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Helle-Valle A, Binder PE, Anderssen N, Stige B. Is restlessness best understood as a process? Reflecting on four boys' restlessness during music therapy in kindergarten. Int J Qual Stud Health Well-being 2017; 12:1298266. [PMID: 28532331 PMCID: PMC5510212 DOI: 10.1080/17482631.2017.1298266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ADHD can be considered an internationally recognized framework for understanding children’s restlessness. In this context, children’s restlessness is understood as a symptom of neurodevelopmental disorder. However, there are other possible understandings of children’s restlessness. In this article, we explore four boys’ collaborative and creative process as it is described and understood by three adults. The process is framed by a community music therapy project in a Norwegian kindergarten, and we describe four interrelated phases of this process: Exploring musical vitality and cooperation, Consolidating positions, Performing together, and Discovering ripple effects. We discuss these results in relation to seven qualities central to a community music therapy approach: participation, resource orientation, ecology, performance, activism, reflexivity and ethics. We argue that in contrast to a diagnostic approach that entails a focus on individual problems, a community music therapy approach can shed light on adult and systemic contributions to children’s restlessness.
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Affiliation(s)
- Anna Helle-Valle
- a Department of Psychosocial Science, Faculty of Psychology , University of Bergen , Bergen , Norway
| | - Per-Einar Binder
- b Department of Clinical Psychology, Faculty of Psychology , University of Bergen , Bergen , Norway
| | - Norman Anderssen
- a Department of Psychosocial Science, Faculty of Psychology , University of Bergen , Bergen , Norway
| | - Brynjulf Stige
- c Grieg Academy - Department of Music, Faculty of Fine Art, Music and Design , University of Bergen , Bergen , Norway
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Schmidt M, Reh V, Hirsch O, Rief W, Christiansen H. Assessment of ADHD Symptoms and the Issue of Cultural Variation: Are Conners 3 Rating Scales Applicable to Children and Parents With Migration Background? J Atten Disord 2017; 21:587-599. [PMID: 23893536 DOI: 10.1177/1087054713493319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective was to evaluate whether Conners 3 ( Conners 3rd edition) ratings of ADHD symptoms are robust to distortion by cultural variation when applied to children with migration background living in Germany. METHOD From 2010 to 2011, Conners 3 data (self-rating, parent rating, and teacher rating) of 243 children with Turkish migration background, aged 6 to 16 years, were collected in various German schools. Allocation of items to latent factors was tested with confirmatory analyses. Reliability and validity of resulting factors was calculated and influence of acculturation, gender, and age on rating-modalities was examined. RESULTS Confirmatory factor analyses showed high model fits for all rating-modalities. Resulting scales had good reliability and validity. There was a small influence of acculturation on parent ratings of oppositional defiant disorder but not on ADHD core symptoms. CONCLUSION Conners 3 ratings seem to be robust against influences of cultural variation. Their German translation can be utilized for children with Turkish migration background without limitation.
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Galloway H, Newman E. Is there a difference between child self-ratings and parent proxy-ratings of the quality of life of children with a diagnosis of attention-deficit hyperactivity disorder (ADHD)? A systematic review of the literature. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2017; 9:11-29. [PMID: 28005216 PMCID: PMC5323486 DOI: 10.1007/s12402-016-0210-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 11/23/2016] [Indexed: 12/05/2022]
Abstract
There are contemporary indicators that parent proxy-ratings and child self-ratings of a child's quality of life (QoL) are not interchangeable. This review examines dual informant studies to assess parent-child agreement on the QoL of children with attention-deficit/hyperactivity disorder. A systematic search of four major databases (PsycINFO, MEDLINE, EMBASE and Cochrane databases) was completed, and related peer-reviewed journals were hand-searched. Studies which reported quantitative QoL ratings for matched parent and child dyads were screened in accordance with relevant inclusion and exclusion criteria. Key findings were extracted from thirteen relevant studies, which were rated for conformity to the recommendations of an adapted version of the STROBE statement guidelines for observational studies. In the majority of studies reviewed, children rated their QoL more highly than their parents. There was some evidence for greater agreement on the physical health domain than psychosocial domains.
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Affiliation(s)
- Helen Galloway
- Clinical Psychology to General Adult Psychiatry, NHS Tayside, Alloway Centre, Dundee, DD4 8UA, UK.
| | - Emily Newman
- Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Gul N, Tiryaki A, Kultur SEC, Topbas M, Ak I. Prevalence of Attention Deficit Hyperactivity Disorder and Comorbid Disruptive Behavior Disorders Among School Age Children in Trabzon. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/10177833.2010.11790634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Neyir Gul
- Karadeniz Technical University Graduate School of Social Sciences, Counseling Psychology Master of Arts Program in Educational Sciences
| | - Ahmet Tiryaki
- Karadeniz Technical University Faculty of Medicine, Department of Psychiatry
| | - S. Ebru Cengel Kultur
- Hacettepe University Faculty of Medicine, Department of Child and Adolescent Psychiatry
| | - Murat Topbas
- Karadeniz Technical University Faculty of Medicine, Department of Public Health
| | - Ismail Ak
- Karadeniz Technical University Faculty of Medicine, Department of Psychiatry KTÜ Tıp Fakültesi Farabi Hastanesi Psikiyatri AD, Trabzon, Turkey
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Psychiatric gene discoveries shape evidence on ADHD's biology. Mol Psychiatry 2016; 21:1202-7. [PMID: 26573769 PMCID: PMC4820035 DOI: 10.1038/mp.2015.163] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/08/2015] [Accepted: 09/08/2015] [Indexed: 12/22/2022]
Abstract
A strong motivation for undertaking psychiatric gene discovery studies is to provide novel insights into unknown biology. Although attention-deficit hyperactivity disorder (ADHD) is highly heritable, and large, rare copy number variants (CNVs) contribute to risk, little is known about its pathogenesis and it remains commonly misunderstood. We assembled and pooled five ADHD and control CNV data sets from the United Kingdom, Ireland, United States of America, Northern Europe and Canada. Our aim was to test for enrichment of neurodevelopmental gene sets, implicated by recent exome-sequencing studies of (a) schizophrenia and (b) autism as a means of testing the hypothesis that common pathogenic mechanisms underlie ADHD and these other neurodevelopmental disorders. We also undertook hypothesis-free testing of all biological pathways. We observed significant enrichment of individual genes previously found to harbour schizophrenia de novo non-synonymous single-nucleotide variants (SNVs; P=5.4 × 10(-4)) and targets of the Fragile X mental retardation protein (P=0.0018). No enrichment was observed for activity-regulated cytoskeleton-associated protein (P=0.23) or N-methyl-D-aspartate receptor (P=0.74) post-synaptic signalling gene sets previously implicated in schizophrenia. Enrichment of ADHD CNV hits for genes impacted by autism de novo SNVs (P=0.019 for non-synonymous SNV genes) did not survive Bonferroni correction. Hypothesis-free testing yielded several highly significantly enriched biological pathways, including ion channel pathways. Enrichment findings were robust to multiple testing corrections and to sensitivity analyses that excluded the most significant sample. The findings reveal that CNVs in ADHD converge on biologically meaningful gene clusters, including ones now established as conferring risk of other neurodevelopmental disorders.
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Rogers WA, Mintzker Y. Getting clearer on overdiagnosis. J Eval Clin Pract 2016; 22:580-7. [PMID: 27149914 DOI: 10.1111/jep.12556] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/20/2016] [Accepted: 04/01/2016] [Indexed: 12/01/2022]
Abstract
Overdiagnosis refers to diagnosis that does not benefit patients because the diagnosed condition is not a harmful disease in those individuals. Overdiagnosis has been identified as a problem in cancer screening, diseases such as chronic kidney disease and diabetes, and a range of mental illnesses including depression and attention deficit hyperactivity disorder. In this paper, we describe overdiagnosis, investigate reasons why it occurs, and propose two different types. Misclassification overdiagnosis arises because the diagnostic threshold for the disease in question has been set at a level where many people without harmful disease are nonetheless diagnosed. We illustrate misclassification overdiagnosis using the example of chronic kidney disease. Misclassification occurs in diseases diagnosed using biomarkers or based on patient reported phenomena. Maldetection overdiagnosis arises because, at the time the diagnosis is made and despite the presence of a 'gold standard' diagnostic test, it is not possible to discriminate between harmful and non-harmful cases of the index disease. We illustrate maldetection overdiagnosis using the example of thyroid cancer. While there is some overlap between misclassification and maldetection overdiagnosis, this conceptual analysis helps to clarify the phenomenon of overdiagnosis and is a necessary first step in developing strategies to address the problem.
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Affiliation(s)
- Wendy A Rogers
- Department of Philosophy and Department of Clinical Medicine, Macquarie University, Australia
| | - Yishai Mintzker
- Faculty of Medicine in the Galilee, Bar Ilan University, Israel
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Ghosh M, Fisher C, Preen DB, Holman CDJ. "It has to be fixed": a qualitative inquiry into perceived ADHD behaviour among affected individuals and parents in Western Australia. BMC Health Serv Res 2016; 16:141. [PMID: 27101981 PMCID: PMC4840935 DOI: 10.1186/s12913-016-1399-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/12/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The use of stimulant medication for Attention Deficit Hyperactivity Disorder (ADHD) to improve classroom behaviour and sustained concentration is well known. Achieving a better academic grade has been reported as the prime motivation for stimulant use and is an increasingly discussed topic. The proliferation of stimulant use for ADHD has been a cause for public, medical and policy concern in Australia. This paper explores individuals' perceptions of ADHD, the meaning that the diagnosis carries for them and their attitudes to stimulant medication treatment. METHODS This qualitative study was underpinned by a social constructivist approach and involved semi-structured interviews with eight participants. The participants were parents of children with ADHD or were adults who themselves had been diagnosed with ADHD. Interviews were audiotaped, transcribed verbatim and thematically analysed. RESULTS There were three interrelated yet contradictory overarching themes: (i) An impairment to achieving success, which can be a double-edged sword, but has to be fixed; (ii) Diagnosis as a relief that alleviates fault and acknowledges familial inheritance; (iii) Responsibility to be normal and to fit in with societal expectations. Collectively, these perceptions and meanings were powerful drivers of stimulant use. CONCLUSIONS Paying attention to perceptions of ADHD and reasons for seeking or not seeking stimulant treatment is important when planning appropriate interventions for this condition.
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Affiliation(s)
- Manonita Ghosh
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Colleen Fisher
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - C D'Arcy J Holman
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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Richardson M, Moore DA, Gwernan-Jones R, Thompson-Coon J, Ukoumunne O, Rogers M, Whear R, Newlove-Delgado TV, Logan S, Morris C, Taylor E, Cooper P, Stein K, Garside R, Ford TJ. Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health Technol Assess 2016; 19:1-470. [PMID: 26129788 DOI: 10.3310/hta19450] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by age-inappropriate levels of inattention, impulsivity and hyperactivity. School can be particularly challenging for children with ADHD. Few reviews have considered non-pharmacological interventions in school settings. OBJECTIVES To assess the effectiveness of non-pharmacological interventions delivered in school settings for pupils with, or at risk of, ADHD and to explore the factors that may enhance, or limit, their delivery. DATA SOURCES Twenty electronic databases (including PsycINFO, MEDLINE, EMBASE, Education Resources Information Centre, The Cochrane Library and Education Research Complete) were searched from 1980 to February-August 2013. Three separate searches were conducted for four systematic reviews; they were supplemented with forward and backwards citation chasing, website searching, author recommendations and hand-searches of key journals. REVIEW METHODS The systematic reviews focused on (1) the effectiveness of school-based interventions for children with or at risk of ADHD; (2) quantitative research that explores attitudes towards school-based non-pharmacological interventions for pupils with ADHD; (3) qualitative research investigating the attitudes and experiences of children, teachers, parents and others using ADHD interventions in school settings; and (4) qualitative research exploring the experience of ADHD in school among pupils, their parents and teachers more generally. Methods of synthesis included a random-effects meta-analysis, meta-regression and narrative synthesis for review 1, narrative synthesis for review 2 and meta-ethnography and thematic analysis for reviews 3 and 4. RESULTS For review 1, 54 controlled trials met the inclusion criteria. For the 36 meta-analysed randomised controlled trials, beneficial effects (p < 0.05) were observed for several symptom and scholastic outcomes. Mean weighted effect sizes ranged from very small (d + < 0.20) to large (d + ≥ 0.80), but substantial heterogeneity in effect size estimates across studies was reported. Moderator analyses were not able to clarify which intervention features were linked with effectiveness. For review 2, 28 included studies revealed that educators' attitudes towards interventions ranged in positivity. Most interventions were rated positively or neutrally across different studies. The only intervention that consistently recorded positive attitudes from educators was daily report cards. For review 3, 33 studies met the inclusion criteria. Key findings included tensions regarding the preferred format of interventions, particularly how structured interventions were and the extent to which they are tailored to the child with ADHD. There were mixed views about the impact of interventions, although it was clear that interventions both influence and are influenced by the relationships held by children with ADHD and participants' attitudes towards school and ADHD. For review 4, 34 studies met the inclusion criteria. Key findings included the importance of causal attributions that teachers, parents and pupils made about ADHD symptoms, the decisions teachers made about treatment, the self-perceptions pupils developed about themselves, the role of the classroom environment and stigma in aggravating ADHD symptoms, and the significant barrier to treatment posed by the common presence of conflict in relationships between pupils-teachers, parents-teachers and pupils-peers in relation to ADHD. An overarching synthesis of the four reviews highlighted the importance of the context affecting interventions. It suggested that ADHD psychoeducation and relationship-building skills are potential implications for interventions. LIMITATIONS The breadth of both interventions and outcomes in the reviewed studies presented a challenge for categorisation, analysis and interpretation in reviews 1-3. Across reviews, relatively few studies were conducted in the UK, limiting the applicability of findings to UK education. In reviews 1 and 2, the poor methodological quality of some included studies was identified as a barrier to establishing effectiveness or comparing attitudes. In review 3 the descriptive analysis used by the majority of studies constrained theorising during synthesis. Studies in review 4 lacked detail regarding important issues like gender, pupil maturity and school level. CONCLUSION Findings suggest some beneficial effects of non-pharmacological interventions for ADHD used in school settings, but substantial heterogeneity in effect sizes was seen across studies. The qualitative reviews demonstrate the importance of the context in which interventions are used. Future work should consider more rigorous evaluation of interventions, as well as focus on what works, for whom and in which contexts. Gaps in current research present opportunities for the development and testing of standardised tools to describe interventions, agreement on gold-standard outcome measures assessing ADHD behaviour and testing a range of potential moderators alongside intervention trials. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Ruth Gwernan-Jones
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Jo Thompson-Coon
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Obioha Ukoumunne
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Rebecca Whear
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Tamsin V Newlove-Delgado
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Stuart Logan
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Christopher Morris
- Peninsula Cerebra Research Unit (PenCRU), University of Exeter Medical School, Exeter, UK
| | - Eric Taylor
- Institute of Psychiatry, King's College London, London, UK
| | - Paul Cooper
- Centre for Special Educational Needs and Inclusive Education (CSENIE), Hong Kong Institute of Education, Hong Kong, China
| | - Ken Stein
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Truro, UK
| | - Tamsin J Ford
- Child Health Group, University of Exeter Medical School, Exeter, UK
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Lebowitz MS, Rosenthal JE, Ahn WK. Effects of Biological Versus Psychosocial Explanations on Stigmatization of Children With ADHD. J Atten Disord 2016; 20:240-50. [PMID: 23264369 DOI: 10.1177/1087054712469255] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Previous studies have found biological conceptualizations of psychopathology to be associated with stigmatizing attitudes and prognostic pessimism. This research investigated how biological and psychosocial explanations for a child's ADHD symptoms differ in affecting laypeople's stigmatizing attitudes and prognostic beliefs. METHOD Three experiments were conducted online with U.S. adults, using vignettes that described a child with ADHD and attributed his symptoms to either biological or psychosocial causes. Dependent measures gauged social distance and expectations about the child's prognosis. RESULTS Across all three studies, the biological explanation yielded more doubt about treatability but less social distance-a result that diverges from previous research with other disorders. Differences in the amount of blame ascribed to the child mediated the social distance effect. CONCLUSION The effects of biological explanations on laypeople's views of ADHD seem to be a "double-edged sword," reducing social rejection but exacerbating perceptions of the disorder as relatively untreatable.
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Reeves K, Charter E, Ford T. Measurement Issues: Is standardised diagnostic assessment feasible as an adjunct to clinical practice? A systematic review. Child Adolesc Ment Health 2016; 21:51-63. [PMID: 32680366 DOI: 10.1111/camh.12089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND A standardised diagnostic assessment (SDA) is a comprehensive assessment of psychiatric disorder that provides a label according to established diagnostic criteria. While standardised assessments are considered essential in child and adolescent mental health research, they are rarely applied systematically in routine clinical practice. METHOD A systematic review of studies that assessed the utility, feasibility and acceptability of SDAs in the assessment of psychopathology among children and young people in routine clinical practice. RESULTS Eight papers were identified that applied mixed research methods. Overall, attitudes towards SDAs were positive, with lack of training in administration and interpretation of SDAs and a concern for the validity of diagnostic categories being key barriers. Two randomised control trials and a case series suggest that SDAs might aid the detection of emotional disorders in particular. CONCLUSION The current evidence is not yet sufficient to recommend that SDAs should be universally adopted as an adjunct to clinical practice, but our findings suggest that can they be used if applied cautiously and mindfully pending further evaluation.
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Affiliation(s)
- Katie Reeves
- Child Mental Health Department, University of Exeter Medical School, 009 Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK
| | - Ella Charter
- Child Mental Health Department, University of Exeter Medical School, 009 Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK
| | - Tamsin Ford
- Child Mental Health Department, University of Exeter Medical School, 009 Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK
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Martinez-Badía J, Martinez-Raga J. Who says this is a modern disorder? The early history of attention deficit hyperactivity disorder. World J Psychiatry 2015; 5:379-386. [PMID: 26740929 PMCID: PMC4694551 DOI: 10.5498/wjp.v5.i4.379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/21/2015] [Accepted: 12/11/2015] [Indexed: 02/05/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a complex, heterogeneous and multifactorial neurodevelopmental disorder characterized by persistent symptoms of inattention, hyperactivity and impulsivity. Although the first clinical description of a constellation of symptoms highly resembling to what currently could be diagnosed as ADHD is generally attributed to George F Still in 1902, there are scattered but significant published historical medical, scientific and non-scientific reports, much prior to Still’s lectures, of what is currently conceptualized as ADHD. The present report aimed at exploring the early history of ADHD, prior to the 20th century in the medical literature and in other historical sources, to provide clinicians, researchers and other professionals with a better understanding of the roots and current conceptualization of this disorder. It is possible to find clues and highly suggestive descriptions of individuals presenting symptoms resembling what is currently defined as ADHD in the literature, in paintings or in the Bible. However, the earliest medical reports of individuals with abnormal degrees of inattention, distractibility and overactivity date from the last quarter of the 18th century, included in two of the first textbooks specifically on the subject of mental diseases, published by the German Melchior Adam Weikard and the Scottish Sir Alexander Crichton. During the 19th century some eminent physicians from Germany, France or Great Britain, such as Charles West, Thomas C Albutt, Thomas S Clouston, William W, Ireland, John Haslam, Heinrich Neumann, or Désiré-Magloire Bourneville, among others provided clinical depictions of patients that most likely presently would be diagnosed as having ADHD. Whilst some of the children described by Still and his predecessors may have suffered from a variety of neurological and psychiatric disorders, many of these patients showed clear symptoms of ADHD and may present with comorbid disorders, as it is commonly the case in clinical practice.
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Storebø OJ, Ramstad E, Krogh HB, Nilausen TD, Skoog M, Holmskov M, Rosendal S, Groth C, Magnusson FL, Moreira‐Maia CR, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Forsbøl B, Simonsen E, Gluud C. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2015; 2015:CD009885. [PMID: 26599576 PMCID: PMC8763351 DOI: 10.1002/14651858.cd009885.pub2] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children with ADHD find it difficult to pay attention, they are hyperactive and impulsive.Methylphenidate is the drug most often prescribed to treat children and adolescents with ADHD but, despite its widespread use, this is the first comprehensive systematic review of its benefits and harms. OBJECTIVES To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD. SEARCH METHODS In February 2015 we searched six databases (CENTRAL, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, Conference Proceedings Citations Index), and two trials registers. We checked for additional trials in the reference lists of relevant reviews and included trials. We contacted the pharmaceutical companies that manufacture methylphenidate to request published and unpublished data. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. At least 75% of participants needed to have an intellectual quotient of at least 70 (i.e. normal intellectual functioning). Outcomes assessed included ADHD symptoms, serious adverse events, non-serious adverse events, general behaviour and quality of life. DATA COLLECTION AND ANALYSIS Seventeen review authors participated in data extraction and risk of bias assessment, and two review authors independently performed all tasks. We used standard methodological procedures expected within Cochrane. Data from parallel-group trials and first period data from cross-over trials formed the basis of our primary analyses; separate analyses were undertaken using post-cross-over data from cross-over trials. We used Trial Sequential Analyses to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach for high risk of bias, imprecision, indirectness, heterogeneity and publication bias. MAIN RESULTS The studies.We included 38 parallel-group trials (5111 participants randomised) and 147 cross-over trials (7134 participants randomised). Participants included individuals of both sexes, at a boys-to-girls ratio of 5:1, and participants' ages ranged from 3 to 18 years across most studies (in two studies ages ranged from 3 to 21 years). The average age across all studies was 9.7 years. Most participants were from high-income countries.The duration of methylphenidate treatment ranged from 1 to 425 days, with an average duration of 75 days. Methylphenidate was compared to placebo (175 trials) or no intervention (10 trials). Risk of Bias.All 185 trials were assessed to be at high risk of bias. Primary outcomes. Methylphenidate may improve teacher-rated ADHD symptoms (standardised mean difference (SMD) -0.77, 95% confidence interval (CI) -0.90 to -0.64; 19 trials, 1698 participants; very low-quality evidence). This corresponds to a mean difference (MD) of -9.6 points (95% CI -13.75 to -6.38) on the ADHD Rating Scale (ADHD-RS; range 0 to 72 points; DuPaul 1991a). A change of 6.6 points on the ADHD-RS is considered clinically to represent the minimal relevant difference. There was no evidence that methylphenidate was associated with an increase in serious (e.g. life threatening) adverse events (risk ratio (RR) 0.98, 95% CI 0.44 to 2.22; 9 trials, 1532 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 0.91 (CI 0.02 to 33.2). SECONDARY OUTCOMES Among those prescribed methylphenidate, 526 per 1000 (range 448 to 615) experienced non-serious adverse events, compared with 408 per 1000 in the control group. This equates to a 29% increase in the overall risk of any non-serious adverse events (RR 1.29, 95% CI 1.10 to 1.51; 21 trials, 3132 participants; very low-quality evidence). The Trial Sequential Analysis-adjusted intervention effect was RR 1.29 (CI 1.06 to 1.56). The most common non-serious adverse events were sleep problems and decreased appetite. Children in the methylphenidate group were at 60% greater risk for trouble sleeping/sleep problems (RR 1.60, 95% CI 1.15 to 2.23; 13 trials, 2416 participants), and 266% greater risk for decreased appetite (RR 3.66, 95% CI 2.56 to 5.23; 16 trials, 2962 participants) than children in the control group.Teacher-rated general behaviour seemed to improve with methylphenidate (SMD -0.87, 95% CI -1.04 to -0.71; 5 trials, 668 participants; very low-quality evidence).A change of seven points on the Child Health Questionnaire (CHQ; range 0 to 100 points; Landgraf 1998) has been deemed a minimal clinically relevant difference. The change reported in a meta-analysis of three trials corresponds to a MD of 8.0 points (95% CI 5.49 to 10.46) on the CHQ, which suggests that methylphenidate may improve parent-reported quality of life (SMD 0.61, 95% CI 0.42 to 0.80; 3 trials, 514 participants; very low-quality evidence). AUTHORS' CONCLUSIONS The results of meta-analyses suggest that methylphenidate may improve teacher-reported ADHD symptoms, teacher-reported general behaviour, and parent-reported quality of life among children and adolescents diagnosed with ADHD. However, the low quality of the underpinning evidence means that we cannot be certain of the magnitude of the effects. Within the short follow-up periods typical of the included trials, there is some evidence that methylphenidate is associated with increased risk of non-serious adverse events, such as sleep problems and decreased appetite, but no evidence that it increases risk of serious adverse events.Better designed trials are needed to assess the benefits of methylphenidate. Given the frequency of non-serious adverse events associated with methylphenidate, the particular difficulties for blinding of participants and outcome assessors point to the advantage of large, 'nocebo tablet' controlled trials. These use a placebo-like substance that causes adverse events in the control arm that are comparable to those associated with methylphenidate. However, for ethical reasons, such trials should first be conducted with adults, who can give their informed consent.Future trials should publish depersonalised individual participant data and report all outcomes, including adverse events. This will enable researchers conducting systematic reviews to assess differences between intervention effects according to age, sex, comorbidity, type of ADHD and dose. Finally, the findings highlight the urgent need for large RCTs of non-pharmacological treatments.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- University of Southern DenmarkDepartment of Psychology, Faculty of Health ScienceCampusvej 55OdenseDenmark5230
| | - Erica Ramstad
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | - Helle B. Krogh
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
| | | | | | | | - Susanne Rosendal
- Psychiatric Centre North ZealandThe Capital Region of DenmarkDenmark
| | - Camilla Groth
- Herlev University HospitalPediatric DepartmentCapital RegionHerlevDenmark
| | | | - Carlos R Moreira‐Maia
- Federal University of Rio Grande do SulDepartment of PsychiatryRua Ramiro Barcelos, 2350‐2201APorto AlegreRSBrazil90035‐003
| | - Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | | | - Dorothy Gauci
- Department of HealthDirectorate for Health Information and Research95 G'Mangia HillG'MangiaMaltaPTA 1313
| | - Morris Zwi
- Whittington HealthIslington Child and Adolescent Mental Health Service580 Holloway RoadLondonLondonUKN7 6LB
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
| | - Bente Forsbøl
- Psychiatric Department, Region ZealandChild and Adolescent Psychiatric ClinicHolbaekDenmark
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark
- Copenhagen UniversityInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchCopenhagenDenmark
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Kim HJ, Yang J, Lee MS. Changes of Heart Rate Variability during Methylphenidate Treatment in Attention-Deficit Hyperactivity Disorder Children: A 12-Week Prospective Study. Yonsei Med J 2015; 56:1365-71. [PMID: 26256981 PMCID: PMC4541668 DOI: 10.3349/ymj.2015.56.5.1365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/08/2014] [Accepted: 11/05/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to clarify the relationship between the autonomic nervous system and attention deficit hyperactivity disorder (ADHD) rating scales and to evaluate the usefulness of heart rate variability (HRV) as a psychophysiological biomarker for ADHD. MATERIALS AND METHODS Subjects were recruited from outpatients in the Department of Child and Adolescent Psychiatry at the Korea University Medical Center from August 2007 to December 2010. Subjects received methylphenidate. Time- and frequency-domain analyses of HRV, the Korean ADHD rating scale (K-ARS), and computerized ADHD diagnostic system were evaluated before treatment. After a 12-week period of medication administration, we repeated the HRV measurements and K-ARS rating. RESULTS Eighty-six subjects were initially enrolled and 37 participants completed the 12-week treatment and HRV measurements subsequent to the treatment. Significant correlations were found between the K-ARS inattention score and some HRV parameters. All of the HRV parameters, except the standard deviations of the normal-to-normal interval, very low frequency, and low frequency to high frequency, showed a significant positive correlation between baseline and endpoint measures in completers. High frequency (HF) and the square root of the mean squared differences of successive normal-to-normal intervals (RMSSD), which are related to parasympathetic vagal tone, showed significant decreases from baseline to endpoint. CONCLUSION The HRV test was shown to be reproducible. The decrease in HF and RMSSD suggests that parasympathetic dominance in ADHD can be altered by methylphenidate treatment. It also shows the possibility that HRV parameters can be used as psychophysiological markers in the treatment of ADHD.
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Affiliation(s)
- Hayeon Jennifer Kim
- Department of Psychiatry, Korea University, College of Medicine, Seoul, Korea
| | - Jaewon Yang
- Department of Psychiatry, Korea University, College of Medicine, Seoul, Korea
| | - Moon Soo Lee
- Department of Psychiatry, Korea University, College of Medicine, Seoul, Korea.
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Validating Screening Tool in Malayalam for Mental Disorders. Indian J Pediatr 2015; 82:595-600. [PMID: 25772940 DOI: 10.1007/s12098-015-1727-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Valid screening tools are needed to identify Indian children and adolescents with mental health problems, both for clinical or research purposes. The present study validated the Strengths and Difficulties Questionnaire (SDQ) in Malayalam across different informants and sub-scales. METHODS A sample of 150 children and adolescents seen in a psychiatric clinic for children in Kerala, India was compared to a community sample of 1984 children from six surrounding urban and rural districts. Children in clinic and community samples were screened with the parent-report SDQ; those over 11 y completed the self-report SDQ. The community sample was also screened with the teacher-report SDQ and the clinical sample received formal diagnoses from a child psychiatrist blind to SDQ scores. The discriminative validity of the SDQ was investigated using Receiver Operator Characteristic (ROC) curves and by assessing Area Under the Curve (AUC). RESULTS The SDQ discriminated reliably between clinical and community samples for the SDQ total score and its subscales. Within the clinic sample, 49 % of patients qualified for more than one broad diagnostic grouping. The SDQ discriminated between diagnostic categories in the clinic sample, but did so most effectively for conduct disorders. Based on the cut-offs that generated the highest combined value of sensitivity and specificity, the estimated rate of psychiatric disorder in the community sample was 13.6 % (parent-report) and 7.3 % (self-report). CONCLUSIONS The SDQ is a useful screening tool for child and adolescent mental disorders for Malayalam speakers in Kerala, India.
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Abstract
OBJECTIVE The current study investigated the combined effect of ADHD, previously associated with executive function (EF) deficits, and of bilingualism, previously associated with EF enhancement, on EF. METHOD Eighty University students, Hebrew monolinguals and Russian Hebrew bilinguals, with and without ADHD participated. Inhibition tasks were a Numeric Stroop task and a Simon arrows task. Shifting tasks were the Trail Making Test (TMT) and a task-switching paradigm. RESULTS Participants with ADHD performed worse than controls, but we did not find a bilingual advantage in EF. The negative impact of ADHD was more pronounced for bilinguals than for monolinguals, but only in interference suppression tasks. Bilingual participants with ADHD had the lowest performance. CONCLUSION Bilingualism might prove to be an added burden for adults with ADHD, leading to reduced EF abilities. Alternatively, the current findings might be ascribed to over- or under-diagnosis of ADHD due to cultural differences between groups. These issues should be pursued in future research.
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Choudhury S, McKinney KA, Kirmayer LJ. "Learning how to deal with feelings differently": Psychotropic medications as vehicles of socialization in adolescence. Soc Sci Med 2015; 143:311-9. [PMID: 25779773 DOI: 10.1016/j.socscimed.2015.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Drawing from ethnographic research among clinicians working with adolescents at a hospital psychiatric emergency department and outpatient clinic, and with interviews with adolescent psychiatric patients and their parents, we examine how psychiatric medicines function as socializing agents. Although psychiatric medications are thought to exert their main effects through direct biological action on neural circuitry, in fact, their use mobilizes specific kinds of moral discourse and social positioning that may have profound effects on sense of self, personhood, and psychological development. Specifically, our data reveal how clinical discourse around medications aims to enlist adolescents in becoming responsible, emotionally intelligent selves through learning to manage their medications. Among doctors, adolescents and their families, talk about psychiatric medications intertwines narratives of 'growing up' and 'getting well'. Our analysis of case studies from the clinic thus demonstrates that while psychiatric medications are explicitly designed to influence behavior by acting directly on the brain, they also act to structure adolescents' selves and social worlds through indirect, rather than direct causal pathways to the brain.
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Affiliation(s)
- Suparna Choudhury
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue West, H3A 1A1 Montreal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste Catherine Rd., Montreal, H3T 1E4 QC, Canada.
| | - Kelly A McKinney
- Department of Humanities, Philosophy and Religion, John Abbott College, 21275 Lakeshore Road, Sainte-Anne-de-Bellevue, H9X 3L9 QC, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue West, H3A 1A1 Montreal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste Catherine Rd., Montreal, H3T 1E4 QC, Canada
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Consequences of the “Attention- Deficit/Hyperactivity Disorder” (ADHD) Diagnosis. An Investigation with Education Professionals. PSYCHOLOGICAL STUDIES 2015. [DOI: 10.1007/s12646-014-0288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Wilhelmsen T, Nilsen RD. Parents' experiences of diagnostic processes of young children in Norwegian day-care institutions. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:241-254. [PMID: 25682794 DOI: 10.1111/1467-9566.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Framed by the sociology of childhood and Foucauldian-inspired perspectives, this article is focused on parents' experiences of parent-professional encounters in diagnostic processes of young children enrolled in Norwegian early childhood education and care (ECEC) institutions or schools. Based on qualitative interviews with parents, we explore how they participate and manoeuvre in encounters with professionals during processes in which their children were constructed as different in a space of normality and deviance, while also bringing their own understandings of their children to the fore. From our analysis, it appears that parents manoeuvre between complying with and adapting to, as well as negotiating and resisting the constructions put forward by the professionals.
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Affiliation(s)
- Terese Wilhelmsen
- Norwegian Centre for Child Research, Norwegian University of Science and Technology
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70
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Abstract
In addition to the symptoms singled out by the diagnostic criteria for Attention-Deficit Hyperactivity Disorder (ADHD), a comprehensive definition should inform us of the events that trigger ADHD in both its acute and chronic manifestations; the neurobiology that underlies it; and the evolutionary forces that have kept it in the germ line of our species. These factors are organized in terms of Aristotle's four kinds of "causes," or explanations: formal, efficient, material, and final. This framework systematizes the nosology, biology, psychology, and evolutionary pressures that cause ADHD.
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Pendergast LL, Vandiver BJ, Schaefer BA, Cole PM, Murray-Kolb LM, Christian P. Factor Structure of Scores from the Conners' Rating Scales-Revised Among Nepali Children. INTERNATIONAL JOURNAL OF SCHOOL & EDUCATIONAL PSYCHOLOGY 2015; 24:261-270. [PMID: 25574454 DOI: 10.1080/21683603.2013.878678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study used exploratory and confirmatory factor analyses to examine the structures of scores from the Conners' Teacher and Parent Rating Scales-Revised (CTRS-R and CPRS-R, respectively; Conners, 1997). The scales were administered to 1,835 parents and 1,387 teachers of children in Nepal's Sarlahi district - a region where no other measures of child psychopathology have been studied. With a Nepali sample, the findings indicate that reduced two factor models for the Conners' scales are superior to the models identified in the scale development research. The hyperactivity and inattention factors were comparable to what has been identified in prior research, while other factors (e.g., social problems) differed substantially. Implications for use of the Conners' scales in Nepal and cross cultural issues in the assessment of ADHD symptoms are discussed.
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Affiliation(s)
- Laura L Pendergast
- Department of Psychological, Organizational, and Leadership Studies in Education, Temple University
| | - Beverly J Vandiver
- Counselor Education and Counseling Psychology, Western Michigan University;
| | - Barbara A Schaefer
- Department of Educational Psychology, School Psychology, and Special Education, The Pennsylvania State University;
| | - Pamela M Cole
- Department of Psychology, The Pennsylvania State University;
| | | | - Parul Christian
- Department of International Health, Johns Hopkins University.
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Arruda MA, Querido CN, Bigal ME, Polanczyk GV. ADHD and mental health status in Brazilian school-age children. J Atten Disord 2015; 19:11-7. [PMID: 22665924 DOI: 10.1177/1087054712446811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the prevalence of ADHD, mental health status, and risk factors in a sample of Brazilian children. METHOD Target sample consisted of all children from 5 to 13 years registered in the public elementary school. Children with ADHD were compared with those without ADHD for sociodemographic, risk factors, and Child Behavior Checklist (CBCL) symptom dimensions. Multivariate models estimated determinants of ADHD diagnosis. RESULTS Of the target sample, consents and complete information were obtained from 1,830 children (91.8%). The prevalence rate of ADHD was 5.1% (95% confidence interval [CI] = [4.2, 6.2]). In contrast to controls, children with ADHD presented higher levels of symptoms in the CBCL dimensions. In multivariate analyses, the diagnosis of ADHD was significantly influenced by maternal educational status (p = .019), income class (p = .012), and prenatal exposure to tobacco (p = .032). CONCLUSION Prevalence and demographic features of ADHD in Brazil are similar to what has been reported worldwide.
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Affiliation(s)
| | - Cícero Nardini Querido
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Marcelo E Bigal
- Merck Investigator Studies Program and Scientific Education Group Office of the Chief Medical Officer-Merck, PA, USA Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Guilherme V Polanczyk
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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Lai KYC, Leung PWL, Luk ESL, Wong ASL. Use of the extended Strengths and Difficulties Questionnaire (SDQ) to predict psychiatric caseness in Hong Kong. Child Psychiatry Hum Dev 2014; 45:703-11. [PMID: 24488045 DOI: 10.1007/s10578-014-0439-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The extended Strengths and Difficulties Questionnaire (SDQ) provides information on problem behaviours and impairment measures. Western studies found impairment measures to be as good as symptom scores in predicting clinical caseness. The high levels of comorbidities among child psychiatric disorders also meant that disorders not specifically captured by the questionnaire could be identified. This study examines its applicability among Chinese school children in Hong Kong. Results found that impairment measures were more predictive of clinical status than were symptom scores. Children with low symptom but high impairment ratings had profiles that were intermediate between the low symptom low impairment and high symptom low impairment groups. The extended SDQ is useful in identifying children who might otherwise be missed if symptom scores alone were used in screening. The acceptance of child psychiatric care in Hong Kong is a multi-step process that depends on how symptoms are perceived.
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Affiliation(s)
- Kelly Y C Lai
- Department of Psychiatry, Chinese University of Hong Kong, Shatin, Hong Kong,
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Bener A, Kamal M, Bener H, Bhugra D. Higher prevalence of iron deficiency as strong predictor of attention deficit hyperactivity disorder in children. Ann Med Health Sci Res 2014; 4:S291-7. [PMID: 25364604 PMCID: PMC4212392 DOI: 10.4103/2141-9248.141974] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: It has been reported that ferritin and iron deficiency may be related to the path physiology of attention deficit hyperactivity disorder (ADHD). Aim: The aim of this study was to determine the association between iron deficiency and ADHD and the impact and role of iron deficiency on the development of ADHD in children. Subjects and Methods: The study based on the case-control study age- and sex-matched control and conducted at the School Health and Primary Healthcare Clinics, Qatar. A total of 630 children with ADHD aged 5-18 and 630 controls aged 5-18 years old. Sociodemographic and clinical data were collected, including physician diagnosis. The health status of the subjects was assessed by ascertaining clinical presentations and symptoms, family history, body mass index (BMI), iron deficiency, ferritin, serum 25-hydroxyvitamin D, calcium, magnesium, and phosphorus levels. Descriptive, univariate, and multivariate statistical analysis were performed. Results: Mean age (standard deviation [SD] in years) for ADHD and control children were 11.54 (3.83) versus 11.50 (3.62). There were statistically significant differences between ADHD versus control children for vitamin D [16.81 (7.84) vs. 22.18 (9.00) ng/ml], serum iron [82.11 (13.61) vs. 85.60 (12.47) ng/ml], ferritin [36.26 (5.93) vs. 38.19 (5.61) ng/ml], hemoglobin [12.02 (2.13) vs. 12.89 (2.02) g/dL], magnesium [0.82 (0.08) vs. 0.88 (0.06) mmol/L], serum calcium level [2.35 (0.12) vs. 2.39 (0.14) mmol/L], and phosphorous [1.47 (0.30) vs. 1.54 (0.26) mmol/L]. Of total 630 of ADHD children, 116 (18.4%) had severe vitamin D deficiency (<10 ng/ml). Multivariate logistic regression analysis revealed that serum vitamin D level, serum iron, ferritin, serum calcium level, physical activity, nervous behavior, consanguinity, BMI, and child order were considered as the main factors associated with the ADHD after adjusting for age, gender, and other variables. Conclusion: The study indicates that low serum iron, ferritin levels, and vitamin D deficiency may be associated with ADHD.
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Affiliation(s)
- A Bener
- Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, Doha, Qatar ; Department of Public Health, Weill Cornell Medical College, Doha, Qatar ; Department Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK
| | - M Kamal
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar ; Department of Pediatrics, Weill Cornell Medical College, Doha, Qatar
| | - Hz Bener
- Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, Doha, Qatar ; Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - D Bhugra
- Department of Psychiatry, Section of Cultural Psychiatry, Institute of Psychiatry, King's College London, London, UK
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Abstract
BACKGROUND Medication in attention deficit/hyperactivity disorder (ADHD) is so controversial that in some countries many children go untreated, while in others the prevalence of medication has become very high, and possibly even higher than the rate of ADHD. AIMS This lecture addresses the reasons for overuse and the obstacles to adequate use. METHODS Clinical and scientific literature is reviewed, with emphasis on published meta-analyses and national guidelines. RESULTS AND CONCLUSIONS The lecture suggests that overuse is associated with economic forces affecting prescribers, while underuse may come about in some European countries because we have overestimated the hazards of drugs, overestimated the value of non-pharmaceutical interventions or underestimated the severity of disorder.
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Affiliation(s)
- Eric Taylor
- Eric Taylor, FRCP, FRCPsych (Hon), FMedSci, Emeritus Professor of Child and Adolescent Psychiatry, King's College London Institute of Psychiatry , London , UK
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Abstract
CONTEXT Attention deficit hyperactivity disorder (ADHD) is common in the general population, and many individuals with this condition participate in sports activity at all competition levels. EVIDENCE ACQUISITION Related studies were selected through literature searches of PubMed, MEDLINE, and Cochrane databases for the years 1991 to 2011. Key search terms were ADD, ADHD, sports, athletes, athletics, guidelines, NCAA, WADA, IOC, college, concussion, diagnosis, management, treatment, evaluation, return-to-play, pharmacotherapy, adult, adolescent, student, screening, injury, risk, neuropsychiatry, TBI, traumatic brain injury, and epidemiology. STUDY DESIGN Literature review. LEVEL OF EVIDENCE Level 4. RESULTS ADHD usually has an early onset, with delayed diagnosis in some patients due to heterogeneous presentations. Suspected cases can be evaluated with available diagnostic tools and confirmed clinically. Athletes with ADHD may participate at all competition levels. CONCLUSION Athletes with ADHD are able to participate at all competition levels by following published guidelines and requirements. Exercise benefits many athletes with ADHD. The relationship between ADHD and concussion syndromes is currently under investigation.
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Milner LC, Cho MK. Focusing on Cause or Cure?: Priorities and Stakeholder Presence in Childhood Psychiatry Research. AJOB Empir Bioeth 2014; 5:44-55. [PMID: 24729931 DOI: 10.1080/21507716.2013.811315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Biomedical research is influenced by many factors, including the involvement of stakeholder groups invested in research outcomes. Stakeholder involvement in research efforts raise questions of justice as their specific interests and motivations play a role in directing research resources that ultimately produce knowledge shaping how different conditions (and affected individuals) are understood and treated by society. This issue is highly relevant to child psychiatry research where diagnostic criteria and treatment strategies are often controversial. Biological similarities and stakeholder differences between attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) provide an opportunity to explore this issue by comparing research foci and stakeholder involvement in these conditions. METHODS A subset of ADHD and ASD research articles published between 1970-2010 were randomly selected from the PubMed database and coded for research focus, funding source(s), and author-reported conflicts of interest (COIs). Chi-square analyses were performed to identify differences between and within ADHD and ASD research across time. RESULTS The proportion of ADHD research dedicated to basic, description, and treatment research was roughly similar and remained stable over time, while ASD research showed a significant increase in basic research over the past decade. Government was the primary research funder for both conditions, but for-profit funders were a notable presence in ADHD research, while joint-funding efforts between non-profit and government funders were a notable presence in ASD research. Lastly, COIs were noted more frequently in ADHD than in ASD research. CONCLUSIONS Our study shows significant differences in research foci and funding sources between the conditions, and identifies the specific involvement of for-profit and non-profit groups in ADHD and ASD, respectively. Our findings highlight the relationship between stakeholders outside the research community and research trajectories and suggest that examinations of these relationships must be included in broader considerations of biomedical research ethics.
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Affiliation(s)
- Lauren C Milner
- Center for the Integration of Research on Genetics and Ethics (CIRGE), Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA 94305
| | - Mildred K Cho
- Center for the Integration of Research on Genetics and Ethics (CIRGE), Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA 94305, Tel: (650) 725-7993,
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Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 2014; 43:434-42. [PMID: 24464188 DOI: 10.1093/ije/dyt261] [Citation(s) in RCA: 992] [Impact Index Per Article: 99.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have identified significant variability in attention-deficit / hyperactivity disorder (ADHD) prevalence estimates worldwide, largely explained by methodological procedures. However, increasing rates of ADHD diagnosis and treatment throughout the past few decades have fuelled concerns about whether the true prevalence of the disorder has increased over time. METHODS We updated the two most comprehensive systematic reviews on ADHD prevalence available in the literature. Meta-regression analyses were conducted to test the effect of year of study in the context of both methodological variables that determined variability in ADHD prevalence (diagnostic criteria, impairment criterion and source of information), and the geographical location of studies. RESULTS We identified 154 original studies and included 135 in the multivariate analysis. Methodological procedures investigated were significantly associated with heterogeneity of studies. Geographical location and year of study were not associated with variability in ADHD prevalence estimates. CONCLUSIONS Confirming previous findings, variability in ADHD prevalence estimates is mostly explained by methodological characteristics of the studies. In the past three decades, there has been no evidence to suggest an increase in the number of children in the community who meet criteria for ADHD when standardized diagnostic procedures are followed.
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Affiliation(s)
- Guilherme V Polanczyk
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil, Research Support Center on Neurodevelopment and Mental Health, University of São Paulo, São Paulo, Brazil, National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil, Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO, USA and ADHD Outpatient Program at the Child and Adolescent Psychiatric Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Bener A, Kamal M. Predict attention deficit hyperactivity disorder? Evidence -based medicine. Glob J Health Sci 2013; 6:47-57. [PMID: 24576365 PMCID: PMC4825397 DOI: 10.5539/gjhs.v6n2p47] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/28/2013] [Indexed: 01/19/2023] Open
Abstract
Background: Attention deficit hyperactivity disorder (ADHD) is the most common behavioral disorders in children and recent studies reported a relationship between low levels of Vitamin D and incidence of ADHD. Aim: The aim of this study was to investigate the association between vitamin D deficiency and attention deficit hyperactivity disorder (ADHD). Also, to study the impact and role of vitamin D on the development of ADH in children. Design: This is a case-control study which was conducted in children below 18 years of age from June 2011 to May 2013 at the School Health and Primary Health care Clinics, Qatar. Methods and subjects: The study was based on 1,331 cases and 1,331 controls. The data collection instrument included socio-demographic & clinical data, physician diagnosis family history, BMI, and serum 25(OH) vitamin D, calcium, albumin, billirubin, magnesium, calcium, cholesterol, urea, triglyceride and phosphorus. Descriptive and univariate statistical analysis were performed. Results: Of the total number of 3470 children surveyed, 1331 of ADHD and 1,331 of healthy children gave their consent to participate in this study. The mean age (± SD, in years) for ADHD versus control children was 10.63±3.4 vs. 10.77±3.4. Overweight (7.7% vs 9.4%) and obesity (4.6% vs 7.7%) were significantly lower in ADHD children compared to their counterparts (P=0.001). Vitamin D deficiency was considerably higher in ADHD children compared to healthy children. The mean value of vitamin D in ADHD children was much lower than the normal value and there was a significant difference found in the mean values of vitamin D between ADHD (16.6±7.8 with median 16) and control children (23.5±9.9) (p<0.0001) and with median 23 (p = 0.006). Mean values of Calcium and phosphorous were significantly higher in control compared to ADHD children (p<0.001). 1331 of all ADHD children had 19.1% had severe vitamin D deficiency (< 10 ng/ml), 44.9% has moderate insufficient levels (between 10-20 ng/ml), 27.3% has mild insufficient levels (between 20-30 ng/ml) and only 8.1% of ADHD had sufficient serum vitamin D levels (>30 ng/ml). Multivariate logistic regression analysis revealed that household income, poor relationship between parents, mothers’ occupation, consanguinity, BMI in percentiles, low duration of time under sun light, physical activity, low serum calcium level and low vitamin D level were considered as the main risk factors associated with the ADHD after adjusting for age, gender and other variables. Conclusion: The study showed that vitamin D deficiency was higher in ADHD children compared to healthy children. Supplementing infants with vitamin D might be a safe and effective strategy for reducing the risk of ADHD, but, further genomic and some other test and relevant studies need to be done.
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Abstract
The role of psychosocial factors in perpetuating and predisposing towards the development of attention deficit hyperactivity disorder (ADHD) symptoms has been neglected within the field of child mental health. Clinicians, when told that a child had a diagnosis of ADHD, have been found to underestimate the presence of psychosocial factors, and are less likely to ask about the possibility of neglect or abuse. This article details the considerable research showing links between ADHD symptoms and parental mental illness, child maltreatment, post-traumatic stress disorder (PTSD), attachment disorders and other environmental factors. Recent neuro-biological findings showing the impact on brain development of early abuse and attachment concerns are cited. The implications of these findings both for clinicians, and at policy level, are discussed, and the reasons underlying the need for a more integrated Bio-Psycho-Social approach to ADHD are outlined.
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81
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Bianchini R, Postorino V, Grasso R, Santoro B, Migliore S, Burlò C, Tata C, Mazzone L. Prevalence of ADHD in a sample of Italian students: a population-based study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2543-2550. [PMID: 23751299 DOI: 10.1016/j.ridd.2013.05.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/12/2013] [Accepted: 05/13/2013] [Indexed: 06/02/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common diagnosis for children and adolescents, although the reported estimates for prevalence are extremely variable worldwide. In the present work we investigate the prevalence of ADHD in a sample of Italian students in a study divided in two phases. In Phase I, a total of 6183 schoolchildren (3178 males and 3005 females, aged range 5-15 years) were screened using the SDAI rating scale for teachers. In Phase II, the parents of children and adolescents who met high screen criteria according to SDAI (cut-off>14; n=471, 7.3%) were invited to complete a specific clinical-diagnostic assessment for ADHD with the help of an experienced clinician. Within the entire sample, 107 children dropped out and 12 had mental retardation, whereas 332 subjects (278 males and 54 females, age range 5-14 years) completed the Phase II of the study. One hundred ninety subjects (163 males and 27 females, male: female ratio 6:1, mean age 8 years) were diagnosed with ADHD, indicating a prevalence of 3%. ADHD subtypes included the following: combined (n=108; 56.8%), inattentive (n=48; 25.2%) and hyperactive/impulsive (n=33; 17.3%). Our findings are in line with other reports of ADHD prevalence in the European Countries, and may contribute to underline the impact of this phenomenon in the population, and the need of achieving an improvement in the quality of the public health mental service for the prevention and treatment of ADHD.
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Affiliation(s)
- Rio Bianchini
- Azienda Sanitaria Provinciale di Siracusa, Service of Child Neuropsychiatry, Via Bianca Sebastiano, 47, Siracusa, Italy
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Singh I, Filipe AM, Bard I, Bergey M, Baker L. Globalization and cognitive enhancement: emerging social and ethical challenges for ADHD clinicians. Curr Psychiatry Rep 2013; 15:385. [PMID: 23933975 DOI: 10.1007/s11920-013-0385-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Globalization of ADHD and the rise of cognitive enhancement have raised fresh concerns about the validity of ADHD diagnosis and the ethics of stimulant drug treatment. We review the literature on these two emerging phenomena, with a focus on the corresponding social, scientific and ethical debates over the universality of ADHD and the use of stimulant drug treatments in a global population of children and adolescents. Drawing on this literature, we reflect on the importance of ethically informed, ecologically sensitive clinical practices in relation to ADHD diagnosis and treatment.
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Affiliation(s)
- Ilina Singh
- Department of Social Science, Health & Medicine, King's College London, London, UK.
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83
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Conley D, Rauscher E, Dawes C, Magnusson PKE, Siegal ML. Heritability and the equal environments assumption: evidence from multiple samples of misclassified twins. Behav Genet 2013; 43:415-26. [PMID: 23903437 DOI: 10.1007/s10519-013-9602-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Classically derived estimates of heritability from twin models have been plagued by the possibility of genetic-environmental covariance. Survey questions that attempt to measure directly the extent to which more genetically similar kin (such as monozygotic twins) also share more similar environmental conditions represent poor attempts to gauge a complex underlying phenomenon of GE-covariance. The present study exploits a natural experiment to address this issue: Self-misperception of twin zygosity in the National Longitudinal Survey of Adolescent Health (Add Health). Such twins were reared under one "environmental regime of similarity" while genetically belonging to another group, reversing the typical GE-covariance and allowing bounded estimates of heritability for a range of outcomes. In addition, we examine twins who were initially misclassified by survey assignment--a stricter standard--in three datasets: Add Health, the Minnesota Twin Family Study and the Child and Adolescent Twin Study in Sweden. Results are similar across approaches and datasets and largely support the validity of the equal environments assumption.
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Affiliation(s)
- Dalton Conley
- Department of Sociology, New York University & NBER, 6 Washington Square North Room 20, New York, NY 10003, USA.
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84
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Comorbidity and continuity of attention deficit hyperactivity disorder (ADHD) from childhood to adolescence in Turkey. ACTA ACUST UNITED AC 2013; 5:353-60. [PMID: 23893566 DOI: 10.1007/s12402-013-0114-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine clinical outcomes, psychiatric comorbidity and neuropsychological characteristics in Turkish adolescents with an attention deficit hyperactivity disorder (ADHD) diagnosis in childhood. A total of 45 children with ADHD diagnosis and 28 children with a psychiatric diagnosis other than ADHD in a 1-year cohort of 7-10-year-olds were reevaluated 6 years later using Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version and Wechsler Intelligence Scale for Children-Revised and Stroop Test TBAG version. This study shows that the clinical outcomes and the comorbidity patterns for ADHD from childhood to adolescence in Turkey are similar to reported rates in the Western countries. In the ADHD group, 75.6 % still has impairing ADHD symptoms and 46.6 % has comorbid psychiatric disorders. The main difference is anxiety disorders being the most common comorbid disorders (37.8 %) in Turkish ADHD youth. These findings stress the high comorbidity associated with ADHD and support the importance of assessment and treatment for ADHD and comorbidities during adolescence.
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Slife BD, Christensen TR. Hermeneutic Realism: Toward a Truly Meaningful Psychology. REVIEW OF GENERAL PSYCHOLOGY 2013. [DOI: 10.1037/a0032940] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article presents a brief introduction to a hermeneutic realist approach to psychology, outlining its differences from mainstream psychology in its conceptions of context, change, and possibility. The term “hermeneutic” indicates that psychology's subject matter (e.g., behavior, cognition) is understood more as contextually constituted meanings than as the conventional notion of self-contained objects. The “realism” portion of this phrase implies that this understanding does not devolve to a relativism or subjectivism, but it is grounded in the reality of the world. Hermeneutic realism is not considered a replacement to psychology's current approach but rather is conceptualized and discussed as a needed supplement that leads to new psychological understandings, including new approaches to theory, method, and practice.
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Tenore A, Tenore A. A pathophysiologic approach to growth problems in children with attention-deficit/hyperactivity disorder. Endocrinol Metab Clin North Am 2012; 41:761-84. [PMID: 23099269 DOI: 10.1016/j.ecl.2012.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In recent years there has been an increasing trend in the diagnosis and treatment of children with attention-deficit/hyperactivity disorder (ADHD) worldwide. One of the most frequently discussed side effects of these treatments is related to problems of growth. In order to better understand what ADHD is and the mechanisms by which it could affect growth, this article reviews relevant data from a clinical and neurophysiologic perspective to improve understanding of this controversial issue.
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Affiliation(s)
- Alfred Tenore
- Division of Pediatric Endocrinology, Department of Pediatrics, DSMSC, University of Udine, Udine 33100, Italy.
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88
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Asherson P, Akehurst R, Kooij JJS, Huss M, Beusterien K, Sasané R, Gholizadeh S, Hodgkins P. Under diagnosis of adult ADHD: cultural influences and societal burden. J Atten Disord 2012; 16:20S-38S. [PMID: 22377849 DOI: 10.1177/1087054711435360] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden. METHOD A review of the literature over the past 10 years was performed using OVID. RESULTS Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse. CONCLUSION The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.
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Abstract
This article describes a comprehensive meta-analysis that was conducted to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). A systematic literature review identified 86 studies of children and adolescents (N = 163,688 individuals) and 11 studies of adults (N = 14,112 individuals) that met inclusion criteria for the meta-analysis, more than half of which were published after the only previous meta-analysis of the prevalence of ADHD was completed. Although prevalence estimates reported by individual studies varied widely, pooled results suggest that the prevalence of DSM-IV ADHD is similar, whether ADHD is defined by parent ratings, teacher ratings, or a best estimate diagnostic procedure in children and adolescents (5.9-7.1 %), or by self-report measures in young adults (5.0 %). Analyses of diagnostic subtypes indicated that the predominantly inattentive type is the most common subtype in the population, but individuals with the combined type are more likely to be referred for clinical services. Additional research is needed to determine the etiology of the higher prevalence of ADHD in males than females and to clarify whether the prevalence of ADHD varies as a function of socioeconomic status or ethnicity. Finally, there were no significant prevalent differences between countries or regions of the world after controlling for differences in the diagnostic algorithms used to define ADHD. These results provide important support for the diagnostic validity of ADHD, and argue against the hypothesis that ADHD is a cultural construct that is restricted to the United States or any other specific culture.
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Affiliation(s)
- Erik G Willcutt
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO 80309, USA.
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Terbeck S, Chesterman LP. Parents, ADHD and the internet. ACTA ACUST UNITED AC 2012; 4:159-66. [DOI: 10.1007/s12402-012-0081-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
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91
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McIntyre R, Hennessy E. ‘He's just enthusiastic. Is that such a bad thing?’ Experiences of parents of children with Attention Deficit Hyperactivity Disorder. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2012. [DOI: 10.1080/13632752.2012.652428] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Fovet F. Towards a new construct of social, emotional and behavioural difficulties. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2011. [DOI: 10.1080/13632752.2011.595089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Baumgardner DJ, Schreiber AL, Havlena JA, Bridgewater FD, Steber DL, Lemke MA. Geographic analysis of diagnosis of Attention-Deficit/Hyperactivity Disorder in children: Eastern Wisconsin, USA. Int J Psychiatry Med 2011; 40:363-82. [PMID: 21391408 DOI: 10.2190/pm.40.4.a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To perform a novel geographic analysis of Attention-Deficit/ Hyperactivity Disorder (ADHD) diagnosis in Midwest United States. METHOD Primary care children age 5-17 with ADHD diagnosis (N = 6833; 13.5%) were compared to those receiving well child care without ADHD diagnosis (N = 43,630) in a Wisconsin integrated medical system. Street addresses, demographic, and block group level U.S. Census 2000 data were mapped and analyzed using ArcGIS, CrimeStat III, and SaTScan. Lead levels from a State database were linked to 2,837 subjects. Univariate analysis was done by chi-square test or Mann-Whitney U test, multivariate analysis by logistic regression. RESULTS ADHD cases were 74% male (p = 0.0001), and more frequently diagnosed in White children (17.3%) than Blacks (10.6%), Hispanics (9.4%), or Asians (3.7%; all p values < 0.001). Overall, male gender, white race, lower block group median household income and population density, and greater distance to nearest park and airport were more predictive of ADHD (p values < 0.001). In urban Milwaukee County (865 cases/10,493 controls) male gender, white race, suburban residence, and younger age were more predictive of ADHD (p values < 0.01). Among children with ADHD diagnosis and linked lifetime lead values, those with a maximum level of 10 microg/dl or more differed significantly from controls (9.3% vs. 5.6%; p = 0.003); elevated lead remained a significant predictor of ADHD diagnosis in multivariate analysis. CONCLUSIONS Further studies are needed to determine if geographic distribution of ADHD diagnosis can be partially explained by differential efficiency of referral for diagnosis by school districts, by race/ethnicity, and/or built environment.
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Affiliation(s)
- Dennis J Baumgardner
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Center for Urban Population Health, Milwaukee, Wisconsin, USA.
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Kondo S, Otsuka K, Sawaguchi GT, Miyasaka LS, Honda ET, Nakamura Y, Kato S. Mental health status of Japanese-Brazilian children in Japan and Brazil. Psychiatry Clin Neurosci 2011; 65:226-32. [PMID: 21507128 DOI: 10.1111/j.1440-1819.2011.02202.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to make a comparison of the mental health status between Japanese-Brazilian children in Japan and in Brazil. METHODS A total of 331 Japanese-Brazilian children at five Brazilian schools in Japan (Japanese Group), and 172 Japanese-Brazilian children at one private school in São Paulo (Brazilian Group) were enrolled in statistical analyses. The Strength and Difficulties Questionnaire was applied for parents, teachers, and students who were aged over 11 years old. RESULTS The total comparison of the Strength and Difficulties Questionnaire scores between the two groups demonstrated that all the average symptom scores except prosocial behavior were significantly higher in the Japanese Group by parent report. By teacher report, the average symptom scores of conduct problems, hyperactivity, peer problems and total difficulties were significantly higher in the Japanese Group, while that of the prosocial behavior was significantly higher in the Brazilian Group. Dividing parent and teacher reports into two age ranges, similar results to the total comparison were seen in the parent report in the age range of 4-10-year-olds and both parent and teacher reports in that of 11-16-year-olds, while in the teacher report for 4-10-year-olds, only conduct problems and total difficulties score showed significantly higher average scores in the Japanese Group. By self-report, the average symptom scores of emotional symptoms, peer problems and total difficulties score were significantly higher in the Japanese Group. CONCLUSION The results indicate poorer mental health status in the Japanese Group than the Brazilian Group, and suggest the adverse circumstances of the former group both at their homes and schools.
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Affiliation(s)
- Shu Kondo
- Department of Psychiatry School of Nursing Department of Public Health, Jichi Medical University, Shimotsuke Tochigi International Association, Utsunomiya, Japan.
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Beaudoin MN, Zimbardo PG. A medical issue affecting the diagnosis of mood, attention and autistic disorders: a closer look at celiac disease and gluten sensitivity. Health Psychol Rev 2011. [DOI: 10.1080/17437199.2010.545514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marie-Nathalie Beaudoin
- a Bay Area Family Therapy & Training Associates , 21760 Stevens Creek, Cupertino , CA , 95014 , USA
| | - Philip G. Zimbardo
- b Department of Psychology , Stanford University , 450 Serra Mall, Palo Alto , CA , 94305 , USA
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Comstock EJ. The end of drugging children: toward the genealogy of the ADHD subject. JOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES 2011; 47:44-69. [PMID: 21207489 DOI: 10.1002/jhbs.20471] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This genealogy of the ADHD subject will demonstrate that over the course of the twentieth century a new relation between power, knowledge, the body, and ethical practices of self-formation emerged around the ADHD-type in ways that are not captured by the received critical perspective. By examining the history of knowledge and practices surrounding the ADHD-type, this work will argue that the deviant subject that was located relative to external institutional moral/juridical values or standards is replaced over the course of the century by a new intelligibility of rational self-management. A further analysis of this emergent intelligibility attempts to advance the critical understanding of the increasingly prevalent ADHD phenomenon by showing how novel drug and brain imaging technologies work to link behaviors to identity, establishing new relations of power to the subject not captured by the received medicalization perspective. This work will be of interest to anybody interested in the relations among knowledge, drugs, power, and the ADHD subject.
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Abstract
PURPOSE OF REVIEW To review recent literature around the controversial diagnosis of personality disorder, and to assess the ethical aspects of its status as a medical disorder. RECENT FINDINGS The diagnostic currency of personality disorder as a psychiatric/medical disorder has a longstanding history of ethical and social challenges through critiques of the medicalization of deviance. More recently controversies by reflexive physicians around the inclusion of the category in the forthcoming revisions of International Classification of Diseases and Diagnostic and Statistical Manual of Mental Disorders classifications reflect the problems of value-laden criteria, with the diagnostic category being severely challenged from within psychiatry as well as from without. SUMMARY The clinical diagnostic criteria for extremely value-laden psychiatric conditions such as personality disorder need to be analyzed through the lens of values-based medicine, as well as through clinical evidence, as the propensity for political and sociolegal appropriation of the categories can render their clinical and diagnostic value meaningless.
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Williams NM, Zaharieva I, Martin A, Langley K, Mantripragada K, Fossdal R, Stefansson H, Stefansson K, Magnusson P, Gudmundsson OO, Gustafsson O, Holmans P, Owen MJ, O'Donovan M, Thapar A. Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis. Lancet 2010; 376:1401-8. [PMID: 20888040 PMCID: PMC2965350 DOI: 10.1016/s0140-6736(10)61109-9] [Citation(s) in RCA: 355] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Large, rare chromosomal deletions and duplications known as copy number variants (CNVs) have been implicated in neurodevelopmental disorders similar to attention-deficit hyperactivity disorder (ADHD). We aimed to establish whether burden of CNVs was increased in ADHD, and to investigate whether identified CNVs were enriched for loci previously identified in autism and schizophrenia. METHODS We undertook a genome-wide analysis of CNVs in 410 children with ADHD and 1156 unrelated ethnically matched controls from the 1958 British Birth Cohort. Children of white UK origin, aged 5-17 years, who met diagnostic criteria for ADHD or hyperkinetic disorder, but not schizophrenia and autism, were recruited from community child psychiatry and paediatric outpatient clinics. Single nucleotide polymorphisms (SNPs) were genotyped in the ADHD and control groups with two arrays; CNV analysis was limited to SNPs common to both arrays and included only samples with high-quality data. CNVs in the ADHD group were validated with comparative genomic hybridisation. We assessed the genome-wide burden of large (>500 kb), rare (<1% population frequency) CNVs according to the average number of CNVs per sample, with significance assessed via permutation. Locus-specific tests of association were undertaken for test regions defined for all identified CNVs and for 20 loci implicated in autism or schizophrenia. Findings were replicated in 825 Icelandic patients with ADHD and 35,243 Icelandic controls. FINDINGS Data for full analyses were available for 366 children with ADHD and 1047 controls. 57 large, rare CNVs were identified in children with ADHD and 78 in controls, showing a significantly increased rate of CNVs in ADHD (0·156 vs 0·075; p=8·9×10(-5)). This increased rate of CNVs was particularly high in those with intellectual disability (0·424; p=2·0×10(-6)), although there was also a significant excess in cases with no such disability (0·125, p=0·0077). An excess of chromosome 16p13.11 duplications was noted in the ADHD group (p=0·0008 after correction for multiple testing), a finding that was replicated in the Icelandic sample (p=0·031). CNVs identified in our ADHD cohort were significantly enriched for loci previously reported in both autism (p=0·0095) and schizophrenia (p=0·010). INTERPRETATION Our findings provide genetic evidence of an increased rate of large CNVs in individuals with ADHD and suggest that ADHD is not purely a social construct. FUNDING Action Research; Baily Thomas Charitable Trust; Wellcome Trust; UK Medical Research Council; European Union.
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Affiliation(s)
- Nigel M Williams
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
- Correspondence to: Dr Nigel M Williams and Prof Anita Thapar, MRC Centre in Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - Irina Zaharieva
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
| | - Andrew Martin
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
| | - Kate Langley
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
| | - Kiran Mantripragada
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
| | | | | | | | - Pall Magnusson
- Child and Adolescent Psychiatry, Landspitali University Hospital, Reykjavik, Iceland
| | - Olafur O Gudmundsson
- Child and Adolescent Psychiatry, Landspitali University Hospital, Reykjavik, Iceland
| | - Omar Gustafsson
- deCODE Genetics, Reykjavik, Iceland
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Peter Holmans
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
| | - Michael J Owen
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
| | - Michael O'Donovan
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
| | - Anita Thapar
- MRC Centre in Neuropsychiatric Genetics and Genomics and Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, Cardiff, UK
- Correspondence to: Dr Nigel M Williams and Prof Anita Thapar, MRC Centre in Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
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Bauermeister JJ, Canino G, Polanczyk G, Rohde LA. ADHD across cultures: is there evidence for a bidimensional organization of symptoms? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2010; 39:362-72. [PMID: 20419577 DOI: 10.1080/15374411003691743] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined the phenotypic expression of attention-deficit/hyperactivity disorder (ADHD) across cultures by assessing the factor/latent class structure of its core symptoms. We conducted a systematic review of the literature published from January 1987 to November 2008 using Medline and PsycINFO. We systematically reviewed 2,511 article abstracts, and 48 of these abstracts were included in this review. Research with school-age children from 15 countries including different samples, informants, and rating instruments supported a two-factor ADHD model consisting of inattention and combined hyperactivity and impulsivity. This model was not supported for preschool children. Cross-cultural equivalence for the two-factor model was suggested in some studies. Latent class analyses using parental data and more recent approaches like factor mixture modeling are generally consistent with factor analyses. These findings argue in favor of a cross-cultural validity of the syndrome. The implications of these findings for further research and classificatory systems in mental health like the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) are discussed.
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Affiliation(s)
- José J Bauermeister
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, PR 00927.
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