Faculty Bibliography

OBJECTIVE/UNASSIGNED:Patients with ADHD are at increased risk of acquiring COVID-19. The present study assessed the possibility that ADHD also increases the risk of severe COVID-19 infection. METHOD/UNASSIGNED:We assessed 1,870 COVID-19 positive patients, aged 5 to 60 years, registered in the database of Leumit Health Services (LHS, Israel), February to -June 2020, of whom 231 with ADHD. Logistic regression analysis models evaluated the association between ADHD and the dependent variables of being symptomatic/referral to hospitalization, controlling for demographic and medical variables. RESULTS/UNASSIGNED: = .03). CONCLUSION/UNASSIGNED:ADHD is associated with poorer outcomes in COVID-19 infection.

Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent but often overlooked and undertreated. Left untreated, it is linked to increased risk of untoward outcomes including unemployment, relationship breakups, substance use, driving accidents and other mental health conditions. Several brief screening tools have been developed for adult ADHD. The most frequently used is the World Health Organization's Adult ADHD Self-Report Scale (ASRS V1.1). Here, we show in two independent population samples (UK: N = 642, USA: N = 579) that the tool resulted in considerable overestimation of ADHD, indicating probable ADHD in 26.0% and 17.3% of participants, as compared to expected prevalence of 2.5%. The estimated positive predictive value was only ~11.5%. Both samples had normal levels of trait impulsivity as assessed using the Barratt Impulsiveness Scale. The data indicate that using the ASRS in general population samples will result in 7-10 times over-identification of ADHD. We use these results to highlight how such tools should most appropriately be used. When being used to determine possible cases (such as for onward referral to an ADHD specialist) they should be complemented by clinical assessment - we give examples of how non-specialists might determine this. When measuring ADHD symptoms dimensionally, researchers should be mindful that the ASRS captures impulsive symptoms other than those due to ADHD. Lastly, we note the need to screen for impulse control disorders (e.g., gambling disorder) when using such tools to measure ADHD, be it for onward referral, or for dimensional research studies.

Poor math and numeracy skills are associated with a range of adverse outcomes, including reduced employability and poorer physical and mental health. Research has increasingly focused on understanding factors associated with the improvement of math skills in school. This systematic literature review and meta-analysis investigated the association between metacognition and math performance in adolescence (11"“16-year-olds). A systematic search of electronic databases and grey literature (to 04.01.2020) highlighted 31 studies. The quantitative synthesis of 74 effect sizes from 29 of these studies (30 independent populations) indicated a significantly positive correlation between metacognition and math performance in adolescence (r =.37, 95% CI = [.29,.44], p <.001). There was significant heterogeneity between studies. Consideration of online (versus offline) measures of metacognition and more complex (versus simple) measures of math performance, and their combination, was associated with larger effect sizes; however, heterogeneity remained high for all analyses.

The patho-etiology of mental disorders with onset in childhood or adolescence other than autism spectrum disorder and attention-deficit/hyperactivity disorder remains largely unknown. We conducted an umbrella review of meta-analyses (MAs) on environmental factors associated with mental disorders with onset in childhood/adolescence. We searched Pubmed-MEDLINE/EMBASE/PsycInfo databases. Quality of MAs was measured with AMSTAR-2. Out of 6,851 initial references, ten articles met inclusion criteria, providing 23 associations between 12 potential environmental factors and nine disorders (cases: 8,884; N = 3,660,670). While almost half of the associations were nominally significant, none of them met criteria from either convincing or highly suggestive evidence. A single association was supported by suggestive evidence (maternal exposure to lithium and antipsychotics with neuromotor deficits), but it was affected by confounding by indication. Ten more associations had weak evidence, and 12 associations were not statistically significant. Quality of meta-analyses was rated as high in two, moderate in one, low in four, critically low in two, and not pertinent in one (individual participant data). Methodologically-sound research is needed in this field.

OBJECTIVE:We conducted a meta-analysis of resting state functional magnetic resonance imaging (R-fMRI) studies in children/adolescents and adults with ADHD to assess spatial convergence of findings from available studies. METHOD/METHODS:, 2019, with no language/type-of-document restrictions. Study authors were systematically contacted for additional unpublished information/data. R-fMRI studies using seed-based connectivity (SBC) or any other method (non-SBC) reporting whole-brain results of group comparisons between individuals with ADHD and typically developing controls were eligible. Voxel-wise meta-analysis via activation likelihood estimation with cluster-level Family Wise Error (FWE) (voxel-level: p < 0.001; cluster-level: p < 0.05) was used. The full dataset used for analyses will be freely available online in an open source platform (http://anima.fz-juelich.de/). RESULTS:30 studies (18 SBC and 12 non-SBC), including a total of 1978 participants (1094 ADHD; 884 controls) were retained. The meta-analysis focused on SBC studies found no significant spatial convergence of ADHD-related hyper- or hypo-connectivity across studies. This non-significant finding remained after integrating 12 non-SBC studies into the main-analysis and in sensitivity analyses limited to studies including only children or only non-medication naïve patients. CONCLUSION/CONCLUSIONS:The lack of significant spatial convergence may be accounted for by heterogeneity in study participants, experimental procedures and analytic flexibility, as well as in ADHD pathophysiology. Alongside other neuroimaging meta-analyses in other psychiatric conditions, our results should inform the conduct and publication of future neuroimaging studies of psychiatric disorders.

There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2020 articles that we think deserve your attention, or at least a second read.

Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help. Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters. Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD. Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.

The putative risk/protective factors for several personality disorders remain unclear. The vast majority of published studies has assessed personality characteristics/traits rather than disorders. Thus, the current umbrella review of meta-analyses (MAs) aims to systematically assess risk or protective factors associated with personality disorders. We searched PubMed-MEDLINE/PsycInfo databases, up to August 31, 2020. Quality of MAs was assessed with AMSTAR-2, while the credibility of evidence for each association was assessed through standard quantitative criteria. Out of 571 initial references, five meta-analyses met inclusion criteria, encompassing 56 associations of 26 potential environmental factors for antisocial, dependent, borderline personality disorder, with a median of five studies per association, and median 214 cases per association. Overall, 35 (62.5%) of the associations were nominally significant. Six associations met class II (i.e., highly suggestive) evidence for borderline personality disorder, with large effect sizes involving childhood emotional abuse (OR = 28.15, 95% CI 14.76-53.68), childhood emotional neglect (OR = 22.86, 95% CI 11.55-45.22), childhood any adversities (OR = 14.32, 95% CI 10.80-18.98), childhood physical abuse (OR = 9.30, 95% CI 6.57-13.17), childhood sexual abuse (OR = 7.95, 95% CI 6.21-10.17), and childhood physical neglect (OR = 5.73, 95% CI 3.21-10.21), plus 16 further associations supported by class IV evidence. No risk factor for antisocial or dependent personality disorder was supported by class I, II, and III, but six and seven met class IV evidence, respectively. Quality of included meta-analyses was rated as moderate in two, critically low in three. The large effect sizes found for a broad range of childhood adversities suggest that prevention of personality disorders should target childhood-related risk factors. However, larger cohort studies assessing multidimensional risk factors are needed in the field.