recorded in the virtual classroom with measures of the Continuous Performance Test (CPT II). Results: ADHD children had signicantly less correct answers than control subjects in the virtual classroom. ADHD children, contrary to controls, showed a signicant worsening of performances over the successive blocks. This worsening appeared as early as the second block. Furthermore, virtual classroom measures correlated with CPT II measures. Conclusion: The new French version of the virtual classroom was able to distinguish performances in children with and without ADHD. This work showed a signicant deterioration of performances over time for only ADHD children but not for controls. This ecological instrument constitutes a good clinical tool for evaluation in ADHD and for studying impact of time on task effects.

P-26-08 AQT cognitive speed and processing efciency differentiate adults with and without ADHD: A preliminary study N. P. Nielsen*, E. H. Wiig * Kbenhavn, Denmark Objective: To evaluate if a quick test of cognitive speed (AQT) processing speed would differentiate ADHD adults pre- and posttreatment with methylphenidate and normal controls.

P-26-10 Different neuropsychological proles in Wechsler Intelligence Scale for Children-fourth edition (WISC-IV) between ADHD subtypes and ADHD with symptoms of Sluggish Cognitve Tempo in patients naive E. Camprodon*, R. Nicolau, L. Duno, M. Garca-Giral, S. Andres, S. Batlle, N. Ibanez, X. Estrada, M. Acena, L. M. Martin * Barcelona, Spain


186 Objective: Attention Decit Hiperactivity Disorder (ADHD) is one of the most common mental health disorders of childhood. In the DSM-IV (TR)s subtypes of ADHD, Combined (C), Inattentive (I) and Hiperactivity-Impulsivity Type are accepted. Some studies suggest the existence of subgroups more homogeneous and it is proposed enlarge the actual symptoms list of DSM-IV TR. As nd other criteria to do subgroups. Specically the construct of Sluggish Cognitive Tempo (SCT) has been associated in a ADHD-I and some studies suggest that it takes part from another clinical entity. Other studies also found in non ADHD clinical groups. Findings support the statistical of the SCT construct, but its clinical utility is still unclear. The aim of this study is to determine whether differences exist between neuropsychological proles of The Wechsler Intelligence Scale for Children (WISC-IV) in the subgroup of ADHD-C, ADHD-I and ADHD with symptoms of SCT in naive patients. Find diferences between of Child Behaviour Checklist proles (CBCL, Achenbach) of different subgroups. Method: This is a multicenter study. The patients were selected from the Child and Adolescent Mental Health Service (CAMHS) Sant Mart and the Hospital Clinic (Barcelona) (N=57). Age range: 7 to 11 years old. Three groups: ADHD-C (N=24), ADHD-I (N=13) and ADHD with symptoms of SCT (N=20). SCT symptoms were assessed in these subjects by means of CBCL scale. A descriptive cross-sectional study design were purpose. Study of descriptive stadistics for age, gender and subgroups. Results: Expected signicant differences between the proles of the WISC-IV. The group of ADHD with symptoms of SCT saved differs signicantly slower cognitive prole of other groups. Signicant differences were found in multivariate ANOVA analysis between all groups (p\0.01). Find signicant differences between the proles of Achenbachs CBCL. Conclusion: Patients with ADHD with symptoms SCT show different neuropsychological proles in the WISC IV compared with other groups. Conclusion: The SR-WRAADDS demonstrated acceptable psychometric properties. It separated clinical from normative subjects. It demonstrated acceptable internal consistency. The SR-WRAADDS correlated well with the original investigator rated version at baseline and much better when addressing treatment effects. The factor structure differed from the investigator version signicantly. It includes additional items not a part of the Utah or DSM criteria.

P-26-12 Measuring restlessness and focus in the context of everyday life in Adults with Attention Decit Hyperactivity Disorder, before and after treatment with psycho-stimulant medication C. Skirrow*, Y. Malliaris, P. Asherson * London, United Kingdom Objective: We measured symptoms relevant to Attention Decit Hyperactivity Disorder (ADHD) using the Experience Sampling Method (ESM). This allows for the unbiased assessment of experiences and their variability (measured using the standard deviation). Using this measure we aimed to uncover whether increased intraindividual variability, commonly seen in reaction-time tasks, is present in everyday experiences of ADHD symptoms. Furthermore, we aimed to discover how symptoms measured in this way respond to psychostimulant medication. Method: We compared psychiatrically healthy men (N=45) to men with ADHD (N=30) before treatment initiation. Follow-up assessments were completed in a sub-group of ADHD patients (N=14) after stabilization on psychostimulant medication, and controls (N=21) roughly matched for duration of follow-up. Participants completed the Barkley Adult ADHD Rating Scale (BAARS). At both time-points participants used the iMonitor (, a portable electronic device, for 5 days which cued them 8 times daily to report on levels of focus, and mental and physical restlessness. Analyses were conducted using non-parametric tests. Results: Baseline symptoms measured using the iMonitor correlated well with BAARS ratings (all measures of restlessness: rho=.58-.64, p\.001; focus variability: rho=.46, P\.001; focus mean: rho: .10, p[.05). ADHD patients reported greater mental and physical restlessness than controls (p\.001) at baseline, as well as greater variability in all three measured domains (mental and physical restlessness p\.002, focus p\.01), but no differences in mean focus. At follow-up signicant differences remained only for mean mental restlessness (p\.05). Conclusion: ADHD-relevant symptoms measured using ESM correlate well with an established clinical measure of ADHD symptoms. Untreated ADHD patients report higher levels of restlessness than control participants, but no difference in mean levels of focus. Interestingly, ADHD patients report greater variability in all three measured domains which were no longer different following treatment; only the greater mental restlessness remained after treatment.

P-26-11 Psychometric properties of a self report version of the Wender Reimherr Adult Attention Decit Disorder scale F. Reimherr*, B. Marchant, E. D. Williams, R. J. Robison, C. Halls, C. Pommerville * Salt Lake City (UT), USA Objective: The seven domains contained in the Utah Criteria for ADHD in adults (Attention Difculties, Hyperactivity/Restlessness, Temper, Affective Lability, Emotional Over-Reactivity, Disorganization and Impulsivity) have been previously assessed using the investigator-rated Wender Reimherr Adult Attention Decit Disorder Scale (WRAADDS). A self-report version of this scale (SR-WRAADDS) has been created which assesses these domains plus the associated areas of: Oppositional Deant Disorder (ODD), Academic Impairment, and Social Adjustment. Method: ADHD adult subjects were collected from two clinical trials of methylphenidate in adults with ADHD.1,2 Normative subjects were males and females ages 20 to 49 without current psychiatric illness. Results: Discriminate validity (normative versus ADHD adults) was signicant for all domains (p\.001). Internal consistency was acceptable with all item-total correlations above 0.38 and Cronbachs Alpha=.86. Factor analysis resulted in 3 factors accounting for 86% of the variance. There was signicant agreement between the SRWRAADDS and investigator rated WRAADDS for related domains (r[.3, p\.001) at baseline. There was substantial agreement regarding treatment response (placebo versus methylphenidate) between the SRWRAADDS and WRAADDS (r[.7, p\.001).

Saturday, 28 May 2011, 14.3016.00 P-27 Epidemiology: Children and adolescents III
P-27-01 A different look at the prevalence of Attention Decit Hyperactivity Disorder and epilepsy R. Cohen*, Y. Senecky, R. Raz, G. Chodick, V. Shalev, A. Shuper, D. Inbar, Y. Senecky


187 * Petach- Tikva, Israel Objective: Epilepsy and Attention Decit Hyperactivity Disorder (ADHD) are frequently inter-related childhood disorders. There are more epileptiform or electroencephalographic (EEG) abnormalities among children with ADHD, and more cases of ADHD among children with epilepsy than in the general population. We investigated the prevalence of both disorders from the perspective of primary care physicians, as opposed to hospital-based clinics. Method: This investigation was conducted in the Maccabi Healthcare Services (MHS), the second largest HMO in Israel, insuring 1.8 million members nationwide. The study population included all pediatric subscribers aged 6-13 years. Information about the presence of a formal diagnosis of ADHD was retrieved from the physicians records and transferred to a central computerized database. Epilepsy was dened as the purchase of at least ten prescriptions for anti-epileptic medications as reported from the MHS pharmacies. Adjusted odd ratios for the presence of epilepsy were calculated by multivariate logistic regression models using SPSS software (SPSS Inc., Chicago, Ill). Results: The study population included 284,419 children (51.5% boys), with a mean age of 9.4 years (SD=2.3 years). The prevalence of epilepsy in the total study population was 5 per 1000 children and the prevalence of ADHD was 12.6%. The prevalence of ADHD among epileptic children was 27.2%, and the risk of epilepsy among ADHD children was almost twice that of the general population. Conclusion: The national prevalence of ADHD and epilepsy among children was extrapolated from computerized data obtained from primary care physicians and pharmacies of a large community-based HMO. Although the clinical data which supported these diagnoses were not available to us, this methodology is nevertheless useful for obtaining reasonable estimates of the prevalence of these two disorders. to have ADHD. Longitudinal studies are needed to better understand the mechanisms underlying the association between ADHD and overweight/obesity.

P-27-03 A community-based longitudinal controlled cohort study of children with ADHD D. Efron*, E. Sciberras, J. Nicholson, V. Anderson, P. Hazell * Parkville, Australia Objective: Previous longitudinal studies investigating the long-term outcomes of children with ADHD have used clinical samples, which tend to over-represent children with more severe symptoms and comorbidities, while under-representing girls and children with ADHDInattentive subtype. In a community-based sample of children we aim to: 1) measure ADHD symptoms over the early years of school; 2) evaluate the extent to which children with ADHD have elevated risks for poor academic, mental health, and social outcomes compared to non-ADHD controls; and 3) assess the inuence of ADHD subtype and severity, comorbidities, and other child, family, and school factors on childrens mental health, academic and social outcomes. Method: Over 2 consecutive years, approximately 5,300 Grade 1 children across 34 schools in Melbourne, Victoria will be screened for ADHD, using Conners Parent and Teacher Rating Scales Revised (ADHD Index subscale). Children with scores one standard deviation above the mean by both parent and teacher report will be assessed further. Their parents will complete a face-to-face standardized diagnostic interview (DISC-IV) to determine whether their child meets criteria for ADHD and/or any other psychiatric diagnoses. A control group (classroom peers matched for gender) will be selected from the sample of children screening negatively. Parents and teachers of children in both groups will complete baseline questionnaires covering child and family variables. Children will also undergo a face-to-face cognitive and academic assessment. Follow-up parent and teacher questionnaires will be completed at 12, 24 and 36 months. At 36 months, the DISC-IV and direct child assessments will be readministered. A pilot study was conducted in 9 schools in 2009-10, demonstrating good feasibility and acceptability. Results: We will test the following hypotheses: Compared to the control group, children with ADHD will have poorer outcomes at 36 month follow-up including: a) More mental health diagnoses b) More total mental health and peer relationship problems, and lower psychosocial quality of life c) Lower mean academic achievement in literacy and numeracy. Conclusion: This will be the rst Australian study, and one of only a few internationally, to provide longitudinal evidence on risk and protective factors for a community sample of children with conrmed ADHD. We plan to follow these children through adolescence and into adult life. The ultimate goal of this work is to identify the key modiable early life risk and protective factors in children with ADHD. The ndings will be relevant to families, mental health, education, allied health and medical professionals, and policy makers.

P-27-02 Examining the relationship between Attention Decit Hyperactivity Disorder and overweight in children and adolescents - results from the BELLA-study B. Sawitzky-Rose*, M. Erhart, N. Wille, B. Herpertz-Dahlmann, H. Holling, U. Ravens-Sieberer * Hamburg, Germany Objective: Although a higher prevalence of overweight/obesity was reported in clinical samples of patients with Attention Decit Hyperactivity Disorder (ADHD), an association between overweight and ADHD has yet not been assessed in the general population. As both disorders are common and signicantly impact on psychosocial functioning, we investigated the prevalence of ADHD in German overweight/obese youth and vice versa. Method: In a cross-sectional nationally representative and community based survey 2863 parents and their children aged 11-17 years rated symptoms on a DSM-IV-based German ADHD Rating scale. Weight and height were assessed by professionals. Body mass index was categorized according to national age and sex specic reference values. Results: Overall, 4.2% of the respondents met criteria for ADHD. The prevalence of ADHD was signicantly higher for overweight/ obese (7%) than for normal weight (3.5%) and underweight (4.9%) children. In a logistic regression analysis controlling for age, gender and socio-economic status, overweight/obese children were twice as likely to have an ADHD diagnosis (OR = 2.0). Vice versa, adjusting for all covariates, children with ADHD had an OR of 1.9 for overweight/obesity status. For all weight-status groups, children with ADHD more frequently reported eating problems as compared to their non-clinical counterparts. Overweight/obese respondents with ADHD displayed the highest level of health services utilization. Conclusion: A clinician should be aware of the signicant risk for a child with ADHD to become overweight and for an overweight child

P-27-04 Attention Decit Hyperactivity Disorder in Turkish preschool children S. S. Basgul*, S. Saltk, A. Beyhun * Istanbul, Turkey Objective: Behavioral and emotional problems experienced in early childhood may have a major impact on the development and functioning of a child, leading to a number of psychiatric problems at a later age. A child with Attention Decit Hyperactivity Disorder


188 (ADHD) has difculty playing alone for more than a short time, destroys rather than plays with toys, and may have few friends because of aggression and inability to cooperate in play. Because of children behaviors are also consistent with a variety of other diagnose, including normal behavior for age or developmental level, diagnosis of ADHD in preschool children is difcult. Scales can be used in addition to the clinical examination to evaluate the incidence of psychiatric disorders. Childhood Inventory-4 (ECI-4) is used to evaluate the incidence of psychiatric disorders in the early childhood period. The purpose of the present study was therefore is to determine the frequency of ADHD in 3 to 6 year-old children presenting at the Outpatients Department. Method: The population sample was selected from 3- to 6 year-old children presenting at the Goztepe Research and Training Hospital, Child Psychiatry and Child Neurology Departments in Istanbul. An interview based on the DSM-IV (1994) diagnostic measures was performed with the children and the family; and the child was observed in a free play environment during the interview; and scores from parent-completed ECI-4. Results: Of the 145 children in the study, 93 (64.1%) were boys and 52 (35.9%) were girls. The mean age was 4.250.08 years. According to the results of ECI-4, 55 patients (53.7%) were diagnosed ADHD. When these patients were reevaluated clinically, the diagnosis of ADHD was corrected in 32 (22.1%) patients. The other diagnoses clinically corrected were intelligence disability in 6 patients, autism in 5 patients, child depression in 3 patients. Nine patients were normal development-related behavior. Conclusion: Our results showed that, ADHD may be seen more common than expected in preschool children. But, it is rather difcult to differentiate certain types of normal development-related behavior from psychiatric disorders in the early childhood period because of children develop rapidly in that period. these children, some were found to be in a depressive/anxious state, while others were deant, delinquent, and occasionally antisocial. The YSR attention problems subscale may enable valuable research in future, providing an easy-to-use and useful diagnostic tool for these children.

P-27-06 Does one out of seven nine-year old boys suffer from ADHD? The increasing administrative prevalence of ADHD in Germany, 20032009 M. Schlander*, O. Schwarz, G.-E. Trott, T. Banaschewski, W. Scheller, M. Viapiano, N. Bonauer * Wiesbaden, Germany Objective: In our earlier health care utilization studies (for year 2003), we observed an administrative prevalence rate of ADHD in Nordbaden (a region in the South-West of Germany with a population of [2.7 million) of 0.53%, with a peak among nine-year old boys at 8.43%. The aim of the present study is to establish a longitudinal ADHD patient database and to assess changes of ADHD diagnosis rates by age and gender during years 2003 to 2009. Method: Patient-level data were extracted for analysis from the physician-centered claims database of the Kassenaerztliche Vereinigung (KV) in Nordbaden/Germany, completely covering the regional population enrolled in statutory health insurance ([2.2 million). Age and gender specic one-year prevalence rates of ADHD were determined for years 2003 through 2009. Results: During the study period, the overall one-year ADHD prevalence rate increased from 0.53% to 0.95%. ADHD (hyperkinetic disorder: ICD-10, F90.0, F90.1) prevalence rates were highest in the age group 6-12 years (peak [2008] among nine-year old children, 10.01%; boys, 13,68%), increasing continuously during the observation period (a) age group 6-12: from 4.75% (boys, 6.91%; girls, 2.46%) to 8.01% (boys, 11.04%; girls, 4.82%); (b) age group 13-17: from 1.73% (boys, 2.66%; girls, 0.75%) to 4.22% (boys, 6.27%; girls, 2.02%); adults (age [18 years): from 0.04% (males, 0.05%; females, 0.03%) to 0.17% (males, 0.22%; females, 0.12%). Conclusion: The administrative prevalence rate of ADHD in Nordbaden/Germany almost doubled during the six-year study period. From 2003 to 2009, methylphenidate prescriptions in Germany grew even 2.75-fold, thus outpacing the increase in ADHD diagnoses from 2003 to 2009. Further research seems warranted looking into the underlying dynamics of physician group involvement, health care utilization patterns, and economic implications.

P-27-05 Attention problems and other psychosocial issues among junior high school students in Japan H. Ozawa*, N. Nakazawa, Y. Kusumoto, R. Iwanaga, A. Imamura * Nagasaki, Japan Objective: Attention Decit Hyperactivity Disorder (AD/HD) is a common developmental condition causing several psychosocial problems. We investigated approximately 5,000 junior high school students in Nagasaki, Japan, to examine the prevalence of AD/HD symptoms among children and the psychosocial problems they face. Method: The attention problems subscale of the Youth Self-report (YSR) questionnaire was used to examine the prevalence of AD/HD symptoms, and associated issues. Of the 5,374 students attending nine junior high schools, 4,977 participated in this survey and 4,864 (90.5%) provided valid responses. Logistic regression analyses were performed to test the association between attentional problems and other items, adjusted for sex and school year. Results: The results revealed that 3.9% of participants were included in the clinical range, and 10.4% were included in the clinical/borderline range on the YSR attention problems subscale. Attentional problems were signicantly associated with a range of social and behavioral problems (suicidal ideation: OR = 4.42, 95% CI 3.60-5.42; smoking: OR = 3.70, 95% CI 2.29-5.97; violence from adults in the home OR = 3.19, 95% CI 2.32-4.38; irritability when exchanging e-mails: OR = 2.93, 95% CI 2.26-3.82; being bullied: OR = 2.82, 95% CI 2.20-3.51; difculty falling asleep due hypersensitivity to noise: OR=2.32, 95% CI 1.85-2.91, self-harming behaviors: OR = 2.32, 95% CI 1.64-3.28). Conclusion: The results of the current study suggested that the YSR attention problems subscale could be used to identify children exhibiting AD/HD symptoms, especially of the inattention type. Among

P-27-07 The direct cost of Attention Decit Hyperactivity Disorder (ADHD) in Germany An age and gender specic analysis M. Schlander*, O. Schwarz, G.-E. Trott, M. Viapiano, N. Bonauer, W. Scheller * Wiesbaden, Germany Objective: International studies have reported that patients with ADHD incur higher health care costs than persons without this condition, but little is known about the direct medical costs associated with ADHD in Germany. Method: Health care resource utilization data for patients with a diagnosis of ADHD (ICD-10 codes F90.0 and/or F90.1) were extracted from the Nordbaden claims database (year 2003), covering the complete regional population insured by Statutory Health Insurance SHI (2.238 million lives in 2003), and were combined with SHI prescription data. Complete datasets were available for 3,831


189 outpatients with ADHD and for a randomly selected control group matched 1:1 by age and gender. For costing, resource use was valued applying SHI acquisition costs. Results: The annual average expenditure per patient was 650 versus 251 for matched controls, with physician charges accounting for 68% (444 versus 170 for controls). Consistently across subgroups dened by age and gender, all categories of costs were higher for patients with ADHD by a factor of 2 to 5 versus controls. Average costs per patient with ADHD increased with age (age group \7 years, 520; 7-12 years, 622; 13-19 years, 661; [20 years, 1,147), primarily reecting higher medication costs. In contrast, average costs per control person showed little change across age groups (at 269, 245, 250, and 272, respectively). Among children and adolescents, there were no substantial spending differences by gender. Conclusion: These data are likely underestimates of the total expenditures attributable to ADHD since they do not include costs of ergotherapeutic interventions, which will be addressed in future studies. They nevertheless provide robust information from Germany on the signicant nancial burden for the SHI attributable to ADHD. Results: In the sample of children with ADHD, the rate of children who were breastfed only, more than 4 months is signicantly less than the controls (P = 0.0001). Duration of breastfeeding was negatively correlated with bottle-feeding (P = 0.01) and pacier use (P = 0.01). Total duration of breastfeeding was negatively correlated with nailbiting (P = 0.05). Girls were more likely to have a history of thumbsucking (P = 0.03). Conclusion: ADHD appears to be associated with various factors relating to oral sciences. Multidisciplinary research with larger sample sizes is needed.

P-27-09 Maternal rejection, family and cognitive factors: Modeling aggression in children with ADHD E. Ercan*, E. S. Ercan, B. Kabukcu Basay, T. Uysal * Izmir, Turkey Objective: To explore the relationship of maternal rejection, family and cognitive factors to aggression of ADHD children as reported by teacher and parents. Method: The study participants consisted of 309 (254 boys, and 55 girls) elementary school age children (7-15 years) with Attention Decit Hyperactivity Disorder (ADHD) combined type or inattentive types and other disruptive behaviour disorders who have normal IQ. The children evaluated with a semistructured interview (Schedule for Affective Disorders and Schizophrenia for SchoolAge Children- Epidemiologic Version (K-SADS-E), and all diagnostic decisions made by using best estimate procedure. Approval from the Facultys review board was attained. Child Behaviour Checklist (CBCL), Teacher Report Form (TRF), DSM-IV Turgay Attention Decit Disorder, Childrens Aggression Scale-Parent and Teacher Versions (CAS-P, CAS-T), Parental Acceptance and Rejection Questionnaire (PARQ); were used in the study and also Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (TDSM-IV-S) was used as a screening instrument in this study. For Cognitive evaluation WISC-R administered by a trained psychologist to estimate the childs overall IQ.Structural equation modeling was used to examine the differential relationships of maternal rejection, family and cognitive factors to aggression in the home and school settings. Results: The principal nding of this study is that family risk factors are associated with pervasive aggressive behavior in children that spans the home and school setting.The model showed that (N = 309; Chi-Square = 464.16; df=143;RMSEA = 0.085) family factors inuenced aggression reported at home and at school. Cognitive factors

P-27-08 Breastfeeding and parafunctional oral habits in children with Attention Decit Hyperactivity Disorder: A preliminary report O. Sabuncuoglu*, A. C. Orengul, A. Bkmazer * Pendik/Istanbul, Turkey Objective: In spite of the fact that, children with ADHD were reported to have shorter duration of breastfeeding, oropharyngeal implications of this nding have not been studied. The less children are breastfed, the more they are bottle-fed and engage in non-nutritive sucking habits which negatively affect their dentofacial development. Since these issues have never been addressed in children with ADHD, we aimed to investigate them in this study. Method: The study group consisted of 68 children and adolescents with ADHD, aged 7 to 17 years. Conners Parent and Teacher Rating Scales were used to assess behavioral disturbances. A questionnaire was developed consisting of items pertaining to breastfeeding period, bottle-feeding experiences, non-nutritive sucking habits, mouth breathing and dental problems. Breastfeeding data was compared to 40 healthy school children.


190 inuenced aggression reported at school. Maternal acceptance and rejection inuenced aggression reported at home. Conclusion: Our ndings indicate that maternal rejection and family factors effects aggression in home setting and suggest that interventions for clinically referred children should target both the individual and his/her family. assessed included hospital admission related to injuries/poisoning (ICD-9 codes 800-999). Incidence rates were calculated by dividing number of events by person-years (PY). Poisson regression analysis was used to adjust crude incidence rate ratios for covariates. Results: The study cohort comprised 1397 patients initiating ADHD treatment and 8382 controls. About 80% of patients were boys and almost two-third initiated ADHD drugs between 6-11 years of age. The rate of hospital admissions was two times higher in the ADHD cohort (11.2 vs. 5.6/1000 person-years), yielding a crude incidence rate ratio (IRR) of 2.00 (95% CI: 1.53-2.62). Adjustment for comedication at baseline had a modest effect: adj. IRR 1.83 (95% CI 1.382.43). Over half of the events were fractures (adj IRR 1.40, 95% CI: 0.93-2.10), followed by intracranial injuries (adj IRR 2.30, 95% CI 1.15-4.62). Stratication by sex showed that risk estimates were higher in girls then in boys (adj. IRR 2.60, 95% CI 1.20-5.61 vs. 1.69, 95% CI: 1.24-2.30) and were the highest among 12-18 year olds (adj. IRR 1.99, 95% CI: 1.38-2.88). Conclusion: The incidence of hospital admissions for injuries and poisoning was two times higher among youth with treated ADHD compared to controls. Due to the serious nature of the outcomes, this represents only the tip of the iceberg. The higher relative risk among girls could be explained by their lower background risk of injury.

P-27-10 Are psychostimulants overprescribed in Brazilian schoolaged children? A nationwide study M. Arruda*, M. V. Moura-Ribeiro, J. H. Golfeto, M. E. Bigal, G. Polanczyk * Ribeirao Preto, Brazil Objective: 1) To conduct a nationwide populational study to estimate the prevalence of psychostimulants use in Brazilian school-aged children; 2) To estimate agreement between gold-standard diagnosis (Diagnostic and Statistical Manual of Mental Disorders, DSM-IV) and parental report of previously medical diagnosis of ADHD. Method: Sample consists of 5,961 children (4 to 18 years) recruited at the school system in 87 cities of 18 Brazilian states (represented of all Brazilian regions). Parents and teachers were interviewed using a standardized questionnaire with validated modules. ADHD was ascertained as per the DSM-IV criteria and the Mental Health Status with the validated Brazilian version of the Strengths and Difculties Questionnaire (SDQ). Results: According to the parental report, 2.1% of children were in use of psychostimulants and 7.7% had been previously received a medical ADHD diagnosis. Of children with a parental report of previous medical diagnosis of ADHD, 23.7% had DSM-IV diagnosis; of children with DSM-IV diagnosis, 58.4% had not been diagnosed (false negatives); of children using psychostimulants, only 27.3% had ADHD according to the DSM-IV. Diagnostic agreement was higher in boys than in girls (p = 0.01) and in those of lower income vs. higher income (p = 0.04). Paradoxically, psychostimulants were more frequently used by girls vs. boys (p = 0.02) and by those of higher incomes (p \ 0.001). Conclusion: The low agreement between medical diagnosis and goldstandard diagnosis of ADHD is strikingly low; similarly, agreement between diagnosis of ADHD and use of psychostimulants is also very low. These results point out important concerns under the ADHD diagnosis and the prescription of psychostimulants in Brazilian school-aged children. Of interest is that children of higher income are less likely to have an ADHD diagnosis and more likely to be treated for ADHD. It may be that social pressure at least partially explains the paradox.

Saturday, 28 May 2011, 14.3016.00 P-28 Epidemiology: Children and adolescents IV P-28-01 Difference in Internet uses between normal adolescents and ADHD
C. Arrizabalaga*, A. Aierbe Barandiarana, M. C. Medrano Samaniego * San Sebastian, Spain Objective: In todays culture, characterized by the proliferation of media, adolescents have become the biggest users of the Internet. In many parts of Spain, the Internet has overtaken television, not only as a source of entertainment and recreation among teenagers, but also as a vehicle for socializing. Adolescents suffering from Attention Decit Hyperactivity Disorder (ADHD) have specic characteristics that may make them more vulnerable when using new technologies. The general objective is to identify some indicators of Internet and television consumption proles and their comparison between people with and without ADHD, within a broader cross-cultural study. Method: This is a descriptive and comparative research and we have used The Television Viewing Habits Questionnaire CH-TV 0.2. Regarding reliability, this questionnaire presents an acceptable Alpha coefcient: .8826. The study involved a total of 232 individuals, divided into two subsamples: normal adolescents and adolescents with ADHD. The sample was designed following the needs of the study. Thus, the subjects with ADHD had to be registered in the Red Sanitaria Publica (Public Health Network), had to study both in public and private schools, and/or had to be linked to an association of ADHD victims and families. Results: The results, which are based on a sample of 232 adolescents from the Basque Country (Spain), indicate differences on Internet use proles between adolescents with ADHD and the normal adolescent population. Contrary to our hypothesis, the former group uses the Internet less than the latter. The former group has an average of 4.31 h versus 9.10 of the latter and these differences are statistically signicant Furthermore, despite the fact that for both sample groups the principal purpose of using the Internet was communication, there are statistically

P-27-11 Accident proneness among youth treated with ADHD medication E. van Den Ban*, P. Souverein, W. Meijer, H. van Engeland, H. Swaab, T. Egberts, R. Heerdink * Utrecht, The Netherlands Objective: To study differences in hospital admissions for injuries between youngsters treated for ADHD and age and sex matched controls. Method: Data were obtained from the Dutch PHARMO record linkage system. From a random sample of 150,000 subjects aged 0 to 18 years, we identied all patients initiating treatment with ADHD drugs. For each patient with ADHD, six patients without ADHD drug use were sampled on year of birth, sex and calender time. Outcomes


191 signicant differences in the use of Internet for downloads and play. In relation to parental mediation, teenagers with ADHD reported a higher degree of instructive and restrictive mediation. Conclusion: The results obtained in this study draw a picture that indicates some inconsistencies regarding the object of study. The low scores about parental mediation generally agree with previous research, which concludes with data on the existence of a low level of parental mediation. If we examine the data in its totality, it could be argued that there are differences in the consumption prole of teens with ADHD and normal adolescents. 1986 (N=9432 alive born children). In the 15-year follow-up, the parents assessed inattention and hyperactive symptoms of their offspring by completing the Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire. The information on any injuries that needed hospital admission was gathered from the national Hospital Discharge Register. The longitudinal associations between injuries occurred between the ages of 6 to 15 years and inattention/hyperactivity symptoms at the age of 15 were studied by using Cox regression analysis. Results: The preliminary results showed that the most common injuries in the cohort were fractures (7.0%), dislocations without fracture of joint structure (3.8%) and intracranial injuries (2.8%). Compared to those without ADHD symptoms, adolescents with ADHD symptoms had a higher risk for any trauma or injury (boys RR 1.4, 95% CI 1.1-1.9 and girls RR 2.8, 95% CI 1.9-4.2) and especially for fractures (boys RR 1.7, 95% CI 1.1-2.5 and girls RR 2.7, 95% CI 1.3-5.6). Girls with ADHD symptoms had a higher risk for dislocations without fracture of joint structure (RR 2.5, 95% CI1.1-5.4) and for intracranial injuries (RR 4.0, 95% CI 1.7-9.7). Conclusion: It seems that the symptoms of ADHD may increase the risk for injuries. Preventive work could be directed more to families with children with ADHD.

P-28-03 ADHD and the family context as a mediating variable and modulating J. M. Garcia Cruz*, M. Rodriguez Ruiz, I. Iraurgi Castillo, J. A. Fernandez de Legaria, E. Perez Fernandez de Landa, T. Sota Leiva, I. Ocio Ocio, M. Landabaso Vazquez, J. M. Jimenez Lerma, J. Caceres Carrasco * Vitoria, Spain Objective: To explore and analyze whether there is a relationship between family functioning and parenting styles in the presence of ADHD among children. to estimate the prevalence of adhd in a group policy from a screening instrument for three sources familiar answer: mother, father and child himself Method: we performed an observational cross-sectional correlational study which involved 250 children (100 belonging to a clinical group and 15o to a student sample) and at least one parent. respond to a battery of family functioning (faces,ea,ene) and screening of ADHD in children (adhd was answered by them and their oparents) and adults (ASRS). Results: Of the three sources of information on ADHD for which the mother is more appropriate with a sensitivity of 89% and specity of 75%.from this source is estimated prevalence in adhad in the school group was 17,1%. have observed a wide range os statiscally signicant associations between family variables and greater expressions of symptons of adhd, but proved theoretically important were: family adapatation, family stress, the expression of rejection by both parents and a rigid style of education by both parents. Conclusion: there is a further deterioration of family relationships in the clinical group with respect to student group, which could be affecting the symptomatic expresion of minors. More longitudinal research to dene more precisely the causations lines is necessary.

P-28-05 Child sexual abuse and ADHD A.-K. Koch*, W. Retz, S. Boureghda, M. Rosler, P. Retz-Junginger * Homburg, Germany Objective: The prevalence of child sexual abuse (CSA) is lower in boys than in girls (Fergusson et al., 1996; MacMillan et al., 1997). A German epidemiological study found the prevalence of CSA to be approximately 16% in girls and 6% in boys (Schotensack et al., 1992). There is a limited body of research available on the possible link between Attention Decit Hyperactivity Disorder (ADHD) and CSA, which displays conicting results. The current retrospective study attempts to uncover the prevalence of ADHD in victims of CSA. Method: In the current study 210 written forensic-psychiatric assessments of alleged CSA victims, which were conducted between 2000 and 2009 at the Institut fur gerichtliche Psychiatrie und Psychologie in Homburg, Germany, were analyzed. The sample consisted of 175 females between the ages of 2 and 38 years (M =14.8, SD = 5.9) and 35 males between the ages of 4 and 26 years (M = 12.6, SD = 5.3). Odds ratios for childhood ADHD were calculated. Results: No signicant differences were found on measures of IQ; number, duration and type of CSA; and offender-victim relationship. ADHD was diagnosed in 36 persons, or 17.1% of the sample. The prevalence of ADHD in the German general population is 4,8% (Schlack et al., 2007). Thirteen of the thirty-ve males and twenty-three of the 175 females had been diagnosed with childhood ADHD. There was an increased chance for a positive ADHD diagnosis in the total sample, as well as in both genders individually (Odds Ratio OR = 4.1; OR = 9.7; OR = 15.1 for the total, female and male samples, respectively). Conclusion: Results of the current study suggest that the prevalence of ADHD is increased in CSA victims.

P-28-04 Are injuries of children and adolescents associated with ADHD symptoms A study in the Northern Finland Birth Cohort 1986 T. Hurtig*, I. Moilanen, H. Ebeling, J. Jokelainen, A. Taanila * University Of Oulu, Finland Objective: Injuries and traumas are one of the main causes of death among children and adolescents in the Western countries. Therefore, it is a great public health concern to investigate the underlying factors, for example, if there are groups of children and adolescents who are more prone to accidents. One of these groups may include those with Attention Decit Hyperactivity Disorder (ADHD). Being a developmental neuropsychiatric disorder, its symptoms of inattentiveness and impulsivity may be related to the increased risk for injuries. Thus, our aim was to examine the association between childhood and adolescence injuries and adolescent ADHD symptoms. Method: The sample is based on a population-based prospective mother-child birth cohort, the Northern Finland Birth Cohort (NFBC)

P-28-06 Symptoms of adult Attention Decit Hyperactivity Disorder and stress in Korean soldiers C.-S. Lee* * Jinju, Republic of Korea Objective: ADHD in children continues through to adulthood in 30% to 70% of cases. In work related settings, adults with ADHD had


192 lower job performance ratings overall. All able-bodied South Korean men must serve in the armed forced or undertake equivalent tasks. Some soldiers may have trouble adapting to life in the military. Sometimes a soldiers difculty in adjusting to life in the military can have serious social repercussions which are often signicant threats to individual safety and security. There have been a number of psychopathologic studies associated with dysfunctional soldiers often regarding the effects of depression and subsequent suicides. The aim of this study was to investigate the relation between symptoms of adult Attention Decit Hyperactivity Disorder (ADHD) and stress among South Korean soldiers. Method: A cross-sectional study of 131 soldiers conducted as a part of a public mental health program. According to the cutoff scores of the stress scale, Brief Encounter Psychosocial Instrument (BEPSIK), soldiers were divided into two groups, those with high to moderate stress (N=34) and those with low stress (N=97). They were also evaluated using the Korean adult attention decit hyperactivity scale (KAADHS), Korean Wender Utah rating scale (KWURS) aside from demographic factors such as rank, age, religion and level of education. These ADHD and stress scales were used in previous Korean studies and showed high validity a