The aim of this thesis was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2 518 infants aged between 6 and 18 months. Factors associated with severe sleep problems were sought. Parents reported 16 % of the infants to have difficulties in falling asleep at night, and 30 % to have frequent night waking. Severe sleep problems were associated with frequent night meals, psychosocial problems in the family, exhaustion and depression in the mother, and parental stress. An association with infant difficultness, high activity and problematic behaviour was also found. In a five-year prospective study a group of children fulfilling specific criteria for severe sleep problems in infancy (N=27) was followed after an interventional sleep programme and compared with a control group regarding sleep characteristics, behaviour and development. One month after an interdisciplinary treatment programme, combining behavioural technique with family work, the average number of times the case babies woke up had diminished from 6.0 to 1.8 times per night. A 92 % rate of improvement was reported. The changes were stable over time. Comparisons with the controls during five years revealed no significant group difference in sleep characteristics. Concerning behaviour and development, however, there were significant differences. At the age of 5.5 years, seven of the children in the former sleep problem group met the criteria for the diagnosis of attention-deficit/hyperactivity disorder. No control child qualified for the diagnosis.

In recent decades a growing number of individuals in preschool, middle childhood and adolescence have been diagnosed with ADHD. Accompanying increasing rates of diagnoses is an increase in the use of stimulant medication in preschool populations, a practice not approved by the Food and Drug Administration. This paper reviews the current literature pertaining the social and developmental consequences of ADHD, its effect on the child and family, treatment strategies with and without the use of stimulants, and cultural and diagnostic trends which may be contributing to the rising number of diagnoses. A review of the literature suggests that there is a dire need for further empirical research into the use of stimulant medications in preschoolers, and a number of cultural factors unique to the United States have contributed to increasing rates of ADHD diagnosis.

Attention deficit/hyperactivity disorder (ADHD) is a common disease with a worldwide prevalence of 5% on preschool children. It has been reported that ADHD patients have volume variant in partial brain regions. Futhermore, functional magnetic resonance imaging have also been used to detect function variant possibility in particular brain regions. In the last decade, some researchers used diffusion MR imaging to investigate the abnormality of neural fibers in disease involved with central nervous system. In general, the diffusion anisotropy of white matter in both ADHD patients and healthy subjects can be estimated seperately to undergo inter-subject comparison. While previous studies often used the popular ICBM brain template (MNI152), this study applied a self-made template of Taiwan adolescents as the common space of image normailization. In this work, group comparison of diffusion fractional anisotropy was performing by using two methods, TBSS and VBM. Both manners found a decreased FA in white matter of ADHD subjects compared with normal control group. However, regions detected by different methods showed low reproducibility. The areas of significant difference include inferior longitudinal fasciculus¡Binternal capsule¡Bexternal capsule¡Bsuperior longitudinal fasciculus¡Boptic radiation¡Bsuperior frontal¡Bsuperior region of corona radiata¡Bcorticospinal tract¡Bposterior region of corona radiata / superior longitudinal fasciculus¡Bsuperior fronto-occipital fasciculus¡Banterior region of corona radiata¡Bgenu of corpus callosum nerve fibers.

Aim of the present study was to evaluate executive functions (EF) such as inhibition, planning, working memory, set-shifting in children with Attention Deficit / Hyperactivity Disorder (ADHD) via comparison of three ADHD subtype groups (ADHD-I, ADHD-C and ADHD-Comorbid) and a normal control group. Participants consist of 147 children. Total of 111 children were assigned into the ADHD groups of the study. Thirty seven children (5 girl and 32 boys) were assigned into the ADHD-Inattentive group, thirty seven children (6 girls and 31 boys) were assigned into the ADHD-Combined group / and thirty seven children (4 girls and 33 boys) were classified as ADHD-Comorbide group (ADHD-C with Oppositional Defiant Disorder consists of 4 girls and 31 boys, and/or Conduct Disorders consists of 2 boys). Thirty six children (6 girls and 30 boys / age range: 7- 12) were assigned as control group by matching with the ADHD groups according to the WISC-R Full Scale IQ score, sex and age. Conner&rsquo / s Parental and Teacher Rating Scales, Child Behavior Check List and Wechsler Intelligence Scale Revised, Tower of London Test, Wisconsin Card Sorting Test, Stroop Color Word Test, Cancellation Task, Trail Making Test, California Verbal List Test for Children, Verbal Fluency Test, Continuous Performance Test, Go-No-Go Task and Bender-Gestalt Test were used for the assessment of children. The data were analyzed by one-way within subject ANOVA for all dependent variables measured by the assessment tools. Additionally discriminant function analyses were conducted to determine the variables that differentiate the three ADHD groups and control group. Outcome of study indicated that subjects in ADHD-Comorbid group had more severe Executive Function (EF) deficits than subjects in ADHD-I and ADHD-C group. The findings were discussed in the light of the literature.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavior developmental disorder that affects around 7.5% of Taiwan children. With the use of magnetic resonance imaging , many results have been reported that ADHD patients have volume atrophy in gray matter and dysfunction in couples of cortical regions. In recent years, diffusion MR imaging with diffusion-sensitizing gradients has been used to investigate the abnormality of neural fibers in disease involved with central nervous system. In this study, the anisotropy of white matter in both ADHD patients and age-matched healthy subjects was estimated using diffusion tensor imaging to undergo inter-subject comparison. In this work, a significant decrease (FWE-corrected p-value <0.05) of FA values has been found in white matter of adolescents diagnosed as ADHD patients, compared with normal controls group. The areas that confirmed by two different algorithms of inter-subject comparison are mainly diffused on white matter region, including middle cerebellar peduncle, left inferior longitudinal fasciculus, internal capsule, left optic radiation, external capsule, splenium of the corpus callosum, superior longitudinal fasciculus, superior frontal and parietal-occipital nerve fibers.

This study examined the impact of working memory deficits (WMD) on the academic achievement of adolescents with ADHD. Adolescents (n=79) aged 13 to 17 years with a clinical diagnosis of ADHD were subtyped into those with and without WMD based on impairment in at least two measures, and then compared on their academic achievement and clinical profile. Results indicated that adolescents with ADHD plus WMD (23%) manifest significantly lower academic achievement than those with adequate WM. By contrast, there were no group differences in psychiatric comorbidity, severity of ADHD symptoms and psychological adjustment. We also found a unique contribution of WM to academic achievement over and above that of other clinical features. These findings suggest that WMD compromise the educational attainment of a subgroup of individuals with ADHD. Individuals with ADHD should be screened for WMD to prevent academic failure and WM should be considered as a treatment target.

The purpose of this study was to investigate which factors contributed to stress in parents of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). The influence of the parents' gender on these stress factors as well as the way in which parents conceptualised extreme stress/burnout were also explored. This study focused on parents whose children have been diagnosed with this disorder and attend the grade two classes at this special school. Thirty seven parents completed a survey questionnaire and semi-structured interviews were conducted with 10 of these parents. The researcher was able to determine which specific factors contributed to these parents' stress relating to parenting their ADHD child and also explored parents' conceptions of stress. The data was quantitatively and qualitatively analysed. The semistructured interviews explored the parents' subjective stress experiences with their ADHD children and encouraged possible solutions from parents. Gender differences were also explored. The responses to the interviews were qualitatively analysed. The results of this study have indicated that generally, parents perceive extreme stress/burnout in terms of physical and emotional symptoms. The factors contributing to extreme stress appeared to be associated with social problems of ADHD children, their inappropriate behaviours and school-related problems. Many possible solutions were offered by parents but they also indicated the need for support and understanding from significant others, such as spouses, teachers, family members, doctors and therapists. Parents of ADHD children in this study indicated that one's gender does play an important role regarding how a person copes with stress, with mothers generally experiencing far more stress than fathers. / Thesis (M.Ed.)-University of KwaZulu-Natal, 2005.

The purpose of this study was to investigate the experiences of mainstream foundation phase educators who teach learners diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), as well as to understand the intervention strategies that these educators use when dealing with these learners. The study is qualitative and based on the interpretivist paradigm. It is a case study of seven mainstream educators who were all teaching learners that were diagnosed with ADHD. The study was guided by the following research questions: What are the experiences of mainstream educators who teach learners diagnosed with ADHD? What intervention strategies do educators employ to handle learners with ADHD? What support structures exist in schools to assist educators of learners with ADHD? The study reveals that the educators in these mainstream schools do not feel sufficiently skilled and effective in meeting the learning needs of their learners diagnosed with ADHD. Their large class groups, lack of available support structures, and lack of parental support and professional intervention, contribute largely to this situation. Drugs such as Ritalin may not be a cure, but are sometimes helpful in improving learner behaviour and productivity. This however is not always possible due to the varying array of symptoms that co-exist in ADHD and the effectiveness of medication and intervention is unique to each learner. Psychological assessment assists in highlighting the unique educational needs of these learners. Educators rely on the advice and support given by physicians and psychologists. Drug therapy must be used in conjunction with behaviour therapy as this is beneficial to the learner diagnosed with ADHD and to the class environment. The findings of the study indicate the absence of remedial education in these mainstream schools. There is a need for all mainstream educators to become trained and skilled in understanding and teaching learners with ADHD. Greater awareness, involvement, coaching and support needs to be available for all those involved with ADHD. This implies that the provision of effective intervention and support will empower educators, potentially minimize the early drop out of learners affected with ADHD and facilitate a productive outcome and future for them. A limitation of this study is that this small sample size does not reflect the education setting of all mainstream schools in South Africa. Mainstream schools vary extremely in degrees of resourcefulness and class size. / Thesis (M.Ed.)-University of KwaZulu-Natal, Durban, 2012.

Atypical antipsychotics (AAPs) (also known as second-generation antipsychotics) are the US Food and Drug Administration (FDA) approved medications for schizophrenia, bipolar I disorder, depression and autism. Compared to the typical antipsychotics, AAPs were marketed as reducing adverse side effects such as extrapyramidal symptoms. This resulted in extensive use of AAPs for not only the FDA approved indications but also other conditions that are not approved. However, several post-marketing clinical trials evaluated the use of AAPs and reported serious adverse side effects, including metabolic syndrome, cardiovascular events, or death. The extensive use of AAPs by pediatrics is an important policy problem that imposes serious concerns on public health and economy in the US. A large proportion of total pediatric AAP use is off-label in which the safety and effectiveness are not yet established. Moreover, among the off-label conditions for which AAPs were used, ADHD was the most common primary mental diagnosis. From public health perspective, the risk of type II diabetes in pediatric AAP users was estimated. A retrospective cohort study was conducted and a twice higher risk of developing type II diabetes was estimated for AAP users compared to non-users in pediatrics. From economic efficiency perspective, the cost-effectiveness of AAPs compared to other ADHD medications in pediatric ADHD patients was estimated. Among non-stimulant ADHD medication treatment strategies, AAPs resulted in the lower expected health outcome than other ADHD medications. Also, AAPs were not a favored choice with respect to cost-effectiveness. A comparative effectiveness study that compares resource utilization and costs between atypical antipsychotic (AAP) users and non-AAP users in ADHD revealed that AAP users were likely to visit a healthcare facility for outpatient and inpatient services more frequently than non-AAP users. Total health care costs were significantly higher for AAP users with additional costs of $1,393 (2012 dollars) during six months and $2,784 (2012 dollars) during a year after initiating the AAP treatment.

The general aim of this study was to investigate the prescribing patterns of products that contain methylphenidate or atomoxetine in a section of the private health care sector of South Africa. A quantitative, retrospective drug uitilisation review was performed according to data obtained from the database of a South African medicine claims pharmacy benefit management company's for three consecutive study years (Le. 2005 to 2007). The results indicated that a total of 7,990 patients had been prescribed products that contained methylphenidate or atomoxetine in 2005. The total for 2006 was 8,575 and it decreased to a total of 7,828 in 2007. Of all the patients who received the mentioned products, the percentage for females increased from 27.75% (N = 7,990) in 2005 to 29.06% (N =7,828) in 2007. With regard to the same products the percentage for males decreased from 72.03% (N = 7,990) in 2005 to 70.89% (N = 7,828) in 2007. The ratio for the gender-related prescribing patterns of medicine items that contained methylphenidate or atomoxetine in this section of the private health care sector of South Africa was ± 2.55:1 for males to females in comparison with the international male:female ratio of 3:1. According to the medicine claims on the database for 2005 the total number of prescriptions that indicated products containing methylphenidate or atomoxetine was calculated as 8,522, 798 (i.e. N = 8, 522,798) or as a percentage of 0.32% prescriptions. The percentage showed an increase to 0.41 % in 2007 (N = 8,015,538). Of all the medicine items containing methylphenidate or atomoxetine those products that contained atomoxetine represented 4.69% and those that contained methylphenidate represented 95.31%. In 2005 the average cost per prescription that indicated items containing methylphenidate or atomoxetine amounted to R318.29 ± R162.09. In 2007 the amount increased to R358.91 ± R208.10. The percentage of children younger than five years of age, and who had been prescribed products containing methylphenidate or atomoxetine, increased from 0.91 % in 2005 (N = 7,990) to 1.11 % in 2007 (N =7,828). The percentage for children aged 5 to 12 years decreased from 53.62% in 2005 to 49.23% in 2007. For adolescents the percentage increased from 26.32% in 2005 to 27.35% in 2007. The same pattern repeated itself in the case of adults (age 18+ years). Among the top trade name products prescribed were Ritalin LA 20mg®, Ritalin 20mg®, Concerta 36mg®, Ritalin LA 30mg® and Concerta 18mg®. Possible drug-drug interactions were found between products containing methylphenidate or atomoxetine and products containing imipramine, amitriptyline and carbamazepine. Findings indicated that the number of products containing methylphenidate or atomoxetine increased from 2005 to 2007, while also revealing that those products containing methylphenidate remained in the majority. The average costs of products containing methylphenidate or atomoxetine increased from 2005 to 2007. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2010.