title: Subclinical immune reactions to viral infections may correlate with child and adolescent diagnosis of attention-deficit/hyperactivity disorder: a preliminary study from Turkey.
abstract: BACKGROUND
  Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neuro-developmental disorders of childhood and adolescence. Studies focusing on the relationship of infectious agents and ADHD are scarce. It is also known that cerebellar injury may lead to hyperactive behavior. This study aimed to evaluate the relationship between viral agents of cerebellitis and the diagnosis of ADHD.
  
  
  METHODS
  The study group was formed of 60 consecutive ADHD patients and 30 healthy children. IgG levels for VZV; HSV-1, CMV, Measles, Mumps, Rubella and EBV were evaluated.
  
  
  RESULTS
  Males were significantly higher among patients with ADHD (65% vs. 40%, p=0.025). Patients with ADHD displayed significantly higher positivity for measles IgG (80% vs. 60%, p=0.044). When patients with ADHD were classified according to their pubertal status, adolescents with ADHD displayed higher positivity for mumps (100% vs. 74.4%, p=0.043). Most of the patients were diagnosed with ADHD-Combined or Hyperactive/Impulsive Subtypes (56.6%) while 43.3% were diagnosed with ADHD-predominantly inattentive type. When patients with subtypes of ADHD were compared in terms of seropositivity, it was found that patients with ADHD-Combined/ Hyperactive-Impulsive subtypes had significantly elevated reactions for Rubella (100% vs. 88.5%, p=0.044).
  
  
  CONCLUSIONS
  Although limited to a single center and may be prone to sampling biases, our results may support the notion that immune reactions may be related with ADHD among children and adolescents. Further, prospective studies from multiple centers are needed to support our findings and establish causality.
authors.affiliation: Department of Pediatrics, Bolu, Turkey.
authors.forename: Mervan
authors.initials: M
authors.lastname: Bekdas
authors.affiliation: Department of Child and Adolescent Psychiatry, Bolu, Turkey.
authors.forename: Ali Evren
authors.initials: AE
authors.lastname: Tufan
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Bolu, Turkey.
authors.forename: Ismail Necati
authors.initials: IN
authors.lastname: Hakyemez
authors.affiliation: Department of Medical Microbiology, Bolu, Turkey.
authors.forename: Tekin
authors.initials: T
authors.lastname: Tas
authors.affiliation: Department of Pediatrics, Bolu, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Altunhan
authors.affiliation: Department of Pediatrics, Bolu, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Demircioglu
authors.affiliation: Department of Pediatrics, Bolu, Turkey.
authors.forename: Erol
authors.initials: E
authors.lastname: Kısmet
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000276:immunology*; D016022:Case-Control Studies; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008297:Male; D011446:Prospective Studies; D017678:Sex Distribution; D014421:Turkey; D014777:Virus Diseases / Q000276:immunology*
chemical_list: D007074:Immunoglobulin G
keywords: ADHD; IgG; immunology; infection; measles; mumps; rubella