Faculty Bibliography

The connectivity of neuronal systems is their most fundamental characteristic. Here, we focus on recent developments in understanding structural and functional connectivity at the macroscale, which is accessible with current imaging technology. Structural connectivity is examined via diffusion weighted imaging methods, of which diffusion tensor imaging is the most frequently used. Many cross-sectional and an increasing number of longitudinal studies using diffusion tensor imaging have been recently conducted over the period of development starting with newborns. Functional connectivity has been studied through task-based functional magnetic resonance imaging, and increasingly through studies on task-free functional imaging, also known as resting state functional imaging. The study of intrinsic functional connectivity beginning during fetal life reveals the developmental organization of intrinsic connectivity networks such as the default mode network, the dorsal attention network, the frontal-parietal executive control network, as well as primary cortical networks. As methods of examining both structural and functional connectivity mature, they increasingly inform our understanding of the development of connectivity in service of the long-term goal of delineating the substrates of much of developmental psychopathology.

The aim of this paper was to review the neuroimaging literature on attention-deficit/hyperactivity disorder (ADHD), with a focus on structural and functional magnetic resonance imaging (MRI) studies. We surveyed in particular studies of structural voxel based morphometry MRI and diffusion tensor imaging, as well as of task-based functional and resting state MRI. The overall evidence points to dysfunctions in frontoparietal, striatal, thalamic, and cerebellar networks in ADHD, but also to dysfunctional interactions among the default network and top-down regulatory networks, and visual and sensorimotor cortex.Therefore, the classic model of ADHD pathophysiology focused on fronto-striatal circuits should be expanded to include a broader set of dysfunctional interactions within and among brain networks. Available neuroimaging studies also show that ADHD pharmacological treatments and, possibly, non-pharmacological approaches, tend to normalize structural and functional brain abnormalities. To date, results from neuroimaging studies do not have a direct application in the day-to-day clinical practice at the single patient level; however, it is hoped that the introduction of machine learning techniques, in particular support vector machine, may contribute to the use of neuroimaging in the clinical practice in terms of prediction of diagnosis for challenging cases and, perhaps more importantly, prediction of outcome and response to treatment

BACKGROUND: An increasing body of research points to a significant association of obesity to Attention-Deficit/Hyperactivity Disorder (ADHD) and deficits in executive functions. There is also preliminary evidence suggesting that children with ADHD may be at risk of obesity in adulthood. DISCUSSION: In this article, we discuss the evidence showing that ADHD and/or deficits in executive functions are a barrier to a successful weight control in individuals enrolled in weight loss programs. Impairing symptoms of ADHD or deficits in executive functions may foster dysregulated eating behaviors, such as binge eating, emotionally-induced eating or eating in the absence of hunger, which, in turn, may contribute to unsuccessful weight loss. ADHD-related behaviors or neurocognitive impairment may also hamper a regular and structured physical activity. There is initial research showing that treatment of comorbid ADHD and executive functions training significantly improve the outcome of obesity in individuals with comorbid ADHD or impairment in executive functions. SUMMARY: Preliminary evidence suggests that comorbid ADHD and deficits in executive functions are a barrier to a successful weight loss in individuals involved in obesity treatment programs. If further methodologically sound evidence confirms this relationship, screening and effectively managing comorbid ADHD and/or executive functions deficits in individuals with obesity might have the potential to reduce not only the burden of ADHD but also the obesity epidemics.

BACKGROUND: A significant association between attention-deficit hyperactivity disorder (ADHD) and obesity has been reported. This study addresses unexplored aspects of this relationship. AIMS: To evaluate the association between adult obesity and: (a) persistent, remitted or lifetime ADHD; (b) number of childhood ADHD symptoms, controlling for socioeconomic status and mood, anxiety and substance use disorders. METHOD: Face-to-face psychiatric interviews in 34 653 US adults from the National Epidemiologic Study on Alcohol and Related Conditions. Obesity was defined as a body mass index >/=30. RESULTS: Persistent, lifetime or remitted ADHD were not associated with obesity after controlling for confounders. The number of childhood ADHD symptoms was significantly associated with adult obesity, even after adjustment, in women. CONCLUSIONS: Childhood ADHD symptoms are associated with obesity in women even after comorbid psychiatric disorders are accounted for. This provides a rationale for longitudinal studies assessing the impact of the treatment of childhood ADHD symptoms on obesity in women.

BACKGROUND: Medication is an important element of therapeutic strategies for ADHD. While medications for ADHD are generally well-tolerated, there are common, although less severe, as well as rare but severe adverse events AEs during treatment with ADHD drugs. The aim of this review is to provide evidence- and expert-based guidance concerning the management of (AEs) with medications for ADHD. METHODS: For ease of use by practitioners and clinicians, the article is organized in a simple question and answer format regarding the prevalence and management of the most common AEs. Answers were based on empirical evidence from studies (preferably meta-analyses or systematic reviews) retrieved in PubMed, Ovid, EMBASE and Web of Knowledge through 30 June 2012. When no empirical evidence was available, expert consensus of the members of the European ADHD Guidelines Group is provided. The evidence-level of the management recommendations was based on the SIGN grading system. RESULTS: The review covers monitoring and management strategies of loss of appetite and growth delay, cardiovascular risks, sleep disturbance, tics, substance misuse/abuse, seizures, suicidal thoughts/behaviours and psychotic symptoms. CONCLUSION: Most AEs during treatment with drugs for ADHD are manageable and most of the times it is not necessary to stop medication, so that patients with ADHD may continue to benefit from the effectiveness of pharmacological treatment.

OBJECTIVE: (a) To compare serum ferritin levels in a sample of stimulant-naive children with ADHD and matched controls and (b) to assess the association of serum ferritin to ADHD symptoms severity, ADHD subtypes, and IQ. METHOD: The ADHD and the control groups included 101 and 93 children, respectively. Serum ferritin levels were determined with the enzyme-linked immunosorbent assay method. RESULTS: Serum ferritin did not significantly differ between children with ADHD and controls, as well as among ADHD subtypes. Correlations between serum ferritin levels and measures related to IQ or ADHD severity were not significant. CONCLUSION: This is the largest controlled study that assessed ferritin levels in stimulant-naive ADHD children. The findings of this study do not support a significant relationship between serum ferritin levels and ADHD. However, the authors' results based on peripheral measures of iron do not rule out a possible implication of brain iron deficiency in ADHD, grounded on neurobiological hypotheses and preliminary empirical evidence.