Neurological Soft Signs in Patients with Attention Deficit Hyperactivity Disorder Aged 6 to 18 Years Old at a University Hospital: A Cross-sectional Study

Abstract

Purpose: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children persisting into adulthood. Evidence suggests that the condition is etiologically related to delayed brain maturation. The detection of the presence of neurological soft signs can be a means to assess neuromaturation. The objective of this study was to assess the prevalence of neurological soft signs in ADHD patients and determine any correlation between the presence of neurological soft signs with age, gender, severity and type of ADHD which could give further insights into this disorder.

 

Methods: A cross-sectional study was conducted at the Child Neurology and Developmental Pediatrics outpatient clinic which included patients 6-18 years old diagnosed with ADHD as well as healthy controls. Patients with other neurodevelopmental conditions (intellectual disability, metabolic disorder, cerebral palsy, abnormal MRI findings), or any condition that may lead to failure to complete the given tasks such as physical handicaps were excluded. Neurological soft signs were measured by utilizing the Physical and Neurological Evaluation for Soft Signs (PANESS) scale.

 

Key Findings: A total of 48 patients between 6 and 18 years of age (24 ADHD patients and 24 healthy controls) were examined. Neurological soft signs were significantly higher in patients with ADHD and were present regardless of gender, type and severity of ADHD. ADHD patients performed worse on the given tasks as evidenced by higher PANESS scores. There was a weak negative correlation between neurological soft signs and age indicating that soft sign scores decrease with increasing age. There was no statistically significant difference in neurological soft sign scores between those with medication versus without treatment, except for dysrhythmia which was significantly higher in the drug-naive group.

 

Significance:

Neurological soft signs are common in patients with ADHD and add scientific evidence to the predictive value of neurological soft signs as indicators of the severity of functional impairment in ADHD. The prevalence of neurological soft signs is much higher in children with ADHD than in controls which may have the potential to improve sensitivity in the diagnosis of ADHD.

 

Keywords: Neurological soft signs, ADHD, PANESS

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