COVID-19 and Continuity of Care in ADHD

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COVID-19 and Continuity of Care in ADHD
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Psychiatric comorbidities are
often linked to attention-deficit/hyperactivity disorder (ADHD)

“Psychiatric comorbidities are often linked to attention-deficit/
hyperactivity disorder (ADHD)

“The heterogeneity of [ADHD] is shown by its extensive psychiatric comorbidity… and the wide range of structural and functional brain anomalies.”1

-Stephen Faraone, MD, et al

In addition to core features (inattention, hyperactivity, and impulsivity), children with ADHD frequently experience other psychiatric symptoms that can diminish their quality of life.2

The overlap of psychiatric symptoms points to a dysregulation in the neurologic pathways seen in children with ADHD. In particular, cortical and subcortical regions of the brain are implicated, including the1,3:

Neurotransmitter circuits are also involved in ADHD and include the1:

Dopaminergic system

Plays a key role in the planning and initiation of motor responses, activation, and reward seeking

Noradrenergic system

Influences arousal and cognitive processing of urgent stimuli

Likewise, executive control networks have also been shown to be underactive in patients with ADHD, leading to deficiencies in planning, goal-directed behavior, inhibition, working memory, and cognitive flexibility.1

In addition to psychiatric comorbidities, certain physical health issues have been shown to correlate to an ADHD diagnosis4,5:

A recent meta-analysis of a large-scale population-based study supports a significant association between asthma and ADHD.4

Dysbiosis of gut microbiome has also recently been shown to predict dopamine precursor synthesis in adolescents with ADHD, leading to decreases in neural reward anticipation.5

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References: 1. Faraone SV, Asherson P, Banaschewski T, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers. 2015;1:1-23. 2. Banaschewski T, Becker K, Dopfner M, Holtmann M, Rosler M, Romanos M. Attention deficit/hyperactivity disorder. Dtsch Arztebl Int. 2017;114(9):149-159. 3. Brown TE. Developmental complexities of attentional disorders. In: Brown TE, Ed. ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults; Arlington, VA: American Psychiatric Publishing Inc; 2009:3-23. 4. Cortese S, Sun S, Sharma E, et al. Association between attention-deficit/hyperactivity disorder and asthma: a systematic review and meta-analysis and a Swedish population-based study. Lancet Psych. 2018;5(9):P717-P726. 5. Aarts E, Ederveen THA, Zwiers MP, et al. Gut microbiome in ADHD and its relation to neural reward anticipation. PLoS One. 2017;12(9):1-17.