The catecholaminergic and serotonergic neurotransmitter systems are implicated in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD). The amino acid tyrosine is the precursor for synthesis of the catecholamines dopamine and norepinephrine, while tryptophan is the precursor of serotonin. A disturbed transport of tyrosine, as well as other amino acids, has been found in a number of other psychiatric disorders, such as schizophrenia, bipolar disorder and autism, when using the fibroblast cell model. Hence, the aim of this study was to explore whether children with ADHD may have disturbed amino acid transport.maxV) and affinity constant (mK) were determined. Any difference between the two groups was analyzed by Student's unpaired t-test or the Mann Whitney U test.Fibroblast cells were cultured from skin biopsies obtained from 14 boys diagnosed with ADHD and from 13 matching boys without a diagnosis of a developmental disorder. Transport of the amino acids tyrosine, tryptophan and alanine across the cell membrane was measured by the cluster tray method. The kinetic parameters, maximal transport capacity (max V(p = 0.039) and m K(increased affinity) (p = 0.010) of tryptophan transport in comparison to controls. They also had a significantly higher maxVof alanine transport (p = 0.031), but the Km of alanine transport did not differ significantly. There were no significant differences in any of the kinetic parameters regarding tyrosine transport in fibroblasts for the ADHD group.The ADHD group had significantly decreased Tryptophan uses the same transport systems in both fibroblasts and at the blood brain barrier (BBB). Hence, a decreased transport capacity of tryptophan implies that less tryptophan is being transported across the BBB in the ADHD group. This could lead to deficient serotonin access in the brain that might cause disturbances in both the serotonergic and the catecholaminergic neurotransmitter systems, since these systems are highly interconnected. The physiological importance of an elevated transport capacity of alanine to the brain is not known to date. Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with a prevalence in children of about 5-7% worldwide ,2. It isAs for many other neurodevelopmental disorders no single etiology of ADHD has been provided, but a number of underlying theories exist. The disorder is highly heritable, based on family, twin and adoption studies , but theMany neuro-imaging studies have identified abnormalities of brain structure and function in ADHD and in particular, a dysfunction of the fronto-subcortical pathways in the brain has been implicated . These pThe rate of synthesis of the neurotransmitters dopamine, norepinephrine and serotonin in the central nervous system (CNS) is partly dependent on the brain's availability of precursor amino acids . The amiIn order to study amino acid transport properties, in various psychiatric disorders, fibroblast cells are being used as a human experimental model. This model is suggested to be relevant since fibroblasts have a similar expression of amino acid transporters as human brain microvascular endothelial cells (hBME) and express several neuronal specific receptors and enzymes -18. ReceThe transport of both tyrosine and tryptophan has recently been characterized in fibroblast cells. Tyrosine was found mainly to be transported by system L, with LAT1 as the main transporter , in accoWhen using the fibroblast cell model, previous findings by our group -29 and oThe aim of this study was to investigate whether children with ADHD have changes in the transport of tyrosine and/or tryptophan, since these amino acids are the precursors for the neurotransmitters implicated in the pathophysiology of ADHD. Moreover, as there is a competition between tyrosine and alanine we studied the transport of alanine in children with ADHD.The study included fibroblast cell lines from 14 boys with ADHD of the combined type (inattention combined with hyperactivity and impulsivity), according to the DSM-IV criteria . They weThe comparison group consisted of fibroblast cell lines from 13 boys matched for age and without a diagnosis of a developmental disorder, between 7 and 13 years old (mean 10 years). Five of the 13 cell lines were used as controls in a previous study and were obtained from a Biobank . Eight s2 skin punch biopsy was taken after anaesthetizing the mid-forearm under aseptic conditions as described previously  + (1/maxV)] as described previously  is the substrate concentration, Vmax is the maximal transport capacity (nmol/min/mg protein) and Km, is the affinity constant . Each experiment was performed in duplicate at the same time point for all amino acid transport assays and a mean value was taken for kinetic analysis.The amino acid kinetic parameters eviously . V0 is tmKof tyrosine, tryptophan and alanine transport, but not for maxVof tyrosine, tryptophan and alanine transport (determined using Shapiro-Wilk W test).All kinetic parameters are presented by descriptive statistics (mean with standard deviations or median with range). Assumptions about parametric methods were fulfilled for mKfor tyrosine, tryptophan and alanine transport between children with ADHD and the comparison group was analysed using the Student's unpaired t-test. Significance of the difference in max Vfor tyrosine, tryptophan and alanine transport between children with ADHD and the comparison group was analysed using the Mann Whitney U test.Significance of the difference in For all statistical analyses a significant level of 5% (two-tailed) was accepted. All statistical analyses were performed using PASW statistics version 18.0 for Windows.The study was approved by the Regional Ethics Committee in Gothenburg, Sweden (Dnr: 218-07). A written and signed consent was obtained from the parent/s and their child before performing the studies.maxV) and mean affinity of binding site (mK) of tyrosine, tryptophan and alanine transport in children with ADHD and in controls are presented in Table Maximal transport capacity . The median maxVfor tyrosine transport was 15.1 (11.5-25.4) nmol/min/mg protein in the ADHD group and 15.5 (7.8-21.5) nmol/min/mg protein in the comparison group. The mean mKfor tyrosine transport was 20.0 (6.3) μmol/L in the ADHD group and 18.8 (5.5) μmol/L in the comparison group.There were no significant differences between the ADHD group and controls in any of the kinetic parameters regarding the tyrosine transport (max V(p = 0.039) and mK(p = 0.010) for tryptophan transport in comparison to controls. The median maxVfor tryptophan transport in the ADHD group was 1.5 (1.1-3.0) nmol/min/mg protein and for the comparison group 2.0 (1.3-4.7) nmol/min/mg protein. The mean mKfor tryptophan transport in the ADHD group was 13.6 (4.7) μmol/L and for the comparison group 21.1 (8.2) μmol/L.The ADHD group had significantly decreased maxVfor alanine transport (p = 0.031) than the controls, but the Km for alanine transport did not differ significantly (p = 0.086). The median maxVfor alanine was 42.8 (36.3-64.9) nmol/min/mg protein in the group of children with ADHD, while the median maxVfor the comparison group was 32.0 (22.7-63.4) nmol/min/mg protein. The mean mKof alanine transport in the ADHD group was 125.7 (41.2) μmol/L and for the comparison group 100.7 (30.1) μmol/L.They ADHD group had a significantly higher maxVof tryptophan transport and an elevated maxVof alanine transport across the fibroblast cell membranes. A low max Vimplies that the transport systems have lower capacity for amino acid uptake, while an increased maxVindicates the opposite. Hence, the children in the ADHD group had a decreased transport of tryptophan and an elevated transport of alanine through the cell membrane of fibroblasts. Several mechanisms could contribute to the differences found between the ADHD group and the controls; 1) altered expression of transporter proteins and/or mutation/s in the genes coding for the involved transporter proteins; 2) general changes in the cell membrane, such as a disturbed membrane phospholipid composition (MPC) that could be altering the structure of the transporter proteins embedded in the membrane, which in turn might change the functionality of the transporters; 3) the altered amino acid transport could be caused by some other molecule(s) affecting the transporter(s) indirectly, e.g. some cytokines are known to influence amino acid uptake [The main finding in the present study was that the group with ADHD had a decreased d uptake -39.m Kfor tryptophan transport, which corresponds to an increased affinity between the amino acid and the transport protein, indicating that a lower concentration of extracellular tryptophan is needed to reach maximal transport capacity. This could be a compensatory mechanism to the decreased maxV. However, there was a negative correlation between the maxVand mKvalues for tryptophan transport within the ADHD group .The ADHD group also had a decreased The use of fibroblast cells as a human experimental model to study amino acid transport across the BBB has gained support by a number of previous studies ,23-29. MThe decreased transport of tryptophan that was found in the ADHD group in the present study may imply reduced levels of serotonin in the CNS that might result in a disturbed serotonergic neurotransmission. A dysfunctional serotonergic system might secondarily lead to disturbances in the catecholaminergic systems as these neurotransmitter systems have strong anatomical and functional interactions .Although the neurotransmitter most clearly implicated in ADHD is dopamine, there is a considerable amount of literature associating the serotonergic system with impulsivity, i.e. a core symptom in the combined type of ADHD . There aIf the transport of tryptophan is decreased through the BBB, as our results indicate, increasing plasma concentration of tryptophan (e.g. via tryptophan supplementation) might not result in more serotonin production. This could be one reason for the inconsistent results for tryptophan supplementation approaches in the treatment of ADHD . HoweverThe physiological relevance of the increased alanine transport that was found in the ADHD group has not been explored. However, at physiological plasma concentrations there is a competition between amino acids for transport across the BBB -15. AlthmaxVfor tryptophan could be linked to a more general alteration in plasma membrane function in ADHD. Altered membrane composition has been implicated in other psychiatric disorders such as schizophrenia and bipolar disorder [We did not find any significant differences in the transport of tyrosine between the ADHD group and the control group. Since tyrosine and tryptophan are considered to be transported across the BBB in similar fashion (i.e. through the LAT1 isoform of system L) it is difficult to explain why the tyrosine transport was not altered, whilst the tryptophan transport was. However, this indicates that it is not the overall capacity (expression) of system L that is affected; rather the isolated decrease in the disorder -53. MoremaxVbut unchanged mK, and this transport disturbance could be caused by different mechanisms (see above), such as a higher expression of the ATA2 transporter protein in the fibroblasts from children with ADHD. Hence, if the LAT1 transporter is disturbed, tyrosine could compulsorily be transported through the ATA2 transporter and therefore the maxVof tyrosine transport will not be affected in the ADHD group.In fibroblasts the tryptophan transport is through different amino acid transport systems at different substrate concentrations . In thisin vitro before being used in the experiments [There are certain limitations with the present study. The patient group was relatively small, i.e. fourteen children with ADHD. The plasma levels of amino acids were not determined at the time of the biopsy collection. A further limitation is that only boys were included. However, our intention was to include children with a very similar phenotype of ADHD according to gender, age, type of ADHD and etiology. To achieve this we selected only boys (with the combined type of ADHD) in a rather narrow age span and for almost all boys there were close relatives/family members with the same disorder. Moreover, the patients were on different medications at the time of the biopsy collection, but it seems rather unlikely that this would affect the results as the cultivated fibroblasts were seeded for multiple generations eriments .in vitro, which makes it rather difficult to translate the results into in vivo situations. A further and extended exploration concerning the disturbance of amino acid transport in children with ADHD is thus necessary. Such exploration should include molecular investigations, looking for polymorphism in gene loci, further transport studies including girls with ADHD, measure the amount of serotonergic receptors in fibroblasts and study the effects of different molecules, such as cytokines, on amino acid uptake.In conclusion, children with ADHD may have a decreased access of tryptophan and an elevated access of alanine in the brain. The decreased tryptophan availability in the brain might cause disturbances in the serotonergic neurotransmitter system, which secondarily might lead to changes in the catecholaminergic system. The physiological relevance of an increased access of alanine in the CNS has not been explored. However, this study was made The authors declare that they have no competing interests.JJ, carried out 70% of primary cultures from skin biopsy specimens, all tryptophan and alanine transport experiments, literature searches, statistical analysis and wrote the first draft of the manuscript. ML, participated in the design of the study and in the recruitment of the patients. EF, participated in the design, coordinated the recruitment of the patients and controls and contributed to the manuscript writing. RV, carried out 30% of primary cultures from skin biopsy specimens, and all tyrosine transport studies. AÅ, participated in the design of the study. LB, participated in the design of the study. NV, conceived, participated in the design, took the biopsies, interpreted the findings and coordinated the whole study. All authors have contributed to and approved the final manuscript.


Young adolescents’ and their parents’ experiences with Attention-Deficit/Hyperactivity Disorder (ADHD) and its treatment were explored to investigate beliefs and attitudes regarding use of stimulant medication, and their influence on treatment decisions.Using in-depth qualitative interviews, 12 adolescents with ADHD aged 12 – 15 years, and their parents described their experiences of ADHD and its treatment. Twenty four interviews, 12 with adolescents and 12 with their parents elicited detailed descriptions of beliefs about ADHD, attitudes about stimulant use and the circumstances surrounding treatment decisions. Verbatim transcripts were iteratively analyzed by a team of researchers following an interpretive interactionist framework.Young people offered three themes describing ADHD: 1) personality trait, 2) physical condition or disorder, and 3) minor issue or concern. Regarding medication use, youth described 1) benefits, 2) changes in sense of self, 3) adverse effects, and 4) desire to discontinue use. Parents’ beliefs were more homogeneous than youth beliefs, describing ADHD as a disorder requiring treatment. Most parents noted benefits from stimulant use. Themes were 1) medication as a last resort, 2) allowing the child to reach his or her potential; and 3) concerns about adverse and long-term effects. Families described how responsibility for treatment decisions is transferred from parent to adolescent over time.Young adolescents can have different beliefs about ADHD and attitudes about medication use from their parents. These beliefs and attitudes influence treatment adherence. Incorporating input from young adolescents when making clinical decisions could potentially improve continuity of treatment for youth with ADHD. Psychostimulant medications are highly effective for controlling the developmentally excessive inattention, overactivity, and impulsivity characteristic of Attention-Deficit/Hyperactivity Disorder (ADHD), as well as many of the associated disruptive behaviours, academic and social impairments. If takeParents are the primary decision makers for young children, and as such, previous research has largely examined use of medication from their perspective. Parents describe the decision to use medications to treat their child’s ADHD behaviors as a difficult one, and they are more likely to start medications if they understand ADHD as a neurobiological condition, and that stimulant medications are safe-10. Not According to college students and older adolescents, the youth’s personal role in deciding about medication becomes increasingly important during adolescence,14. SurvMany clinicians note that poor family functioning or parent–child conflict appears to play a role in discontinuation of medication. Qualitative studies where children and youth are interviewed provide a range of descriptions of how young people experience ADHD. Some studies report that children describe primarily negative experiences from having ADHD,-20 whereThe current research explores the treatment experiences of young adolescents with ADHD and their parents in order to examine their beliefs about ADHD, attitudes regarding stimulant medication, and the parent–child decision-making process regarding the young person’s medication use during the developmental transition to early adolescence.The study methods and results are described in accordance with guidelines provided in the consolidated criteria for reporting qualitative research.Participants were twelve adolescents with a current or past diagnosis of ADHD and their parents, for a total of 24 interviews. The youth were chosen purposively to provide a sample that was six females and six males, and represented the age range from 12 to 15 years, with seven youth aged 12–13 years and five youth aged 14–15 years. In nine cases only the mother of the child participated in the parent interview; in the remaining three cases, both the mother and father of the adolescent participated. The children were chosen to represent a range of medication use histories. Seven youth were long-term users of stimulant medication , two youth had recently started medication for the first time within the past 5 weeks, and three were not using medication at the time of the interview, one of these had had two brief trials and the other two had discontinued use one or more years previously. See Tables All youth had previously received a diagnostic assessment at a specialty clinic for children with attention, learning and behavior disorders. Inclusion criteria for the adolescents were DSM IV diagnosis of ADHD, recommendation of stimulant medication, age 12 to 15 years, one or both parents willing to participate, and ability to communicate in English. Youth who had other medical, developmental or psychiatric conditions that required ongoing medical treatment were excluded.We approached youth who were identified by clinicians as likely to be willing to talk about their treatment experiences. Initially, one of the interviewers approached parents first followed by the young person; three youth preferred not to participate following their parent’s agreement, while two others agreed to schedule interviews and participate in the study. We changed strategies following these refusals and the interviewer approached the youth first, followed by the parent. None of the young people referred by their clinician refused when approached before the parent. Only one parent preferred not to participate. With this recruitment strategy there were two families who did not follow through with organizing an appointment following initial agreement to participate and a third family who was not home when the interviewers arrived, and could not easily reschedule with a follow up phone contact. Young people who were actively in treatment and using medication were more often referred by clinicians as willing to participate. As the data collection and analysis progressed, we purposely sought to speak with teens that had just started or were no longer using medication to obtain a range of subjective experiences. Clinicians were less able to suggest youth to approach who met these adjusted criteria. Both the adolescent and his/her parent or parents were approached to discuss participation in the study and interviews were scheduled at a subsequent time, allowing potential participants to change their mind. Formal consent with the parent and assent with the child were obtained immediately before the interviews according to the protocol approved by the Hospital for Sick Children Research Ethics Board, Toronto Ontario, Canada.To ensure confidentiality, parents and youth were interviewed separately by teams of two researchers  with experience in semi-structured interview techniques. Sampling and data collection continued until no new themes emerged regarding beliefs about ADHD and attitudes about medication use, consistent with the qualitative method underpinning this study.The specific interview questions for the adolescents and their parents covered similar content areas, although the specific questions differed. The semi-structured interview guide for youth was adapted from one that was used in a focus group study examining subjective experiences of adolescents’ formal and informal supports for their difficulties with ADHD. QuestioInterviews and field notes were audio recorded and transcribed verbatim. Analysis was conducted following the interpretive interactionist framework set out by Denzin. Under tIn the initial phase of analysis, a team of four investigators representing several perspectives, including a pediatric psychiatrist, a sociologist, an education researcher, and a health researcher, independently read the transcripts and identified specific codes. Team members compared notes and developed a comprehensive code list through discussion following the initial interviews. The team met regularly and following each pair of interviews, the coding manual was revised; codes were refined, collapsed, or eliminated as needed. The interview questions and prompts for the semi-structured interview guides were also refined as the data analysis progressed. Consistent with the epistemology of qualitative research methods, the process of generating and refining codes continued until no new unique codes were identified.Using the coding manual developed, all transcripts were compiled and organized using QSR International’s NVivo 9 qualitative data analysis software. One invcredibility, dependability, and confirmability as recommended by Linclon and Guba. (F1)“I think she realizes that she’s successful in school when she takes it” (Mother of F2); a perceived need for the youth to be more in charge of his /her life, “he’s going to be out in the world soon, I can’t be mothering him.” (Mother of M5); and, the youth’s increased ability to express him or her self, “this year’s been different for a couple of reasons. She’s older…started to voice her opinion.”(Mother of F6).Several themes accompanied the transfer of responsibility to the young person, among them how the parent perceived the young person’s maturity, In some cases, the decision to discontinue medication followed a series of different medication trials with less than optimal results. For adolescents who had stopped medication,“it didn’t seem to be helping him sufficiently in school” (Mother of M6).Tension in the relationship between child and parent regarding medication use was clearly present on more than one occasion, a theme often expressed in the narratives of both the young person and the parent.Medication this, medication that…Well sometimes medication doesn’t help! (F6)I feel so strongly about it because I don’t see what else is gonna work… these are such crucial years. (Mother of F6)“my mom tries to force me to take it.” In our interview with M4’s mother, she described a talk she had with her son:Participant M4 stated that it is annoying to take medication, because …we’ve promised your teachers, we’ve wasted (the clinician's) time and y’know we need to try this…and then I make him do it.The young people currently in conflict with their parents about using medication emphasized the lack of benefit, the unpleasant adverse effects, and their happiness when not taking it.If I weren’t taking the meds, I’d go to school happy and I think I’d have a much better day. (M4)I just like notice when I don’t take the medication I’m happier, I’m more perky. I can get along with people. (F6)But I’m on this new stuff now? They’re putting me on such a low dose that I don’t even think it’s going to make a difference. (M4)I think the medication…it’s kind of impairing my learning because a lot of time I’m sent to the office because I feel sick…. (F6)Youth who had already discontinued using stimulants echoed similar themes.And I was kind of like, I would kind of like lose energy, I was kind of tired. I felt kind of isolated. I felt kind of overwhelmed. (M6)In contrast, a number of young people recognized the benefits, sometimes tolerating negative effects , and chose to remain on medication over time,makes me feel more like a normal student” (F2);““there was a really big difference. (F4);like putting on a seat belt… like the one day I don’t take it and I’m having a quiz …-I just don’t need that day. (F2)“Not surprisingly, as the responsibility for decision-making about medication use shifted from parent to adolescent, the youth’s subjective experience determined whether or not they continued to take it on a regular basis.Our interviews with young adolescents and their parents revealed a more diverse range of beliefs and attitudes about ADHD among young people than among their parents. These differences underscore the importance of the young person’s perspective in making decisions about their treatment for ADHD. Several youth viewed their ADHD as a chronic physical disorder, a belief shared almost uniformly by the parents we interviewed. While parents who held this belief generally expressed support for medication use, this was not the case with the young people. One youth who expressed this belief (M5, see Tables The adolescents’ attitudes toward medication use reflected their beliefs about ADHD. For example, worries expressed about having a changed personality with medication maps onto the understanding of ADHD behaviors as a positive aspect of self. On the other hand, descriptions of benefit with medication use may reflect the theme of ADHD as a chronic disorder that requires intervention. Young people who experienced benefit, also described potentially unwanted effects, (F2, F4, see Table A unique aspect of our study was the concurrent interviewing of young people and their parents, thereby avoiding the potential for parents and children to directly influence each other’s responses. Overall these parents held a relatively homogenous conceptualization of their children’s difficulties and the role of medication, in contrast to the diverse views expressed by their children. Consistent with previous studies of parental views, these parents viewed ADHD as a long-term problem, with the choice for medication treatment a “last resort”; and their concerns centered on adverse and long-term physical effects-11. As aWe heard from both parents and adolescents that as the young persons grew older, they were given greater responsibility by their parents and health care providers, and their opinions increasingly dominated decisions about medication use. Not surprisingly, the transfer of decision-making from parent to youth occurred more easily for those parent–child pairs where the adolescent and the parent agreed about whether to use medication or not. Our interviews captured two parent-youth pairs who were in the midst of active conflict regarding use of medication and for whom transfer of responsibility was not an easy process. These examples provide a simultaneous parent–child lens on the increasing participation by young teenagers in their treatment decisions about ADHD.The results of this study are exploratory and limitations include the small sample recruited through a specialty clinic where most families had a history of ongoing engagement in treatment. While our sample may be small in number, our goal is not to generalize results to large numbers of teens with ADHD but to investigate in-depth the phenomenology of beliefs and attitudes about ADHD and decisions about stimulant medication use, within the contextual frame of parent–child relationships and early adolescence. The experiences of our sample reflect primarily those of families engaged in ongoing treatment, and this is an important group for whom understanding the phenomenon of transferring medical decision-making from parent to youth during early adolescence is highly applicable. Indeed we purposefully sought out young people who had recently started medication or who were not taking medication at the time of the interview in order to hear a variety of beliefs and attitudes and to capture descriptions of crucial moments in the parent -child decision-making process. Parents in the current study describe the process of transferring responsibility as they see their child becoming more capable. In a study focused on medication treatment decisions among ADHD youth, Brinkman et al. intervieWhile there is some controversy in the field about the concept of reaching saturation and when to stop recruitment, we easiOverall, the study findings underline how the perspectives of young people with ADHD may differ from their parents in ways that have important implications for ongoing adherence to stimulant treatment. These preliminary results confirm that divergent opinions between a youth and his or her parents can appear early in the teen years. While clinicians who work with young people know that adolescents should play an active role in their own health care as they get older, the majority of prescriptions for ADHD medications are written by primary care practitioners, who areIn summary, little evidence exists about the process of health-care decision making for young adolescents and their parents. In this preliminary study, we describe how beliefs and attitudes about ADHD in children ages 12 to 15 sometimes differ from those of their parents. Not surprisingly, the young person’s beliefs and attitudes have increasing impact on medication use as decision-making shifts from parent to youth. Clinicians can facilitate improved medication adherence by working both with the young adolescent as well as their parent when developing the treatment plan.The authors declare that they have no competing interests.AC initiated study concept, assisted in study design and analyses and was the primary author of the manuscript. EY assisted with study design, interviewed participants, was primary data analyst, and assisted in writing the manuscript. TV participated in study design and analyses, reviewed and revised the manuscript. TG interviewed participants, assisted with study design and analyses, reviewed and revised the manuscript. SD advised in study design and analyses, reviewed and revised the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/14/110/prepub


Although Attention Deficit Hyperactivity Disorder (ADHD) is recognised to be a familial and heritable disorder, little is known about the broader family characteristics of having a parent with ADHD problems. The main aim of this study was to investigate the relationship between parent ADHD problems, child clinical presentation and family functioning in a sample of children with ADHD. The sample consisted of 570 children with ADHD. Child psychopathology was assessed using a semi-structured diagnostic interview. Questionnaires were used to assess ADHD in the parents (childhood and current symptoms), family environment and mother/father-child relationship. Parental ADHD problems were associated with a range of adverse clinical outcomes in children with no difference in effects for mothers with ADHD problems compared to fathers with ADHD problems. Levels of maternal hostility were higher in families where mothers had ADHD problems, but reduced where fathers had ADHD problems. Parental ADHD problems index higher risk for more severe clinical presentation of ADHD in children and higher levels of family conflict . This study highlights that children with more severe behavioural symptoms are more likely to have a parent with persistent ADHD which has important implications when considering treatment and intervention strategies.The online version of this article (doi:10.1007/s00787-013-0378-x) contains supplementary material, which is available to authorized users. It is well established that Attention Deficit Hyperactivity Disorder (ADHD) is a familial and highly heritable disorder . PreviouLittle is known about the relationship between parent ADHD, the severity of child ADHD and other clinical and family factors. There is increasing recognition of the significance of ADHD symptoms in adults. Adults with ADHD are reported to have much impairment in the form of repeated life failures such as academic underachievement, frequent job changes, marital breakdown and high rates of divorce , 41. TheThe family environment is thought to be an important aspect in development, outcomes and manifestation of a disorder in children . PreviouParental psychopathology is clearly important, not only as an index of inherited risk but because of the role a parent plays in providing care and in becoming a role model to the child. Having a parent with ADHD may index additional risk to the child, influencing the course or persistence of ADHD in the child. Unfortunately, few studies have investigated the relationship between parent ADHD and child’s clinical presentation and findings have so far been inconsistent. This difference could be due to different definitions and timing of parental ADHD used in each study. Parent ADHD has been either measured only during childhood or only currently in adult life , 35. In To diagnose ADHD in adults, clinicians often use the symptom criteria outlined in the DSM-IV as a guideline. One of the requirements is to establish the presence of symptoms both during childhood and 6 months before interview . This deUnderstanding the influence of parent ADHD has important clinical relevance; if having a parent with ADHD indexes a more severe child clinical presentation, regardless of whether these links are inherited and/or environmental, then it may be important to ask about parental history during clinical assessment.Literature on familial models has suggested gender differences in prevalence of ADHD exist due to the different burden of risk in males and females. It is suggested that females with ADHD require a greater load of risk than males before manifesting symptoms , 14. By This study aims to investigate the association between parent ADHD and child clinical presentation in a UK sample of children with ADHD and examine if there are any differences according to which parent has ADHD. It was hypothesised that children with a parent with ADHD problems will have a more severe clinical presentation of the disorder compared to children without a parent with ADHD and that there will be less warmth and higher hostility in this subgroup of children.The sample of children with ADHD and their parents was obtained from a study of ADHD . Participants were recruited from child and adolescent psychiatry and paediatric services in the UK. All children referred had a clinical diagnosis of ADHD or were currently being assessed for a diagnosis. Each child had to be living with one biological parent. All children were of British Caucasian origin and met research diagnostic criteria for ADHD confirmed by research diagnostic interviews . For theParent psychopathology. Mothers and fathers each completed a questionnaire regarding the presence of ADHD symptoms in themselves at age 7–11 years (childhood) and in the last 6 months (current), using an 18-item checklist of DSM-IV ADHD symptoms [symptoms . CronbacChild psychopathology. Child psychopathology was assessed using the Child and Adolescent Psychiatric Assessment (CAPA), a semi-structured research diagnostic interview [nterview . The parnterview . All intnterview , the Connterview , 13. ConImpairment of ADHD symptoms on functioning in several areas of life was assessed . Parents were asked to rate their child’s ADHD symptoms as interfering ‘never’, rarely’, ‘sometimes’ or ‘often’. Impairment scores of ‘sometimes’ or ‘often’ were taken as indicating significant impairment. Based on this, a total summed impairment score out of 8 was obtained. Cognitive ability was assessed using the Wechsler Intelligence Scale for Children IV (WISC-IV) . From thFamily factors. Parents completed questionnaires rating the family environment and parent warmth and hostility at home. Two subscales from The Family Environment Scale (FES) were used to assess family environment; nine items on family conflict and nine items on family cohesion. [ohesion. . The iteParent warmth and hostility was assessed using the Iowa Youth and Families Project Interaction Ratings Scales  that comInformation on demographics, family background and history of mental health was obtained from each family. Families were categorised as having a lower social economic status or not according to classifications from the Standard Occupational Classification. Information on medication was also collected and children were classified according to whether or not they had a current prescription for ADHD medication.Analyses were conducted using linear regression for continuous outcomes and binary logistic regression for categorical outcomes. For variables that were not normally distributed, scores were transformed using the square root and natural logarithmic transformations. Child age and gender were used as covariates.To investigate the relationship between parent ADHD and child clinical presentation, data were analysed using the ‘Adult’ measure of parental ADHD for mothers and fathers separately. Further analysis was conducted to explore differences in timing of parental ADHD by looking at mother and father ADHD status in childhood-only. Direct comparisons between mother and father ADHD groups as well as between the ‘Adult’ ADHD group and parent ADHD in childhood-only group were also conducted.The sample consisted of 570 children, 88 15.4 %) females and 482 (84.6 %) males, with a mean age of 10.78 years (SD 3.01 years). This male to female ratio here is typical of a clinical ADHD sample [.4 % femaHigh rates of parental ADHD problems were found in this sample; 29 % of parents met criteria for ‘adult’ definition of ADHD  and increased conduct symptom severity . Mother hostility was higher when mothers have ADHD compared to when fathers have ADHD (p < 0.01). (see supplementary Table 1).Children reported significantly higher levels of maternal warmth and weaker evidence of less mother hostility when fathers have ADHD , fathers 4.46 (2.75).Direct comparisons between the two groups show that children in the mother and father ‘Adult’ ADHD group have significantly higher symptom severity than those in the mother and father childhood-only group (results available from the first author).As a separate analysis, we examined to what extent all observed associations changed after adjustment for social class. Adjusting for social class attenuated associations with child total ADHD symptoms, conduct symptoms, conduct disorder, and mother hostility by approximately 20–30 %. However, associations for inattention symptoms, family conflict, cohesion and maternal warmth were relatively unchanged (see Supplementary Table 2).This is, to our knowledge, one of the first studies to investigate parent ADHD in a large clinical sample of children with ADHD in the UK. It includes the analysis of both parents and explores the timing of parent ADHD; persistent (‘Adult’ ADHD) and ADHD in childhood-only.The prevalence of adult ADHD is estimated to be around 2.5–4.4 % , 33. In The findings in this study suggest that having a parent with ADHD, particularly persistent/adult parental ADHD is associated with more severe clinical presentation in children with ADHD; maternal ADHD was associated with increased severity of overall ADHD, inattention and conduct symptoms and increased likelihood of CD in children. Paternal ADHD was found to be associated with the severity of children’s ADHD symptoms and a trend for higher rates of CD for children in the paternal ADHD group. The effect sizes of associations were relatively small apart from the prevalence of conduct disorder between those with and without a parent with ADHD. This may perhaps be due to less variability in the sample as all children have a diagnosis of ADHD. In other words, the association between parental ADHD and child characteristics might be stronger in general population (non-ADHD) samples.Thus it appears that having a parent with persistent ADHD problems provides additional risk which is associated with a more severe clinical presentation of ADHD that could represent inherited or environmental risks as well as gene-environment interplay. Previous offspring twin studies suggest that the association between parent antisocial behaviour and child hyperactivity is genetic whilst the association to child conduct disturbance has genetic and environmental influences . The traThis study also investigated the differential effects of parent gender on offspring clinical presentation. There have been mixed findings on parent gender differences , 16, 35.We also investigated if parent ADHD was associated with adverse family environment. Maternal ADHD was associated with higher levels of conflict and lower levels of cohesion in the family. Although these are based on parent reports, there was a similar trend for higher levels of mother hostility reported by the children in this group. In a sample of affected sibling pairs, both maternal history of mood disorder and current ADHD was a predictor of impairment in family functioning .One explanation for the effects of maternal ADHD on family environment could be because mothers are frequently the main caregiver and primarily responsible for the day-to-day organising for the family. Parenting a child with ADHD is already in itself challenging; parenting a child with ADHD when the parent has ADHD impairments themselves could be very stressful. This added stress may result in more conflict and hostility in the family. Parenting studies have found that parental ADHD symptoms were associated with decreased positive and involved parenting and more negative expressed emotion , 30. ParInterestingly, mothers were reported to be warmer to their children when fathers have ADHD. This may indicate that mothers living with a spouse with ADHD may be more empathic to their child’s ADHD symptoms. This is supported by findings from Minde and colleagues  who repoLow social class has previously been found to be associated with child mental health problems including ADHD. As low social class is also highly correlated with parent ADHD, we explored this by including social economic status as a covariate. Comparison of estimates showed that some associations were attenuated by 20–30 % and some remained relatively unchanged. However, it is not possible to distinguish whether social class is a confounder or acts as a mediator of the relationship between parent ADHD and child presentation and family functioning. For example, adults with persistent ADHD have functional impairments which lower their ability to achieve both educationally and occupationally. Thus, it is feasible that these individuals end up in a lower social class as a result of this. Consequently, growing up in this environment could increase the severity of ADHD in offspring (e.g. insufficient resources or support). Even if social class is a confounder the associations were not completely attenuated by adjustment for this. However, as for any observational study, we are unable to exclude the possibility of residual confounding for example by other characteristics associated with parent ADHD.Firstly, this is a cross-sectional study; therefore we were unable to determine the direction of transmission from parent to child. Findings suggest that having a parent with persistent ADHD is associated with greater severity in children with ADHD. These findings are in need of replication as associations may not withstand correction for multiple testing. However, this was exploratory and findings add potential insight into how parent ADHD may be associated with presentation of ADHD in children. We found that having parents with only a childhood history of parent ADHD was not associated with more severe clinical presentation in children. This might suggest that exposure to parent ADHD behaviours during the child’s lifetime is more relevant. However, this needs to be explored further in studies with a genetically sensitive design.Secondly, our definition of ‘Adult’ ADHD may be over restrictive therefore the percentage of parental ADHD may have been underestimated. Unfortunately there is no formal definition in diagnosing ADHD in adults. Given controversy and uncertainty in this area, it was decided that the diagnostic criteria in the DSM-IV was most reasonable to define adult ADHD. However, there was no measure of symptom impairment for parents in this study. Measures of parent ADHD were based on self report and retrospective measures for parent childhood ADHD. Nevertheless, evidence from previous studies has suggested that adults can give a reasonable account of their own childhood and current symptoms .There may be possible shared rater bias as mostly mothers had rated child symptoms, family environment and parent child relationships. However, child reports of parent warmth and hostility showed similar directions of associations to parent reports. Teacher reports of child symptoms were available but a decision was made not to use these reports as 79 % of children in the sample were on medication for their ADHD, thus influencing child severity characteristics during school hours. In support of this, teacher rated ADHD severity was negatively correlated with child medication status.Most families ascertained in this sample were not complete trios as there were many single parent families (mostly mothers). As a result of lack of information, the rate of father ADHD may have been underestimated. This limits power to examine whether paternal ADHD has more or less influence on child clinical presentation compared to maternal ADHD. However, by including data from single parent families makes this sample more representative of families with ADHD children. Significant differences were found between families of trios (both parents) and families with missing fathers similar to those reported by . We wereThis study highlights the importance of considering parent ADHD during clinical assessment. Results indicate that children with more severe behavioural symptoms are more likely to have a parent with persistent ADHD. Having a parent with ADHD problems could exacerbate or impede improvement in child symptoms through parenting and treatment administration. Screening parents during assessment of the child can help identify families with these problems, where parents may have more difficulties. It may be important to consider current treatment needs or interventions for the family as a whole. If further studies provide evidence that persistent parental ADHD is associated with the severity of child ADHD, this would encourage parenting programmes to cater for parents with ADHD with support and coping strategies for spouses. Perhaps treatment strategies can be extended to parents who have current symptoms as previous studies have found that treatment of other forms of parent psychopathology, notably depression might result in improvement in child symptoms .Overall, the results suggest children of parents with ADHD have more severe symptoms of the disorder compared to children without an affected parent. Family environment is also more adverse in these families especially when mothers have ADHD.Supplementary material 1 (DOC 58 kb)Below is the link to the electronic supplementary material.


Moreover, numerous studies have found little or no benefit of stimulants on neuropsychological tests of ADHD-diagnosed as well as normal, individuals. This paper examines the apparent paradox: why don't drugs that improve “attention,” produce better academic outcomes in ADHD-diagnosed students? We found that stimulant drugs significantly improved impairment of episodic memory in ADHD-diagnosed undergraduate students. Nevertheless, we also found consistent academic deficits between ADHD students and their non-ADHD counterparts, regardless of whether or not they used stimulant medications. We reviewed the current literature on the behavioral effects of stimulants, to try to find an explanation for these conflicting phenomena. Across a variety of behavioral tasks, stimulants have been shown to reduce emotional reactions to frustration, improve the ability to detect errors, and increase effortful behavior. However, all of these effects would presumably enhance academic performance. On the other hand, the drugs were also found to promote “risky behavior” and to increase susceptibility to environmental distraction. Such negative effects, including the use of drugs to promote wakefulness for last minute study, might explain the lack of academic benefit in the “real world,” despite their cognitive potential. Like many drugs, stimulants influence behavior in multiple ways, depending on the environmental contingencies. Depending on the circumstances, stimulants may, or may not, enhance cognition.Recent increases in attention deficit hyperactivity disorder (ADHD) diagnoses, and the escalation of stimulant prescriptions, has raised concern about diversion and abuse of stimulants, as well as the ethics of using these drugs as “cognitive enhancers.”Such concern appears misplaced in the face of substantial evidence that stimulant drugs  One analysis of current use argues that the medical consumption of these two drugs is now comparable to past stimulant epidemics  to release a special report, “Responding to requests from adult patients for neuroenhancements,”  and to groups of students with ADHD who were tested when they were either “on” or “off” their medication. We used several types of tasks, ranging from motor dexterity, saccadic eye movements, attention, verbal fluency, memory (acquisition and retention of word lists), distractibility, and problem solving , group recalled the “emotional” parts of the story significantly better than the “neutral” story segments. The data also show, for the first time, this “inverted-U shape” recall function in ADHD-diagnosed participants regardless of whether they were tested while on or off their medication. We appreciate that, in contrast to the classic definition, we cannot conclude that the descending limb of the U is due to a continued increase in arousal during the second neutral story segment. The outcome mainly illustrates an example of emotionally enhanced recall, which occurred reliably in all three groups.In addition, the figure also shows that the performance of the non-medicated ADHD group was worse than the other groups on both, the first neutral segment, and on the emotional segment. Last, the score of the non-medicated group on the final segment was the same as that of the other two groups and was significantly better than on their first neutral phase.These data show a substantial improvement, essentially normalization, of long-term, episodic, memory in medicated ADHD diagnosed adults. This result provides clear-cut evidence of cognitive benefit from stimulant drugs, and is one of the most dramatic examples of memory improvement demonstrated by stimulants. The results are reminiscent of Izquierdo et al. , who foucan improve episodic memory in ADHD-diagnosed adults. Like the outcome of the neuropsychological assessments, the data suggest that the drugs do have some cognitive benefit. That is, in addition to their well-known ability to enhance attention, we found that stimulant drugs can also improve episodic recall. Again, however, this does not explain why they do not improve academic performance.In summary, our results show that stimulant medications Because they were college students, our presumptive ADHD population was perhaps not representative of the typical ADHD adult. Maybe they had learned how to gain some academic benefit from the stimulants. If that were true, they might not be academically impaired, relative to their non-ADHD counterparts. To find out more about the respective academic behavior of our undergraduates, we conducted a couple of surveys.believed that stimulants improved their cognitive performance. Most important, the groups in our study also differed significantly in Grade Point Average (GPA), in that the GPA of the ADHD group  was significantly lower than that of the normal group (3.19).In the first study  with ADHD specifically stated that they took medication to avoid distractions.Our data showed that on average ADHD participants were diagnosed about 5 years before entering college. While nearly 98% of that group had initially taken ADHD medication, only 78.3% were currently using the drugs, while 19.6% stated that they were not . When asked why they stopped taking stimulant medications, the majority cited side effects. Although specific side effects weren't always mentioned , some individuals cited headaches, irritability, temporary heart rate elevation, nausea, sleep interference and “antisocial” feelings as examples of undesirable reactions. A few also stated that they either didn't need the drugs anymore, or, they wanted to see if they didn't need them anymore. Similar to the previous study, more than 90% of the students with ADHD endorsed the statement that medications helped them academically. Most of them stated that the drugs helped them to focus or to concentrate better, to pay attention, stay awake, and organize their studying. However, relatively few students (ADHD and non-ADHD undergraduates did not differ in their scores on the Scholastic Aptitude Test (SAT), Advanced Placement credits, scholarship awards, course credits, or number of hours they studied per week. Students in both groups believed they studied about the same as their peers, that the quality of their notes was the same, and stated that they rarely reviewed their class notes or read assigned readings before class.However, the two groups did differ on several academic measures. As in our first study, the college GPAs of ADHD students were statistically lower than that of the Controls (2.94 vs. 3.12) and they also had significantly lower high school GPA and ACT scores . Although small, this difference was statistically significant, in spite of the fact that a minimum high school GPA and ACT score were required for university admission. ADHD students were also significantly more likely to withdraw from a class, to say that they were worse than other students at planning for and in completing class assignments, in their frequency of taking class notes, and in avoiding distractions.One of the questions we asked in this survey was whether students studied “ahead of time” for exams, or whether they waited until just before the test to prepare. We then looked at how this related to their GPA. The results are shown in Table higher GPAs than those (the majority of this group) who didn't. Unlike normal students, ADHD students did “pay a price” if they waited until the last minute to study. Admittedly, this question did not distinguish among the possible types of exams (such as multiple choice or essay), nor did it take into account the level of knowledge that was assessed (such as application or synthesis). So we don't know if the students' preparation might differ depending on the nature of the assessments.The data in Table We then looked at whether the stimulant medications had any effect on the GPA of ADHD-diagnosed students as a function of whether they studied ahead of time or waited until the last minute. These data are shown in Table F = 4.06, p = 0.047). This result showed that, if ADHD students utilized the well-known strategy of studying ahead of time for exams, they could overcome their achievement deficit, even if they didn't take stimulant medications. In spite of the fact that only three ADHD students “studied ahead of time” without using the drugs, their GPA was comparable to that of the 19 undergraduates who did take the drugs in addition to using good study habits.A two-way analysis of these GPAs found no effect of medication, but a statistically significant effect of study interval,  to medium (50%) to low (12%). In normal adults, amphetamine selectively increased the proportion of high rates of responding on the low probability trials. This was interpreted to mean that the stimulant selectively increased willingness to work harder, particularly when the probabilities are low . But, because the stimulant did not improve the performance of ADHD participants, the authors speculated that, in environments that are very distracting, ADHD promotes poor decision-making and apparently the drugs don't help.While the Campbell-Meiklejohn studies involved normal participants, Agay et al.  directlyimpaired performance only when the ADHD group was on medication. Distracting stimuli did not reduce accuracy of either healthy controls or ADHD patients when they were off their medication.Results of a study by Prehn-Kristensen et al.  also shoOur research attempted to address the paradox of why drugs described as “cognitive enhancers” did not improve long-term academic performance of college students. Consistent with previous reports in adults with ADHD, we found minimal deficits on neuropsychological tests, and very modest improvements from stimulants. On the other hand, we discovered a substantial deficit in episodic memory in ADHD undergraduates, which was eliminated with stimulant medications. Whether or not this phenomenon would also occur in non-ADHD individuals remains to be seen. It might be that stimulant-induced facilitation of episodic memory will only occur when there is some baseline deficit, as is often the case with these drugs.if they acquire well-established effective study habits. While these results increase our knowledge of ADHD related cognitive impairment, they do not explain why ADHD undergraduates, as a group, do not match their peers in academic performance.We also found the same academic impairment in ADHD college students previously reported in children and adolescents with the disorder. We further showed that in spite of the small absolute quantitative differences between these two groups, their deficits were not eliminated by stimulants alone. Moreover, our data show that, conversely, even without the stimulant drugs, ADHD undergraduates are capable of performing just as well in college as their non-ADHD peers, To address that question we considered some non-cognitive behavioral effects of stimulants on mood and motivation. We found evidence that stimulants reduce frustration, improve self-regulation, and increase effortful behavior, and that the drugs' euphoric effects do not necessarily impair attention. However, all of these actions would facilitate academic performance and would not explain the discrepancy.increase the interfering effect of environmental distractions. Results concerning risky behavior might be reinterpreted as evidence of stimulant-induced “inflexibility,” or “cognitive stereotopy,” which have been recognized for a long time (Robbins and Sahakian, On the other hand, we also found evidence that stimulants “promote risky behavior” and may The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Increasing the amount of bioavailable mineral elements in plant foods would help to improve the nutritional status of populations in developing countries. Legume seeds have the potential to provide many essential nutrients. It is important to have information on genetic variations among different lentil populations so that plant breeding programs can use new varieties in cross-breeding programs. The main objective of this study was to characterize the micro- and macronutrient concentrations of lentil landraces seeds collected from South-Eastern Turkey. We found impressive variation in the micro- and macroelement concentrations in 39 lentil landraces and 7 cultivars. We investigated the relationships of traits by correlation analysis and principal component analysis (PCA). The concentrations of several minerals, particularly Zn, were positively correlated with other minerals, suggesting that similar pathways or transporters control the uptake and transport of these minerals. Some genotypes had high mineral and protein content and potential to improve the nutritional value of cultivated lentil. Cross-breeding of numerous lentil landraces from Turkey with currently cultivated varieties could improve the levels of micro- and macronutrients of lentil and may contribute to the worldwide lentil quality breeding program. Lens culinaris Medik.) is an ancient crop of classical Mediterranean civilization and continues to play an important role in the global human diet and modern agriculture. Lentil is one of the oldest dry legumes and was domesticated about 9000 years ago from the wild progenitor Lens culinaris subsp. orientalis (Boiss.), in an area that comprises modern day South-Eastern Turkey and an adjoining part of Syria [L. culinaris.Lentil (of Syria . Fergusoof Syria  showed tPhaseolus vulgaris L.), pea (Pisum sativum L.), and chickpea (Cicer arietinum L.). According to the Statistical Bureau of the Food and Agriculture Organization of the United Nations, lentil is currently cultivated on 4 million ha in warm temperate, subtropical, and tropical regions of more than 40 countries and is grown in all continents except Antarctica [microsperma) and large seeded (macrosperma). Microsperma lentils are widely grown in South-Eastern Turkey and provide an inexpensive source of protein. Lentils are commonly consumed throughout the Mediterranean and Middle East regions. They are also used to make nutritious and inexpensive soups that are popular in Northern Europe and North America. Turkey has its own version of red lentil soup locally known as “Kırmızı Mercimek Çorbası”, that is distinct from South Asian and North African dishes. The composition and nutritional quality of the lentil make it an important crop, especially in the developing world.Lentil is the fourth most important pulse (legume) crop in the world after bean , micronutrients , and trace elements . Enrichment of food crops with mineral nutrients is currently a high-priority research area. Producing micronutrient-enriched cultivars (biofortification), particularly those with increased Zn and Fe either agronomically or genetically, and improving the bioavailability of these minerals are considered a promising and cost-effective method to manage micronutrient deficiencies. One approach that can be used to increase the level of mineral nutrients in food crops is to identify natural variants that have favorable traits and use these variants to develop new cultivars. There are many lentil landraces owing to differences in traditional farming systems and taste preferences in regions where lentils are cultivated. Agronomists must assess the amount of variability in a trait within the germplasm of a crop to determine whether this trait can be enhanced. South-eastern Turkey is the core area of plant domestication in the Fertile Crescent. This region is located at the junction of the East Mediterranean and Anatolian regions and is thought to be the place where einkorn wheat and various legume species such as lentil, chickpea, field pea, and faba bean were first domesticated . PreviouRecently, a group of researchers from the Department of Field Crops, University of Cukurova, Adana, and another group from the University of Dicle, Diyarbakır, Turkey, have been evaluating genetic variations in lentil landraces collected from South-Eastern Turkey by analysis of morphological traits and DNA markers. These studies indicated that the Turkish lentil landraces had substantial genetic diversity at the genotypic and phenotypic levels , 15. Howmicrosperma variety. Information about these landraces and cultivars, collection sites, and years of release has been provided previously [Thirty-nine Turkish lentil landraces and 7 commercial lentil cultivars were examined in this study. These landraces were collected from nine provinces in southeast Turkey, and all were of the eviously , 15. All landraces and cultivars were sown in November 2007 in well-prepared seed beds, using a randomized completely blocked design with three replicates per sample. The field trail was conducted at a research and experimental area of the Seed Science and Technology Department, Vocational School of Kozan, which has an eastern Mediterranean climate. All genotypes were grown in plots of three rows, each 3 m in length, with 10 cm between plants within a row and 45 cm between rows. All plots were treated identically with standard local agricultural practices. Seeds of all lentil landraces and cultivars were harvested on June 15, 2008.3 and 2 mL of concentrated H2O, and then analyzed for mineral nutrients with an inductively coupled plasma optical emission spectrometer . Nitrogen was measured using AOAC method 997.09 [Seed samples (0.4 g) were digested in a closed microwave digestion system  in 5 mL of concentrated HNOd 997.09  on a Lec The protein content of seeds was determined using a standard method . The weir). Grouping of landraces based on mineral composition was performed by principal component analysis (PCA). JMP software [Analysis of variance was performed for each trait. Means were compared using Duncan's multiple-range test. Associations among traits were assessed using the Pearson correlation coefficient  and 1.06 g kg−1 (range: 0.89–1.26 g kg−1), respectively. The Kahmar1, Mar-Kız, and Şurfa-Siv landraces had the highest K levels and the Mar-Kız2, Diy-Çın, and Sir-Sil2 landraces had the lowest K levels. The Kahmar1, Kahmar2, and Diy-Haz landraces had the highest Mg levels and the Diy-Mer and Diy2 landraces had the lowest Mg levels (g levels . −1 (range: 6.71–8.38 g kg−1) and 0.99 g kg−1 (range: 0.85–1.15 g kg−1), respectively. The mean concentration of Ca in the landraces was 0.85 g kg−1 (range: 0.48–1.28 g kg−1) and the mean concentration of Ca in the cultivars was 0.82 g kg−1 (range: 0.69–1.02 g kg−1). The Diy-Dic1, Diy-Kulp, and Diy-Dic2 landraces had the highest Ca levels, and the Şır-Sil2, Şır-Sil3, and Diy-sil2 landraces had the lowest Ca levels (The mean K and Mg concentrations in the 7 lentil cultivars were 7.38 g kga levels . −1 (range: 9.10–16.92 mg kg−1) and 11.73 mg kg−1, respectively. The Kahmar1, Diy-Krcd, and Mar-Kız3 landraces had the highest Cu levels, and the Diy-Mer1, Mar-Kız1, and Şır-Sil3 landraces had the lowest Cu levels. The mean Cu concentrations of landraces and cultivars were 12.10 mg kg−1, and the mean was 63.61 mg kg−1. The seven cultivars had a mean Fe concentration of 58.94 mg kg−1 and the range was 49.40 to 69.90 mg kg−1. The Diy-Kulp, Kahmar1, and Mar-Kız landraces had the highest Fe levels and the Diy-Haz, Gantep-Niz, and Şır-Ciz landraces had the lowest Fe levels. The average Zn concentration of the landraces was 55.01 mg kg−1 and the range was 42.30 to 73.10 mg kg−1. The Kahmar1, Adıy-kah2, and Diy-Kulp landraces had the highest Zn levels. The mean Mn contents of the landraces and cultivars were 13.43 mg kg−1 and 13.49 mg kg−1, respectively, and the ranges for all landraces and cultivars were 11.5 to 16.2 and from 11.5 to 15.4 mg kg−1. The Kahmar2 and Adıy-Kah2 landraces had the highest Mn levels, and the Diy-Haz and Mar-Kız1 landraces had the lowest Mn levels , and Fe (P < 0.05). K was positively correlated with Cu and Zn (P < 0.01 for both). Mg was positively correlated with Cu and Zn (P < 0.01). Ca was positively correlated with Zn (P < 0.01) but negatively correlated with seed size and 100-seed weight (P < 0.05 and 0.01 for both). Cu was positively correlated with Zn, Fe, and seed size . Fe had a strong positive correlation with Mn (P < 0.01), Zn (P < 0.01), and protein content (P < 0.01). Mn was positively correlated with Zn . Zn was negatively correlated with seed size and seed yield (P < 0.05 for both). Seed size had a strong positive correlation with 100-seed weight . Finally, we used PCA to assess the patterns of variations by considering all variables simultaneously. Using PCA based on the correlation matrix, we calculated eigenvalues, percentage of variation, and load coefficients of the first six components for all traits. The first four PCs accounted for 79.45% of the variability . PC1 accProviding safe, nutritious, and affordable food is a major challenge faced by developing nations, and more than 170 million preschool children and nursing mothers are adversely affected by micronutrient malnutrition . MicronuBiofortification and/or plant breeding is a widely accepted strategy and the most sustainable approach that may increase both essential micronutrients concentrations and their bioavailable form in plant foods through genetic improvement. It is also a cost-effective way to minimize the extent of mineral deficiencies, especially deficiencies of micronutrients such as Fe, Zn, Cu, and Ca in economically disadvantaged populations. Thus, new legume varieties with high micro- and macronutrient contents could improve the nutritional status of people in developing countries. On average, global pulse consumption is in decline, but lentil consumption is increasing faster than human population growth, making this species ideal for biofortification. Thavarajah et al.  showed t−1; −1), whereas Fe concentration of Turkish lentil was lower than that of Canadian lentil [In this study, we determined micro- and macronutrients, protein content, and 100-seed weight in 39 lentil landraces and 7 cultivars. We grew all landraces and cultivars under the same conditions to eliminate the role of environment on observed variations. We found impressive genetic variation in the lentil germplasm for the investigated micro- and macronutrients. The range of Zn concentration of Turkish lentil landraces  associated with mineral uptake and transport. We also found significant positive and negative correlations among different traits, suggesting correlation among phenotypic characteristics. The data provided in this study provide an important basis for improvement of lentil, but multi-location trials conducted over several years are needed to more completely evaluate lentil landraces. Lentil landraces from Turkey could be useful for improving the micro- and macronutrient content of lentil seed through genetic improvement.


Although possible, tick transmission to a vertebrate host has not been proven. Anaplasma, Borrelia, Ehrlichia, and Rickettsia spp. Recent reports involving humans and canines suggest that ticks should be considered as potential vectors of Bartonella spp. To strengthen this suggestion, numerous molecular surveys to detect Bartonella DNA in ticks have been conducted. However, there is little evidence that Bartonella spp. can replicate within ticks and no definitive evidence of transmission by a tick to a vertebrate host.As worldwide vectors of human infectious diseases, ticks are considered to be second only to mosquitoes. Each tick species has preferred environmental conditions and biotopes that determine its geographic distribution, the pathogens it vectors, and the areas that pose risk for tick-borne diseases. Researchers have identified an increasing number of bacterial pathogens that are transmitted by ticks, including  Bartonella spp. are gram-negative bacilli or coccobacilli that belong to the α-2 subgroup of Proteobacteria. According to 16S rDNA gene comparisons, they are closely related to the genera Brucella and Agrobacterium , bacillary angiomatosis , peliosis hepatitis (B. henselae), bacteremia and/or endocarditis , Carrión disease (B. bacilliformis), trench fever (B. quintana), retinitis and uveitis , myocarditis , splenomegaly , and fever and fatigue    gene, the riboflavin synthase gene, the heat shock protein gene (groEL), the 16S–23S intergenic spacer, the heme binding protein gene, and the cell division protein gene or the 16S rDNA gene  contained B. burgdorferi DNA, 1 (0.9%) contained B. microti DNA, 1 (0.9%) contained A. phagocytophilum DNA, 1 (0.9%) contained both B. burgdorferi and A. phagocytophilum DNA, and 1 (0.9%) contained B. microti and A. phagocytophilum DNA  was detected in 1 of the adult ticks tested. The authors also reported that 1% of the ticks contained Bartonella spp. and B. burgdorferi DNA, 4% contained Bartonella and Babesia spp. DNA, and 1% contained Bartonella spp., B. burgdorferi, and Babesia spp. DNA  contained B. henselae genotype I DNA  harbored detectable Bartonella DNA. Furthermore, 16.3% of 86 individual I. sinensis ticks  from the cities of Tiantai, Jindong, and Jiangshan contained Bartonella DNA. One tick harbored all 4 bacteria , and a second tick pool was positive by PCR for Borrelia, Bartonella, and Ehrlichia spp  . One patient exhibited no laboratory evidence of Lyme disease, suggesting that these symptoms might have been caused by an agent other than B. burgdorferi. However, 2 patients reported illness within 1 week to 3 months after being bitten by a tick. Upon further investigation, all patients were seroreactive to B. henselae; immunofluorescence assay showed immunoglobulin (Ig) G titers of 64–256. According to the authors, B. henselae DNA was amplified from blood of 1 patient, from CSF of 1 patient, and from both blood and CSF of the other 2 patients . Ticks, identified as I. scapularis, found in 2 patients’ homes potentially harbored both B. henselae and B. burgdorferi DNA. Whether B. henselae was specifically detected in this case series is unclear because sequencing of amplicons was not performed and because the PCR primer set targeted the Bartonella 16S rRNA, a highly conserved region. Without sequencing of amplicons or confirmation of results by targeting a more highly variable gene, ascertaining whether B. henselae was present in the ticks or in the patients would be difficult. However, the results derived from these cases are of interest because, to our knowledge, this was the first case series to propose simultaneous detection of both B. burgdorferi and Bartonella DNA in the CSF of patients with neurologic signs.Other case reports have suggested potential human co-infections with B. burgdorferi and B. henselae  egg clutches did not harbor detectable Bartonella DNA (,Recently, Cotté et al. detailed the potential transmission of Bartonella spp. identified in the past 15 years has increased considerably. This review indicates that a diversity of Bartonella spp. DNA can be amplified from various tick species from numerous geographic locations, that tick attachment has preceded the onset of illness in a small number of patients from whom B. henselae DNA has been amplified, and that serologic and molecular evidence suggests cosegregation of Bartonella spp. with known tick-borne pathogens. Therefore, ticks might serve as potential Bartonella vectors. However, there is little evidence that Bartonella spp. can replicate within ticks and no definitive evidence of transmission by a tick to a vertebrate host. Only Kruszewska and Tylewska-Wiezbanowska reported successful isolation of Bartonella sp. from a tick (Bartonella DNA from ticks by using PCR. As the medical relevance of the genus Bartonella continues to evolve, it is clearly necessary to determine whether ticks or other arthropods play a role in the transmission of Bartonella spp. among animals and humans. For this reason, experimental transmission studies, using infected ticks placed on live animals, are required to determine whether ticks are vector competent for the transmission of Bartonella spp.The number of zoonotic B. henselae infection transmitted by Dermancentor spp. ticks. These patients had scalp eschar and neck lymphadenopathy (Since the submission of this manuscript, we found 3 cases of


To identify prognostic factors associated with recurrence of low birthweight (LBW) in successive gestations, a study was carried out with a subsample of mothers enrolled in the 2004 Pelotas Birth Cohort.th week of pregnancy or the Dubowitz method. Mothers who reported at least one LBW newborn in the two previous gestations were included. Prevalence ratios (PR) and 95% confidence intervals were estimated from Poisson Regression. All estimates were adjusted for parity.Data were collected by hospital-based interviews. Newborns were weighed and measured. Gestational age was defined according to the date of last menstrual period, ultra-sound scan before the 20A total of 4558 births were identified in 2004, and 565 met inclusion criteria, out of which 86 (15.2%) repeated LBW in 2004. Among mothers with two LBW babies before 2004, 47.9% presented LBW recurrence. Belonging to the highest socio-economic stratum  and gaining ≥ 10 kg during pregnancy  were protective against LBW recurrence. Higher risk of LBW recurrence was observed among mothers with higher parity ; who had given birth to a previous preterm baby ; who delivered a female newborn in current gestation ; and that had not received adequate antenatal care .Improved quality of antenatal care and adequate maternal weight gain during pregnancy may be feasible strategies to prevent LBW repetition in successive pregnancies. Low birthweight (LBW) defined as birth weight lower than 2500 grams is an important infant mortality and morbidity predictor,2. BirthThe identification of factors involved in the repetition of LBW is an attempt to understand the causal links that increase the chance of some women to be more susceptible to give birth to a LBW child. Previous LBW and preterm birth are usually investigated as risk markers in studies aiming to assess risk factors for LBW and preterm births. Studies planned to specifically explore LBW repetition or gestational age repetition are lacking in the literature. After a systematic review for publications in the last 40 years only six studies were identified[This study was carried out within a larger project – The 2004 Pelotas Birth Cohort. Data weOnly mothers who reported at least one previous LBW newborn in the two immediate pregnancies before 2004 were included in the current analyses. The inclusion criteria also demanded that these pregnancies were not multiple and did not result in malformation or abortion. From the 2004 births, primiparas, malformation cases and multiple pregnancies were also excluded.th week of pregnancy. When ultra-sound was missing too, the Dubowitz score was used. Interviewers in charge of data collection were graduated nutritionists, previously trained for a period of seven days. During data collection interviewers were re-evaluated periodically to confirm quality of interview and of newborn physical examination. Interviewers were allocated in a way that each member of the team worked in every hospital, changing working location and shifts weekly. In order to assure data quality, after hospital discharge a fieldwork supervisor repeated 10% of the interviews by telephone, using a short version of the questionnaire. Around 5% of the mothers were contacted while still in the hospital to answer a similar short version of the questionnaire; the latter was done by a gynecologist (fieldwork supervisor) who also performed a Dubowitz examination.Newborns were weighed with digital pediatric scales soon after labor. Scales were checked for accuracy weekly by using standard weights. Length measurements were performed in supine position and thoracic, cephalic and abdominal circumferences were obtained with inelastic measuring tapes. Gestational age was calculated by an algorithm starting with the date of last menstrual period. When last menstrual period was missing or implausible, ultra-sound information was used as long as the exam had been done before the 20http://www.abep.org/codigosguias/ABEP_CCEB.pdf). Information on mother’s and father’s schooling  and maternal marital status (mother currently living with or without a partner) was collected. Maternal biologic variables included age (at the moment of the interview), skin color , height (in cm), LBW born-mothers , and preterm born-mothers . For the father, current age was collected. Reproductive and behavioral maternal characteristics gathered were parity (number of previous births), smoking , caffeine consumption (coffee ingestion for each trimester of pregnancy), abortion history (yes/no), interpartal interval (months between last and current delivery), newborn sex, preterm history (yes/no), antenatal care [Five social classes, labeled A (richest) to E (poorest) based on nine assets, presence of domestic employees and the education level of the household head were defined according to the Brazilian Research Companies Association  and 95% Confidence Intervals (95%CI) were estimated through robust Poisson Regression, to prevent overestimation of PR obtained through logistic regression. For mulStudy protocol was approved by the Medical Ethics Committee of the Federal University of Pelotas. Written consent was obtained from mothers before the interview.A total of 4558 births were identified in Pelotas in 2004, from which, 565 were eligible according to the inclusion criteria (at least one LBW baby prior to 2004). From the 565 mothers, 86 (15.2%) gave birth to a LBW baby in 2004 and therefore were considered positive for the outcome. Among mothers with two LBW births prior to 2004, recurrence of LBW was 47.9%.TableRegarding maternal own birthweight, 15.1% of the women were LBW born-mothers, among whom recurrence of LBW in 2004 was 26.3% in comparison to 12.2% among non-LBW born-mothers. Seven percent of the women were preterm born-mothers and the recurrence of LBW among them was 29.7% against 13.3% among non-preterm born-mothers.TableTableTableIn the fifth level, women with intermediate or inadequate quality of antenatal care presented a PR = 2.57 and in the sixth level, mothers with weight gain of 10 kg or more had a probability of LBW recurrence almost 100% smaller than that of women gaining less than 7 kg during pregnancy.Frequency of LBW in the group of mothers with at least one previous pregnancy ending in a LBW newborn 15.2%) was 1.5 times higher than the observed for the entire 2004 Birth Cohort population (10.0%)[.2% was 1It’s difficult to establish comparisons between this study and findings from other authors due to different methodologies and different outcome definitions. Findings from other studies showed that LBW recurrence was associated to mother’s smoking, shorterOthers have found that recurrence of SGA infants in successive gestations was associated to maternal ages younger than 20 and older than 35, lower mMost of these studies however compared mothers with repeated outcome  against mothers who had given birth only to normal weighed and term infants, thus exploring risk factors for LBW occurrence, not for LBW recurrence. Nonetheless, risk factors for LBW recurrence may not necessarily be the same as prognostic factors for repetition of LBW among mothers who have already experienced the delivery of a LBW newborn. Because LBW is a recognized risk marker for subsequent LBW delivery, identification of modifiable prognostic factors among this high risk group of mothers is important for recurrence prevention. The historical cohort design of our study analyzing a group of women with previous experience of a LBW delivery is appropriate to uncover prognostic factors for repeated LBW in a subsequent pregnancy.With regard to the association with low socio-economic class, Bakketeig et al. similarlWe found that mothers with preterm history presented a fourfold increase in probability to repeat LBW. The study by Krymo et al. identifiLimitations of the study must be highlighted. First, since our conclusions rely on information from the past, like mother’s own birthweight and gestational age as well as occurrence of LBW in previous pregnancies, recall bias might have happened. On the other hand, efficient mother’s recruitment methods in the hospitals coupled with the fact that more than 99% of Pelotas deliveries take place in these hospitals, strengthened our results for the studied population.Second, the small number of LBW infants did not allow for separate analyses that would account for the etiologically heterogeneous character of LBW (mothers with previous LBW fetuses at term and mothers with previous LBW who were born preterm may present different prognostic factors). Furthermore and for the same reason, potential etiologic differences related to the severity of LBW  were not accounted for in the study. Furthermore, the number of previous LBW newborns experienced by women with ≥2 previous deliveries was not considered. Nonetheless, interaction between all independent variables including parity was tested and none were statistically significant.Although this study cannot answer whether the probability of LBW repetition depends on the mother’s persistence in risk factors or whether the risk for LBW recurrence would be the same if those factors could be changed in successive gestations, our results point out that appropriate antenatal care and adequate maternal weight gain in pregnancy may help to prevent recurrence of LBW among high risk mothers.LBW: Low birth weight; SGA: Small for gestational age; PR: Prevalence ratio; 95% CI: 95% confidence interval.The authors declare that they have no competing interests.IKTS conceived the study, participated in its coordination, performed the statistical analysis, and draft the first version of the manuscript. ISS participated in the design and coordination of the study and helped to draft the manuscript. MRD participated in the coordination of the study and in the statistical analysis. AM and AJDB participated in the design and coordination of the study. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/13/20/prepub


Descriptions of the ADHD, ASD, and ADHD+ASD groups reflected greater impairment than descriptions for patients with other psychiatric disorders in most problem areas. Although differences were observed between ADHD and ASD patients in the core diagnostic areas, these syndromes also shared a number of childhood difficulties. The ESSENCE approach can assist in understanding the symptom history of adult ADHD and ASD patients and can be helpful to distinguish their childhood experiences from other psychiatric patients' experiences.Diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are increasingly being made in adulthood. However, assessments can fail to address the diverse range of problems that patients have experienced. The current study applied an early symptomatic syndromes eliciting neurodevelopmental clinical examinations (ESSENCE) framework to explore retrospectively reported childhood developmental and behavioral problems. It examined if adult ASD and ADHD patients would show problems outside those reflected in the respective diagnostic criteria, and also if these patient groups would show more extensive childhood problems than other psychiatric patients. Parents of adults with ADHD ( Adult diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have increased in recent decades and are currently estimated to occur in one and four percent of the adult population, respectively , 2. AlthDiagnosis of ASD is based on a qualitative impairment of social interaction and communication as well as restricted repetitive and stereotyped patterns of behavior, interest, and activities . ADHD diIn addition to symptoms described in the diagnostic criteria, patients with ASD and/or ADHD tend to also experience a range of other behavioral and developmental problems. Both syndromes are associated with language , 9 and mBoth ASD and ADHD are associated with a range of difficulties, of which only some are located within the diagnostic criteria , 20. HowAlthough ADHD and ASD are usually diagnosed in childhood, adult diagnoses are rapidly increasing . FurtherThis study applies the ESSENCE framework to the adult assessment of ASD and ADHD. In Nordic psychiatry, the five to fifteen (FTF) questionnaire is a widely used instrument that addresses a variety of childhood neurodevelopmental problems . In addin = 413) were consecutive admissions referred to an outpatient tertiary psychiatric clinic in northern Stockholm (Sweden) by a clinician for diagnosis and treatment of ADHD or ASD. The catchment area of the clinic has a population of nearly 320,000 adult inhabitants from both high and low socioeconomic regions. Self-referrals or patients with an intellectual disability or obvious drug/alcohol problems were not included in the study.Participants , ADHD (n = 130), or coexisting ADHD+ASD (n = 38) were compared to a psychiatric disorders group (n = 56), mostly comprised of patients with major depression, OCD and other anxiety disorder diagnoses, who were identically assessed but did not receive an ASD and/or ADHD diagnosis. Of the initial sample, 281 participated  . Parent reports of patients diagnosed by the clinic with ASD (.86) see .In addition to clinical interviews, the following instruments assisted in the diagnosis of ASD and ADHD. For ASD assessment, the Autism Spectrum Screening Questionnaire (ASSQ)  and the For ADHD symptoms, patients completed the Wender Utah Rating Scale (WURS), which addresses childhood symptoms of ADHD . They weIn addition, the assessment of general functioning was made using the global assessment of functioning (GAF) . This prdoes not apply, applies sometimes or to some extent, and definitely applies).The five to fifteen (FTF) was used to describe a range of developmental and behavioral problems that patients displayed in childhood between ages five and fifteen years . This inhttp://www.515.org/). Younger children receive higher ratings than older children [The items represent eight broader domains: (a) motor skills, (b) executive functions, (c) perception, (d) memory, (e) language, (f) learning, (g) social skills, (h), and emotional/behavioral problems. To examine childhood problems in more detail and illustrate the ESSENCE domains, the current study examined 19 FTF subdomains see . The subchildren ; thus, uThe FTF subdomains of “communication” and “social skills” refer to symptoms in ASD diagnostic criteria, while “attention” and the combined subdomains “hypoactivity and hyperactivity/impulsivity” and “attention” refer to symptoms in ADHD diagnostic criteria.U test. A significance P value of <.05 was regarded as significant. As the analyses were largely exploratory, the application of a Bonferroni adjustment was not considered as fully applicable in this context.Statistical analyses were performed in Statistica 7.1 . All sigP = .10)  and had low social contact than the other groups . No significant differences in fulltime employment rates were observed between groups (P = .15). Consistent with diagnoses, the ADHD and ADHD+ASD groups showed the highest WRAADDS scores, while the ASD and ADHD+ASD groups showed the highest ASDI scores. Poorer general functioning (lower GAF scores) was observed for the ASD and the ADHD+ASD groups compared to the ADHD group and other psychiatric disorders group  = 30.5, P < .0001). The four patient groups shared a similar proportion of males and females as well as age distribution (.10) see . SignifiTo explore the extent to which ASD and ADHD patients were described as having childhood problems beyond those listed in the diagnostic criteria, median subdomain scores for each diagnostic group were compared to the FTF median norms. As shown in The ADHD, ASD, and ADHD+ASD groups were then compared to patients with other psychiatric disorders to examine if the latter group showed fewer childhood problems. As shown in However, there were no significant differences between the ASD group and patients with other psychiatric disorders in “time concepts” and “visual perception”. There were also no differences observed between the ADHD group and the other psychiatric disorders group in “obsessions-compulsions” or “expressive language skills”. Finally, no differences were observed between ADHD+ASD and the other psychiatric disorders group in “obsessions-compulsions”. P < .001), “hypoactivity and hyperactivity/impulsivity” (P < .01), “planning and organization” (P < .001), “time concepts” (P < .01), and “memory” (P < .05). Although the majority of main effects for differences amongst the ASD and ADHD groups were nonsignificant, several differences were observed see . PairwisP < .001). Furthermore, the ADHD+ASD group had higher scores than the ASD group in “attention” (P < .01) and “time concepts” (P < .05). They also had higher scores than the ADHD group for “communication” (P < .05) and “social skills” (P < .01).In comparison, the ASD group showed greater difficulties than the ADHD group in “social skills”  as well as voice expression, and the FTF addresses these abilities within “social skills”. Although they are theoretically distinct constructs, social skills and communication can be difficult to distinguish in practice and measurement. Consistent with this, the diagnostic criteria for ASD in DSM-5 will merge difficulties in social skills and communication into a single criterion [The childhood problems described by parents generally reflected impairments characterising the diagnostic criteria for ADHD and ASD. However, the two groups did not differ on “communication” scores. This may be due to the conceptualization of the FTF “communication” items. Only one of the three “communication” items, namely, riterion .Our results are consistent with the ESSENCE framework and previous studies showing significant problems for ADHD and ASD patients beyond the diagnostic criteria , 41, 42.Although the ADHD and ASD groups shared difficulties in several areas of functioning outside the diagnostic criteria, parent reports also revealed trends specific to each condition relating to executive functions. Greater memory function problems were reported for ADHD patients than for ASD patients. This is consistent with impairments reported in other studies for ADHD patients in working memory and long-term memory , 45–47 aThe current findings illustrate that ASD and ADHD share many problems during childhood that may often be overlooked in specialised treatment and research focusing on exclusively one of these two specific disorders. However, there are some limitations that should be considered when evaluating the findings. Firstly, participants in this study were diagnosed in adulthood. As individuals diagnosed earlier in development (childhood or adolescence) tend to have a more severe condition than those diagnosed at a later stage , our parSecondly, there is a possibility that parent reports may be influenced by their adult child's symptoms rather than purely reflecting childhood difficulties. Given that all differences amongst the diagnostic groups were in the expected direction , this influence appears unlikely. Future research could further validate the retrospective use of the FTF by using a prospective design comparing parent reports made in childhood and adulthood.Thirdly, as multiple comparisons were made, there was an increased risk of making a type-I error, falsely rejecting the null hypothesis. However, given that the analyses were largely exploratory, the application of a Bonferroni adjustment was not considered as fully applicable. Nevertheless, if such an adjustment had been applied, nearly all of the current findings would still apply.The current study adds to the evidence that neurodevelopmental syndromes such as ADHD and ASD are associated with a considerable range of developmental and behavioral problems. It also extends prior research by demonstrating that adult ADHD and ASD patients are likely to have displayed more difficulties in childhood when compared to other psychiatric patients and that retrospective parent reports can assist in building a symptom history. The ESSENCE framework and instruments such as the FTF appear to be useful for identifying areas of difficulty that are not diagnostic of ADHD and/or ASD but are nevertheless important for understanding the complexity of patients' needs.