101
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Thorsen AL, Meza J, Hinshaw S, Lundervold AJ. Processing Speed Mediates the Longitudinal Association between ADHD Symptoms and Preadolescent Peer Problems. Front Psychol 2018; 8:2154. [PMID: 29487545 PMCID: PMC5816923 DOI: 10.3389/fpsyg.2017.02154] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/27/2017] [Indexed: 12/02/2022] Open
Abstract
We investigated the relation between dimensional aspects of inattention and hyperactivity-impulsivity in childhood and peer problems 4 years later, as well as the potential mediating effects of intellectual function. The sample included 127 children (32 with attention-deficit/hyperactivity disorder). Symptoms of inattention and hyperactivity-impulsivity were assessed via parent and teacher reports on Swanson Nolan and Pelham-IV questionnaire. Peer problems were assessed by parent reports on the Strengths and Difficulties Questionnaire, and children's intellectual functioning by the third edition of the Wechsler Intelligence Scale for Children. Linear regressions showed a significant effect of inattention on future peer problems, partially mediated by slow processing speed. These effects remained significant when ADHD status was covaried. Findings highlight the importance of processing speed in explaining the predictive relation between childhood inattention and later peer problems. Inattention and processing speed in early childhood are potentially malleable factors influencing adolescent social functioning.
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Affiliation(s)
- Anders L Thorsen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Jocelyn Meza
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Stephen Hinshaw
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
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102
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Sibley MH, Rohde LA, Swanson JM, Hechtman LT, Molina BS, Mitchell JT, Arnold LE, Caye A, Kennedy T, Roy A, Stehli A. Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25. Am J Psychiatry 2018; 175:140-149. [PMID: 29050505 PMCID: PMC5814300 DOI: 10.1176/appi.ajp.2017.17030298] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD. METHOD Individuals without childhood ADHD (N=239) were administered eight assessments from comparison baseline (mean age=9.89 years) to young adulthood (mean age=24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing. RESULTS Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history. CONCLUSIONS Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatric history, and substance use before treating potential late-onset cases.
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Affiliation(s)
- Margaret H. Sibley
- Department of Psychiatry & Behavioral Health, Florida International University
| | - Luis A. Rohde
- Department of Psychiatry, Federal University of Rio Grande do Sul
| | - James M. Swanson
- Child Development Center, School of Medicine, University of California, Irvine
| | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Brooke S.G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Nisonger Center, Columbus Ohio
| | - Arthur Caye
- Department of Psychiatry, Federal University of Rio Grande do Sul
| | - Traci Kennedy
- Departments of Psychiatry, University of Pittsburgh School of Medicine
| | - Arunima Roy
- Division of Molecular Psychiatry, University Hospital Wuerzberg, Germany
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103
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Attention Deficit Disorder. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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104
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Evans SW, Owens JS, Wymbs BT, Ray AR. Evidence-Based Psychosocial Treatments for Children and Adolescents With Attention Deficit/Hyperactivity Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:157-198. [DOI: 10.1080/15374416.2017.1390757] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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105
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Houghton S, Alsalmi N, Tan C, Taylor M, Durkin K. Treating Comorbid Anxiety in Adolescents With ADHD Using a Cognitive Behavior Therapy Program Approach. J Atten Disord 2017; 21:1094-1104. [PMID: 23382576 DOI: 10.1177/1087054712473182] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate an 8-week cognitive behavior therapy (CBT) treatment specifically designed for adolescents with ADHD and comorbid anxiety. METHOD Using a multiple baseline design, nine adolescents (13 years to 16 years 9 months) received a weekly CBT, which focused on four identified anxiety-arousing times. Participants self-recorded their levels of anxiety for each of the four times during baseline, intervention, and a maintenance phase. Anxiety was also assessed using the Multidimensional Anxiety Scale for Children (MASC). RESULTS Paired samples t tests supported the success of the intervention. Interrupted time-series data for each participant revealed varying rates of success across the four times, however. The MASC data revealed significant reductions in Physical Symptoms of Anxiety, Social Anxiety, Separation Anxiety, Harm Avoidance, and Total Anxiety. CONCLUSION The data demonstrate the efficacy of a CBT program for the treatment of comorbid anxiety in adolescents with ADHD.
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Affiliation(s)
- Stephen Houghton
- 1 The University of Western Australia, Perth, Australia.,2 University of Strathclyde, Glasgow, UK
| | | | - Carol Tan
- 3 Nanyang Technological University, Singapore
| | - Myra Taylor
- 1 The University of Western Australia, Perth, Australia
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106
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Barnes G, Wilkes-Gillan S, Bundy A, Cordier R. The social play, social skills and parent-child relationships of children with ADHD 12 months following a RCT of a play-based intervention. Aust Occup Ther J 2017; 64:457-465. [DOI: 10.1111/1440-1630.12417] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Gabrielle Barnes
- Faculty of Health Science; The University of Sydney; Lidcombe Australia
| | | | - Anita Bundy
- Faculty of Health Science; The University of Sydney; Lidcombe Australia
| | - Reinie Cordier
- School of Occupational Therapy and Social Work; Curtin University; Perth Western Australia Australia
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107
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Ng QX, Ho CYX, Chan HW, Yong BZJ, Yeo WS. Managing childhood and adolescent attention-deficit/hyperactivity disorder (ADHD) with exercise: A systematic review. Complement Ther Med 2017; 34:123-128. [PMID: 28917364 DOI: 10.1016/j.ctim.2017.08.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 07/21/2017] [Accepted: 08/28/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders affecting some 8-10% of children worldwide. Increasing research has shed light on the life course of the disorder, suggesting that majority of children with ADHD will continue to have persistent symptoms into adulthood. The mainstay of ADHD management has been pharmacologic and behavioural/psychological interventions, with little attention paid to exercise as a potential management strategy. A systematic review, examining both the short-term and long-term effects of exercise on children with ADHD, is timely and necessary to guide further research in this area. METHODS Using the keywords [exercise OR physical OR activity OR sport] AND [attention deficit hyperactivity disorder OR ADHD OR ADDH], a preliminary search on the PubMed and Ovid database yielded 613 papers published in English between 1-Jan-1980 and 1-July-2016. Full articles were also reviewed for references of interest. RESULTS A total of 30 studies were included in this systematic review. Both short-term and long-term studies support the clinical benefits of physical activity for individuals with ADHD. Cognitive, behavioural and physical symptoms of ADHD were alleviated in most instances, and the largest intervention effects were reported for mixed exercise programs. No adverse effects arising from physical exercise were reported in any of the studies, suggesting that exercise is a well-tolerated intervention. CONCLUSION Physical activity, in particular moderate-to-intense aerobic exercise, is a beneficial and well-tolerated intervention for children and adolescents with ADHD. Future research should include more adequately-powered trials and investigate the ideal exercise prescription.
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Affiliation(s)
- Qin Xiang Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore.
| | - Collin Yih Xian Ho
- National University Hospital, National University Health System, 119074, Singapore
| | - Hwei Wuen Chan
- National University Hospital, National University Health System, 119074, Singapore
| | - Bob Zheng Jie Yong
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Wee-Song Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore; National University Hospital, National University Health System, 119074, Singapore
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108
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Forehand R, Parent J, Peisch VD, Sonuga-Barke E, Long N, Breslend NL, Abikoff HB. Do parental ADHD symptoms reduce the efficacy of parent training for preschool ADHD? A secondary analysis of a randomized controlled trial. Behav Res Ther 2017; 97:163-169. [PMID: 28800444 DOI: 10.1016/j.brat.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 07/28/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Abstract
Previous studies have suggested that children with Attention-Deficit/Hyperactivity Disorder (ADHD) may benefit less from behavioral parent training (BPT) if their parents have high levels of ADHD symptoms. We conducted a secondary analysis of data from a randomized controlled trial to test the hypothesis that parental ADHD symptoms reduce the efficacy of two BPT programs in a sample of preschoolers with ADHD. One intervention was specifically designed for children with ADHD (NFPP: New Forest Parenting Programme) and one was designed for children with Oppositional Defiant Disorder (ODD) (HNC: Helping the Noncompliant Child). Neither intervention was adapted to address parental ADHD symptoms. This secondary analysis included data from 164 parents and their 3-4 year-old children who were randomly assigned to one of the two programs or a waitlist group. Children were compared on ADHD and ODD outcomes at post-intervention and a 6-month follow-up. The presence of parent ADHD symptoms reduced the efficacy of BPT in only one of 16 analyses. Implications and limitations (e.g., low baseline rate of parental ADHD symptoms) of the findings are provided.
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Affiliation(s)
| | | | | | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, Kings College, London
| | - Nicholas Long
- University of Arkansas Medical School, United States
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109
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Abstract
OBJECTIVE Concerns about serious cardiovascular (CV) events among stimulant-treated youth have led to clinical and policy debates. Accordingly, several population-based empirical studies have assessed the risk of CV events in children and adolescents treated with stimulants. The main objective of this review was to summarize findings and to evaluate the strengths and weaknesses of these population-based studies. In addition, we discuss the CV monitoring and policy implications for a clinically focused audience. METHODS A computerized literature search of Medline and PsycINFO was conducted for the calendar years 1990-2015 to identify population-based studies assessing stimulant treatment-emergent CV events in youth. Additional reports, peer-reviewed or gray literature, for example, government reports, were also included. RESULTS Nine population-based studies (one case-control and eight retrospective cohort designs) were included in this review. The case-control study compared sudden unexplained death cases to age-matched controls (motor vehicle passenger deaths) with respect to prior stimulant use and found a significant association (odds ratio = 7.4 [95% CI: 1.4-74.9]). By contrast, most retrospective cohort studies assessed the risk of serious CV events (i.e., sudden death, myocardial infarction, and stroke) and did not find an association with current stimulant exposure. The absolute rate for these serious events was low, but other data support risk. For example, cardiac-related emergency department visits showed a 20% increased risk for current stimulant users compared with nonusers in one study, and another study showed a 64% and 90% increased risk for concurrent use of stimulants with antidepressants and antipsychotics, respectively. Similarly, in another study, compared with nonusers, stimulant users had twofold greater odds of CV-related inpatient or outpatient services. CONCLUSION In the face of mixed results from population-based safety studies, this review supports the inclusion of baseline and ongoing monitoring of cardiac status to assure a favorable benefit risk profile for stimulant users, particularly in concomitant regimens with antipsychotics and antidepressants.
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Affiliation(s)
- Julie M Zito
- 1 Department of Pharmaceutical Health Services Research, University of Maryland , Baltimore, Maryland.,2 Department of Psychiatry, University of Maryland , Baltimore, Maryland
| | - Mehmet Burcu
- 1 Department of Pharmaceutical Health Services Research, University of Maryland , Baltimore, Maryland
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110
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Roy A, Hechtman L, Arnold LE, Swanson JM, Molina BSG, Sibley MH, Howard AL. Childhood Predictors of Adult Functional Outcomes in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA). J Am Acad Child Adolesc Psychiatry 2017; 56:687-695.e7. [PMID: 28735698 PMCID: PMC5555165 DOI: 10.1016/j.jaac.2017.05.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recent results from the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD; MTA) have demonstrated impairments in several functioning domains in adults with childhood ADHD. The childhood predictors of these adult functional outcomes are not adequately understood. The objective of the present study was to determine the effects of childhood demographic, clinical, and family factors on adult functional outcomes in individuals with and without childhood ADHD from the MTA cohort. METHOD Regressions were used to determine associations of childhood factors (age range 7-10 years) of family income, IQ, comorbidity (internalizing, externalizing, and total number of non-ADHD diagnoses), parenting styles, parental education, number of household members, parental marital problems, parent-child relationships, and ADHD symptom severity with adult outcomes (mean age 25 years) of occupational functioning, educational attainment, emotional functioning, sexual behavior, and justice involvement in participants with (n = 579) and without (n = 258) ADHD. RESULTS Predictors of adult functional outcomes in ADHD included clinical factors such as baseline ADHD severity, IQ, and comorbidity; demographic factors such as family income, number of household members and parental education; and family factors such as parental monitoring and parental marital problems. Predictors of adult outcomes were generally comparable for children with and without ADHD. CONCLUSION Childhood ADHD symptoms, IQ, and household income levels are important predictors of adult functional outcomes. Management of these areas early on, through timely treatments for ADHD symptoms, and providing additional support to children with lower IQ and from households with low incomes, could assist in improving adult functioning.
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Affiliation(s)
- Arunima Roy
- Division of Molecular Psychiatry, University Hospital Würzburg
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal, Quebec, Canada.
| | | | | | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine
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111
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Boesen K, Saiz LC, Erviti J, Storebø OJ, Gluud C, Gøtzsche PC, Jørgensen KJ. The Cochrane Collaboration withdraws a review on methylphenidate for adults with attention deficit hyperactivity disorder. ACTA ACUST UNITED AC 2017; 22:143-147. [PMID: 28705922 PMCID: PMC5537554 DOI: 10.1136/ebmed-2017-110716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 12/11/2022]
Abstract
A Cochrane systematic review on immediate-release methylphenidate for adults with attention deficit hyperactivity disorder (ADHD) was withdrawn from the Cochrane Library on 26 May 2016 after substantial criticism of its methods and flawed conclusions. Retraction of scientific papers on this basis is unusual but can be necessary. We provide a summary of the criticism that led to the withdrawal. We detail the methodological flaws of the withdrawn Cochrane systematic review and general issues of bias and shortcomings of the included ADHD trials: cross-over designs compared with parallel-group designs, exclusion of participants with psychiatric comorbidity, absence of 'functional outcomes' and use of clinical outcomes with limited relevance, short trial duration and small trial populations, broken blinding caused by easily recognisable side effects, combining outcome assessments by trial investigators and participants, outcome reporting bias, poor evaluation of cardiovascular and psychiatric harms and conflicts of interest of trialists and systematic reviewers. The withdrawal of the Cochrane systematic review signals recognition of previous unreliable clinical ADHD research. We conclude that clinical trials of immediate-release methylphenidate in adults with ADHD are of very low quality. We urgently need well-conducted long-term trials free of bias to assess the benefits and harms of central stimulant treatment in adult ADHD.
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Affiliation(s)
- Kim Boesen
- Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
| | - Luis Carlos Saiz
- Drug Prescribing Unit, Navarre Regional Health Service, Pamplona, Spain
| | - Juan Erviti
- Drug Prescribing Unit, Navarre Regional Health Service, Pamplona, Spain
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
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112
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Molitor SJ, Langberg JM, Evans SW, Dvorsky MR, Bourchtein E, Eddy LD, Smith ZR, Oddo LE. Evaluating the Factor Validity of the Children's Organizational Skills Scale in Youth with ADHD. SCHOOL MENTAL HEALTH 2017; 9:143-156. [PMID: 28983327 PMCID: PMC5624737 DOI: 10.1007/s12310-016-9205-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Children and adolescents with ADHD often have difficulties with organization, time management, and planning (OTMP) skills, and these skills are a common target of intervention. A limited array of tools for measuring these abilities in youth is available, and one of the most prominent measures is the Children's Organizational Skills Scale (COSS). Although the COSS fills an important need, a replication of the COSS factor structure outside of initial measure development has not been conducted in any population. Given that the COSS is frequently used in ADHD research, the current study evaluated the factor structure of the parent-rated COSS in a sample (N = 619) of adolescents with ADHD. Results indicated that the original factor structure could be replicated, although the use of item parcels appeared to affect model fit statistics. An alternative bi-factor model was also tested that did not require the use of parcels, with results suggesting similar model fit in comparison to the original factor structure. Exploratory validity tests indicated that the domain-general factor of the bi-factor model appears related to broad executive functioning abilities.
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Affiliation(s)
- Stephen J. Molitor
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA, United States, 23284-2018
| | - Joshua M. Langberg
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA, United States, 23284-2018
| | - Steven W. Evans
- Ohio University, 200 Porter Hall, Athens, OH, United States, 45701
| | - Melissa R. Dvorsky
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA, United States, 23284-2018
| | - Elizaveta Bourchtein
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA, United States, 23284-2018
| | - Laura D. Eddy
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA, United States, 23284-2018
| | - Zoe R. Smith
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA, United States, 23284-2018
| | - Lauren E. Oddo
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA, United States, 23284-2018
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113
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Timimi S. Non-diagnostic based approaches to helping children who could be labelled ADHD and their families. Int J Qual Stud Health Well-being 2017; 12:1298270. [PMID: 28532324 PMCID: PMC5510228 DOI: 10.1080/17482631.2017.1298270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2017] [Indexed: 12/05/2022] Open
Abstract
Mental health services are not always good for you. There are some troubling facts to confront such as the increase in the use of diagnostic based approaches and psychotropic medications for children and young people being associated with poorer rather than better outcomes. In this article I will outline some of the evidence around outcome as a result of treatment for young people diagnosed with attention deficit hyperactivity disorder (ADHD) and for those who are prescribed long-term stimulants. I will then discuss clinical approaches that move beyond a focus on symptom management that diagnostic paradigms encourage. This includes clinical models that take account of the diversity of contextual and relational issues that young patients present with and the possibility afforded of engaging in more positive and hopeful therapeutic approaches such as the Relational Awareness Programme (RAP).
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Affiliation(s)
- Sami Timimi
- Faculty of Health and Social Sciences, University of Lincoln, Lincoln, UK
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114
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Swanson JM, Arnold LE, Molina BSG, Sibley MH, Hechtman LT, Hinshaw SP, Abikoff H, Stehli A, Owens EB, Mitchell JT, Nichols Q, Howard A, Greenhill LL, Hoza B, Newcorn J, Jensen P, Vitiello B, Wigal T, Epstein J, Tamm L, Lakes KD, Waxmonsky J, Lerner M, Etcovitch J, Murray D, Muenke M, Acosta M, Arcos-Burgos M, Pelham WE, Kraemer H. Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. J Child Psychol Psychiatry 2017; 58:663-678. [PMID: 28295312 PMCID: PMC6168061 DOI: 10.1111/jcpp.12684] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. METHODS Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication. RESULTS For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self-report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38). CONCLUSIONS In the MTA follow-up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.
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Affiliation(s)
- James M. Swanson
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Nisonger Center, Columbus, OH
| | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, PA
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | | | - Howard Abikoff
- Child Study Center at New York University Langone Medical Center, NY
| | - Annamarie Stehli
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | | | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Quyen Nichols
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Andrea Howard
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | | | - Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Jeffrey Newcorn
- Department of Psychiatry, Mount Sinai Medical School, New York, NY
| | - Peter Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Jeffery Epstein
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Kimberly D. Lakes
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | | | - Marc Lerner
- Orange County Department of Education, Costa Mesa, CA
| | - Joy Etcovitch
- Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Desiree Murray
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC
| | | | - Maria Acosta
- National Human Genome Research Institute, Bethesda, MD
| | | | - William E. Pelham
- Department of Psychology, Florida International University, Miami, FL
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115
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Enns JE, Randall JR, Smith M, Chateau D, Taylor C, Brownell M, Bolton JM, Burland E, Katz A, Katz LY, Nickel NC. A Multimodal Intervention for Children with ADHD Reduces Inequity in Health and Education Outcomes. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:403-412. [PMID: 28146649 PMCID: PMC5455871 DOI: 10.1177/0706743717692301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate whether a multimodal intervention for children with attention-deficit hyperactivity disorder (ADHD) resulted in better long-term health and education outcomes and reduced inequity across the socioeconomic gradient. METHOD We analyzed administrative data held in the Manitoba Population Research Data Repository describing recipients of a combined pharmacological/behavioural intervention for ADHD. The study cohort included children aged 5 to 17 years who visited the Manitoba Adolescent Treatment Centre's ADHD intervention service at least 3 times (2007-2012). Controls were matched on age, sex, year of ADHD diagnosis, and income quintile. We compared rates of hospital and emergency department visits, medication use and adherence, contact with child welfare services, and whether children were in their age-appropriate grade. We used concentration curves to estimate differences in outcomes between children from high- and low-income families. RESULTS Children who received the intervention ( n = 485) had higher rates of medication use (rate ratio [RR], 1.21; 95% CI, 1.08 to 1.36) and adherence (RR, 1.42; 95% CI, 1.03 to 1.96) and were more likely to be in their age-appropriate grade (RR, 1.33; 95% CI, 1.09 to 1.63) compared with controls ( n = 1884). The intervention was also associated with reduced inequity in these outcomes across income deciles. There was no difference in the rates of hospital or emergency department visits or contacts with child welfare services. CONCLUSIONS A multimodal ADHD intervention was associated with increased medication use and adherence and higher academic achievement. It was also related to lower inequity across the socioeconomic gradient. These results suggest that multimodal approaches may provide more equitable health and education outcomes for children with ADHD.
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Affiliation(s)
- Jennifer E Enns
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Jason R Randall
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Mark Smith
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Dan Chateau
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Carole Taylor
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Marni Brownell
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - James M Bolton
- 2 Department of Psychiatry, University of Manitoba, Manitoba, Canada
| | - Elaine Burland
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Alan Katz
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
| | - Laurence Y Katz
- 2 Department of Psychiatry, University of Manitoba, Manitoba, Canada
| | - Nathan C Nickel
- 1 Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Manitoba, Canada
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116
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Specific Components of Pediatricians' Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement. J Am Acad Child Adolesc Psychiatry 2017; 56:483-490.e1. [PMID: 28545753 PMCID: PMC5448310 DOI: 10.1016/j.jaac.2017.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/23/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes. METHOD Parents of 372 medication-naïve children in grades 1 to 5 presenting to their community-based pediatrician (N = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and then approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure 12 different components of ADHD care. RESULTS Across all children, the mean decrease in VAPRS total symptom score during the first year of treatment was 11.6 (standard deviation 10.1). Of the 12 components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater decreases in patient total symptom scores. Notably, it was timeliness of contacts, defined as office visits, phone calls, or email communication, that predicted more ADHD symptom decreases. Office visits alone, in terms of number or timeliness, did not predict patient outcomes. CONCLUSION The magnitude of ADHD symptom decrease that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development and modifications of ADHD quality care metrics should include these ADHD care components.
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117
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Sibley MH, Swanson JM, Arnold LE, Hechtman LT, Owens LE, Stehli A, Abikoff H, Hinshaw SP, Molina BS, Mitchell JT, Jensen PS, Howard A, Lakes KD, Pelham WE. Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. J Child Psychol Psychiatry 2017; 58:655-662. [PMID: 27642116 PMCID: PMC5809153 DOI: 10.1111/jcpp.12620] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Longitudinal studies of children diagnosed with ADHD report widely ranging ADHD persistence rates in adulthood (5-75%). This study documents how information source (parent vs. self-report), method (rating scale vs. interview), and symptom threshold (DSM vs. norm-based) influence reported ADHD persistence rates in adulthood. METHOD Five hundred seventy-nine children were diagnosed with DSM-IV ADHD-Combined Type at baseline (ages 7.0-9.9 years) 289 classmates served as a local normative comparison group (LNCG), 476 and 241 of whom respectively were evaluated in adulthood (Mean Age = 24.7). Parent and self-reports of symptoms and impairment on rating scales and structured interviews were used to investigate ADHD persistence in adulthood. RESULTS Persistence rates were higher when using parent rather than self-reports, structured interviews rather than rating scales (for self-report but not parent report), and a norm-based (NB) threshold of 4 symptoms rather than DSM criteria. Receiver-Operating Characteristics (ROC) analyses revealed that sensitivity and specificity were optimized by combining parent and self-reports on a rating scale and applying a NB threshold. CONCLUSION The interview format optimizes young adult self-reporting when parent reports are not available. However, the combination of parent and self-reports from rating scales, using an 'or' rule and a NB threshold optimized the balance between sensitivity and specificity. With this definition, 60% of the ADHD group demonstrated symptom persistence and 41% met both symptom and impairment criteria in adulthood.
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Affiliation(s)
| | - James M. Swanson
- Child Development Center, School of Medicine, University of California, Irvine
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Nisonger Center, Columbus Ohio
| | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | | | | | - Howard Abikoff
- Child Study Center at New York University Langone Medical Center
| | | | - Brooke S.G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
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118
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Kim HS, Lee EK, Hong IH, An JS, Yoo HK. Augmentative Effects of Working Memory Training on Clinical Symptoms and Neuropsychology in Medicated Children and Adolescents with Attention-Deficit Hyperactivity Disorder. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hye Sun Kim
- Seoul Brain Research Institute, Seoul, Korea
| | | | - In Hwa Hong
- Seoul Brain Research Institute, Seoul, Korea
| | - Jung Sook An
- Seoul Regional Military Manpower Administration, Seoul, Korea
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119
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Ng X, Bridges JFP, Ross MM, Frosch E, Reeves G, Cunningham CE, dosReis S. A Latent Class Analysis to Identify Variation in Caregivers' Preferences for their Child's Attention-Deficit/Hyperactivity Disorder Treatment: Do Stated Preferences Match Current Treatment? THE PATIENT 2017; 10:251-262. [PMID: 27798814 PMCID: PMC6029258 DOI: 10.1007/s40271-016-0202-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate variation in caregiver preferences for their child's attention-deficit/hyperactivity disorder (ADHD) care and to determine if their stated preferences align with current care management. METHODS Caregivers of a child aged 4-14 years and in care for ADHD were recruited from pediatric outpatient clinics and advocacy groups across the state of Maryland. Participants completed a survey collecting demographics, the child's treatment, and caregiver preferences-elicited using a best-worst scaling experiment (case 2). Latent class analysis was used to identify distinct preference segments and bivariate analyses were used to compare the association between segment membership with what the child was currently receiving for their ADHD. RESULTS Participants (n = 184) were predominantly White (68%) and the child's mother (84%). Most children had ADHD for 2 or more years (79%). Caregiver preferences were distinguished by two segments: continuous medication (36%) and minimal medication (64%). The two groups had very different preferences for when medication was administered (p < 0.001), but they had similar preferences for provider-oriented and non-medication interventions (p > 0.05 for the caregiver behavior training, provider communication, provider specialty, and out-of-pocket costs). One third of the sample did not receive the preferred individualized education program and 42% of the minimal medication group reported using medication 7 days a week all year round. CONCLUSIONS Although behavior management training and school accommodations aspects of an ADHD care plan are more important to caregivers than evidence-based medication, fewer families had access to educational accommodations. Further research is needed to clarify how stated preferences for care align with treatments used in actual practice settings.
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Affiliation(s)
- Xinyi Ng
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - John F P Bridges
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa M Ross
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Emily Frosch
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gloria Reeves
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
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Abstract
OBJECTIVE Despite widespread use, there is little data investigating the long-term impact of micronutrients on psychiatric disorders. This study investigated the naturalistic outcome 1-year post-baseline of a randomized controlled trials (RCT) that compared micronutrients with placebo in 80 adults with ADHD. METHOD All participants were contacted and clinician-rated questionnaires completed. RESULTS A total of 72 (90%) of the sample participated; although there was significant regression in psychiatric functioning from the end-of-trial on all measures, outcomes remained significantly improved from baseline. Dominant treatment from the end-of-treatment to follow-up was investigated as a mediator of outcome; those staying on the micronutrients performed better than those who switched to medications or discontinued micronutrients. Cost was the most substantial reason why people stopped micronutrient treatment. CONCLUSION For the small number of participants who stayed on micronutrients, the benefits conferred through the controlled trial were maintained. The results are limited by small sample, lack of blinding, expectation, and reliance on self-report of symptoms.
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Affiliation(s)
| | | | | | - Anna Boggis
- 3 Canterbury District Health Board, Christchurch, New Zealand
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121
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Chronis-Tuscano A, Wang CH, Woods KE, Strickland J, Stein MA. Parent ADHD and Evidence-Based Treatment for Their Children: Review and Directions for Future Research. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:501-517. [PMID: 28025755 PMCID: PMC5357146 DOI: 10.1007/s10802-016-0238-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
One fourth to one half of parents of children with attention-deficit/hyperactivity disorder (ADHD) have ADHD themselves, complicating delivery of evidence-based child behavioral and pharmacological treatments. In this article, we review the literature examining the relation between parent ADHD and outcomes following behavioral and pharmacological treatments for children with ADHD. We also review research that has incorporated treatment of parent ADHD (either alone or in combination with child treatment) with the goal of improving parenting and child outcomes. Finally, we offer recommendations for future research on the relation between parent ADHD and evidence-based treatment outcomes for their children, with the purpose of advancing the science and informing clinical care of these families.
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Affiliation(s)
| | | | | | | | - Mark A. Stein
- University of Washington, Seattle Children's Hospital
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122
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Forehand R, Parent J, Sonuga-Barke E, Peisch VD, Long N, Abikoff HB. Which Type of Parent Training Works Best for Preschoolers with Comorbid ADHD and ODD? A Secondary Analysis of a Randomized Controlled Trial Comparing Generic and Specialized Programs. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 44:1503-1513. [PMID: 26909683 DOI: 10.1007/s10802-016-0138-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present study examined whether the presence of comorbid ODD differentially moderated the outcome of two Behavioral Parent Training (BPT) programs in a sample of preschoolers with ADHD: One designed specifically for ADHD (NFPP: New Forest Parenting Programme) and one designed primarily for ODD (HNC: Helping the Noncompliant Child). In a secondary analysis, 130 parents and their 3-4 year-old children diagnosed with ADHD were assigned to one of the two programs. 44.6 % of the children also met criteria for ODD. Significant interactions between treatment conditions (NFPP vs. HNC) and child ODD diagnosis (presence vs. absence) indicated that based on some parent and teacher reports, HNC was more effective with disruptive behaviors than NFPP but only when children had a comorbid diagnosis. Further, based on teacher report, NFPP was more effective with these behaviors when children had a diagnosis of only ADHD whereas HNC was equally effective across ADHD only and comorbid ODD diagnoses. Comorbidity profile did not interact with treatment program when parent or teacher reported ADHD symptoms served as the outcome. Implications for clinical interventions are discussed and directions for future work are provided.
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Affiliation(s)
- Rex Forehand
- University of Vermont, 2 Colchester Ave., Burlington, VT, 05405, USA.
| | - Justin Parent
- University of Vermont, 2 Colchester Ave., Burlington, VT, 05405, USA
| | - Edmund Sonuga-Barke
- University of Southampton, Southampton, UK.,Ghent University, Ghent, Belgium.,Aarhus University, Aarhus, Denmark
| | - Virginia D Peisch
- University of Vermont, 2 Colchester Ave., Burlington, VT, 05405, USA
| | - Nicholas Long
- University of Arkansas Medical School, Little Rock, AR, USA
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123
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Abstract
The diagnostic criteria for attention-deficit hyperactivity disorder (ADHD) require both symptoms and impairment to be present. Impairment in functioning is commonly the primary reason for referral, and is also a better predictor of long-term outcomes than ADHD symptoms. And yet, only recently has research begun to examine the impact of ADHD treatments on functional impairment using efficient and psychometrically sound outcome measures. In this article, we identify several noteworthy multidimensional measures of functional impairment (ADHD FX, Barkley Functional Impairment Scale [BFIS], Impairment Rating Scale [IRS], Weiss Functional Impairment Rating Scale [WFIRS]) utilized in recent clinical trials for ADHD, and describe their psychometric properties and clinical utility. We also review existing evidence on the impact of pharmacological and behavioral treatments on different domains of functional impairment in ADHD youth as measured by these specific measures. Further research is needed to evaluate longitudinal effects of ADHD treatments on functional impairment, and the use of these measures in adaptive treatment designs.
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124
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Findling RL, Townsend L, Brown NV, Arnold LE, Gadow KD, Kolko DJ, McNamara NK, Gary DS, Kaplin DB, Farmer CA, Kipp H, Williams C, Butter EM, Bukstein OG, Rice R, Buchan-Page K, Molina BS, Aman MG. The Treatment of Severe Childhood Aggression Study: 12 Weeks of Extended, Blinded Treatment in Clinical Responders. J Child Adolesc Psychopharmacol 2017; 27:52-65. [PMID: 28212067 PMCID: PMC5327034 DOI: 10.1089/cap.2016.0081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Previous "Treatment of Severe Childhood Aggression" (TOSCA) reports demonstrated that many children with severe physical aggression and attention-deficit/hyperactivity disorder (ADHD) responded well to two randomized treatments (parent training [PT]+stimulant+placebo = Basic vs. PT+stimulant+risperidone = Augmented) for 9 weeks. An important clinical question is whether these favorable outcomes are maintained over longer times. METHODS Clinical responders to the 9-week trial (n = 103/168), defined as Clinical Global Impressions (CGI)-Improvement of much/very much improved plus substantial reduction in parent ratings of disruptiveness, were followed another 12 weeks (21 weeks total) while remaining on blinded treatment. Outcome measures included Clinical Global Impressions scale, Nisonger Child Behavior Rating Form (NCBRF), other parent/teacher-rated scales, laboratory tests, clinician ratings of abnormal movement, and other adverse events (AEs). RESULTS Parent ratings of problem behavior showed minimal worsening of behavior from end of the 9-week acute trial (expected from regression to the mean after selecting best responders), but outcomes at Extension endpoint were meaningfully improved compared with acute study baseline. As expected, outcomes for Basic and Augmented treatment did not differ among these children selected for good clinical response. During Extension, more Augmented subjects had elevated prolactin; there were no clinically confirmed cases of tardive dyskinesia. Delayed sleep onset was the most frequent Basic AE. We also conducted a last-observation-carried-forward analysis, which included both nonresponders and responders. We found that, at the end of Extension, Augmented subjects had more improvement than Basic subjects on the NCBRF Positive Social subscale (p = 0.005; d = 0.44), the Antisocial Behavior Scale Reactive Aggression subscale (p = 0.03; d = 0.36), and marginally so on the Disruptive Behavior Total subscale (p = 0.058; d = 0.29, the primary outcome). CONCLUSIONS The medium-term outcomes were good for the participants in both treatment groups, perhaps because they were selected for good response. When nonresponders were included in ITT analyses, there was some indication that Augmented surpassed Basic treatment.
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Affiliation(s)
- Robert L. Findling
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland.,Department of Psychiatry, Kennedy Krieger Institute, Baltimore, Maryland
| | - Lisa Townsend
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole V. Brown
- Center for Biostatistics, Ohio State University Medical Center, Columbus, Ohio
| | | | - Kenneth D. Gadow
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - David J. Kolko
- Department of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nora K. McNamara
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | - Devin S. Gary
- Department of Psychiatry, Kennedy Krieger Institute, Baltimore, Maryland
| | - Dana B. Kaplin
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland
| | - Cristan A. Farmer
- Pediatrics & Developmental Neuroscience Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Heidi Kipp
- Department of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Craig Williams
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio
| | - Eric M. Butter
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Robert Rice
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio
| | | | - Brooke S.G. Molina
- Department of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael G. Aman
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio
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125
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Howard AL, Strickland NJ, Murray DW, Tamm L, Swanson JM, Hinshaw SP, Arnold LE, Molina BSG. Progression of impairment in adolescents with attention-deficit/hyperactivity disorder through the transition out of high school: Contributions of parent involvement and college attendance. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 125:233-247. [PMID: 26854508 DOI: 10.1037/abn0000100] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Long-term, prospective follow-up studies of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) show that symptoms tend to decline with age, but impairments in daily life functioning often persist into adulthood. We examined the developmental progression of impairments before and after the transition out of high school in relation to parent involvement during adolescence, parent support during adulthood, and college attendance, using 8 waves of data from the prospective 16-year follow-up of the Multimodal Treatment of ADHD (MTA) study. Participants were 548 proband children diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV; American Psychiatric Association, 2000) ADHD Combined Type and 258 age- and sex-matched comparison children (Local Normative Comparison Group; LNCG) randomly sampled from probands' schools. Impairment was assessed consistently by parent report from childhood through adulthood. Results showed that impairment worsens over time both before and after the transition to adulthood for those with ADHD histories, in contrast to non-ADHD peers, whose impairments remained stably low over time. However, impairment stabilized after leaving high school for young adults with ADHD histories who attended college. Involved parenting in adolescence was associated with less impairment overall. Attending college was associated with a stable post-high school trajectory of impairment regardless of parents' involvement during adolescence, but young adults with histories of involved parenting and who attended college were the least impaired overall.
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Affiliation(s)
| | | | - Desiree W Murray
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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126
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Pelham WE, Meichenbaum DL, Smith BH, Sibley MH, Gnagy EM, Bukstein O. Acute Effects of MPH on the Parent-Teen Interactions of Adolescents With ADHD. J Atten Disord 2017; 21:158-167. [PMID: 23543401 DOI: 10.1177/1087054713480833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored the nature of interactions between adolescent males with ADHD and their mothers, and the effects of methylphenidate (MPH) on an analogue parent-teen interaction task. Twenty-five adolescent males with ADHD ( M = 13.6 years) and their mothers and 14 non-ADHD adolescent males ( M = 13.4 years) and their mothers completed ratings of perceived dyadic conflict. Behavioral observations of dyads during 10-min conflict-resolution tasks were also collected. The ADHD dyads completed these tasks twice, with adolescents receiving either 0.3 mg/kg MPH or placebo. Videotaped sessions were coded using the Parent-Adolescent Interaction Rating Scale. Following the conflict-resolution task, participants rated their perceived conflict and affect during the interaction. Findings indicated higher conflict in the ADHD dyads, and minimal MPH effects on parent-teen interactions during the analogue task. Results suggest that stimulant medication does not produce meaningful acute effects on parent-teen interactions.
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Affiliation(s)
| | | | | | | | | | - Oscar Bukstein
- 4 University of Texas Health Sciences Center-Houston, USA
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127
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Chang Z, D’Onofrio BM, Quinn PD, Lichtenstein P, Larsson H. Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Depression: A Nationwide Longitudinal Cohort Study. Biol Psychiatry 2016; 80:916-922. [PMID: 27086545 PMCID: PMC4995143 DOI: 10.1016/j.biopsych.2016.02.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is associated with high rates of psychiatric comorbidity, including depression. However, it is unclear whether ADHD medication increases or decreases the risk for depression. METHODS We studied all individuals with a diagnosis of ADHD born between 1960 and 1998 in Sweden (N = 38,752). We obtained data for prescription of ADHD medication, diagnosis of depression and other psychiatric disorders, and sociodemographic factors from population-based registers. The association between ADHD medication and depression was estimated with Cox proportional hazards regression. RESULTS After adjustment for sociodemographic and clinical confounders, ADHD medication was associated with a reduced long-term risk (i.e., 3 years later) for depression (hazard ratio = 0.58; 95% confidence interval, 0.51-0.67). The risk was lower for longer duration of ADHD medication. Also, ADHD medication was associated with reduced rates of concurrent depression; within-individual analysis suggested that occurrence of depression was 20% less common during periods when patients received ADHD medication compared with periods when they did not (hazard ratio = 0.80; 95% confidence interval, 0.70-0.92). CONCLUSIONS Our study suggests that ADHD medication does not increase the risk of later depression; rather, medication was associated with a reduced risk for subsequent and concurrent depression.
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Affiliation(s)
- Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Brian M. D’Onofrio
- Department of Psychological and Brain Sciences, Indiana University Bloomington, IN, USA
| | - Patrick D. Quinn
- Department of Psychological and Brain Sciences, Indiana University Bloomington, IN, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Medical Sciences, Örebro University, Örebro, Sweden
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128
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Amado L, Jarque S, Ceccato R. Differential impact of a multimodal versus pharmacological therapy on the core symptoms of attention deficit/hyperactivity disorder in childhood. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:93-104. [PMID: 27521718 DOI: 10.1016/j.ridd.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/26/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
UNLABELLED The aim of this study was to analyze the relative and differential efficacy of a combined versus medical treatment to reduce the symptoms of ADHD children in the school and family environment. A total of 100 subjects participated: 20 children with ADHD, their 40 parents and their 40 teachers. Half of the subjects were assigned to the drug group and half to the combined (drug plus psychosocial, psychoeducational intervention with teachers and mothers/fathers). RESULTS The group analyses indicated that both treatments were effective, without significant differences between them. Individualized clinical analyses indicated that higher percentages of improvement and normalization were obtained in the children in the combined group than in the drug only group. Our findings point to the desirability of implementing long-lasting multimodal, multicontextual interventions for ADHD in childhood.
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Affiliation(s)
- Laura Amado
- Abat Oliba-CEU University, Psychology Department, Bellesguard, 30, Barcelona Spain.
| | - Sonia Jarque
- University of Barcelona, Department of Developmental and Educational Psychology, P. Vall d'Hebron, 171, Barcelon 08035, Spain.
| | - Roberta Ceccato
- University of Valencia, Department of Developmental and Educational Psychology, Avda Blasco Ibáñez, 21, Valencia, Spain.
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Caye A, Swanson J, Thapar A, Sibley M, Arseneault L, Hechtman L, Arnold LE, Niclasen J, Moffitt T, Rohde LA. Life Span Studies of ADHD-Conceptual Challenges and Predictors of Persistence and Outcome. Curr Psychiatry Rep 2016; 18:111. [PMID: 27783340 PMCID: PMC5919196 DOI: 10.1007/s11920-016-0750-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
There is a renewed interest in better conceptualizing trajectories of attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood, driven by an increased recognition of long-term impairment and potential persistence beyond childhood and adolescence. This review addresses the following major issues relevant to the course of ADHD in light of current evidence from longitudinal studies: (1) conceptual and methodological issues related to measurement of persistence of ADHD, (2) estimates of persistence rate from childhood to adulthood and its predictors, (3) long-term negative outcomes of childhood ADHD and their early predictors, and (4) the recently proposed new adult-onset ADHD. Estimates of persistence vary widely in the literature, and diagnostic criteria, sample characteristics, and information source are the most important factors explaining variability among studies. Evidence indicates that ADHD severity, comorbid conduct disorder and major depressive disorder, and treatment for ADHD are the main predictors of ADHD persistence from childhood to adulthood. Comorbid conduct disorder and ADHD severity in childhood are the most important predictors of adverse outcomes in adulthood among children with ADHD. Three recent population studies suggested the existence of a significant proportion of individuals who report onset of ADHD symptoms and impairments after childhood. Finally, we highlight areas for improvement to increase our understanding of ADHD across the life span.
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Affiliation(s)
- Arthur Caye
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - James Swanson
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Margaret Sibley
- Department of Psychiatry and Behavioral Health at the Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Louise Arseneault
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lily Hechtman
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - L Eugene Arnold
- Department of Psychiatry, Nisonger Center, Ohio State University, Columbus, OH, USA
| | - Janni Niclasen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Centre for Collaborative Health, Aarhus University, Aarhus, Denmark
| | - Terrie Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clinicas de Porto Alegre, 4o andar, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
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Hoza B, Martin CP, Pirog A, Shoulberg EK. Using Physical Activity to Manage ADHD Symptoms:The State of the Evidence. Curr Psychiatry Rep 2016; 18:113. [PMID: 27807701 DOI: 10.1007/s11920-016-0749-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article summarizes the evidence for management of attention-deficit/hyperactivity disorder (ADHD) using chronic aerobic physical activity (PA). Known studies comparing chronic aerobic PA to at least one control group are listed; uncontrolled studies and studies of non-aerobic PA are not considered. Key challenges to conducting chronic PA studies with children and youth with ADHD are summarized. After condensing information from widely varying studies, measures, and research designs, conclusions are stated in broad brush stroke terms. Preliminary evidence supports PA as beneficial for ADHD symptoms, executive function, and motor abilities. Social, emotional, and behavioral outcomes also may benefit. The preliminary state of the evidence supports PA as an adjunctive treatment for ADHD at this time, but the body and sophistication of the research to date is insufficient at present to support PA as a stand-alone treatment. Critical directions for future research are discussed.
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Affiliation(s)
- Betsy Hoza
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT, 05405, USA.
| | - Caroline P Martin
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT, 05405, USA
| | - Anna Pirog
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT, 05405, USA
| | - Erin K Shoulberg
- Department of Psychological Science, University of Vermont, 2 Colchester Ave, Burlington, VT, 05405, USA
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131
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Heins MJ, Bruggers I, Dijk LV, Korevaar JC. ADHD medication prescription: Effects of child, sibling, parent and general practice characteristics. J Child Health Care 2016; 20:483-493. [PMID: 27708116 DOI: 10.1177/1367493515620913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6-18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel analyses, we examined predictors of ADHD medication prescription. Children diagnosed as 'hyperactive' were 16 times more likely to be prescribed ADHD medication than those with 'behavioural concerns'. Children with a parent or sibling receiving ADHD medication were three to four times more likely to be prescribed ADHD medication themselves. Children from GP practices with a high percentage of children with ADHD were twice as likely to be prescribed ADHD medication. Concluding, factors on the individual, family and GP practice level determine ADHD medication prescription. Future research into the decision-making process for ADHD medication is warranted.
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Affiliation(s)
- Marianne J Heins
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Inge Bruggers
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Liset van Dijk
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Joke C Korevaar
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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132
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Storebø OJ, Zwi M, Krogh HB, Moreira-Maia CR, Holmskov M, Gillies D, Groth C, Simonsen E, Gluud C. Evidence on methylphenidate in children and adolescents with ADHD is in fact of 'very low quality'. EVIDENCE-BASED MENTAL HEALTH 2016; 19:100-102. [PMID: 27935808 PMCID: PMC10699534 DOI: 10.1136/eb-2016-102499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 11/03/2022]
Abstract
Banaschewski and colleagues from the European Attention Deficit Hyperactivity Disorder (ADHD) guideline group make a number of critical comments regarding our systematic review on methylphenidate for children and adolescents with ADHD. In this article, we present our views, showing that our trial selection was not flawed and was undertaken with scientific justification. Similarly, our data collection and interpretation was systematic and correct. We have followed a sound methodology for assessing risk of bias and our conclusions are not misleading. We acknowledge that different researchers might make risk of bias judgments at higher or lower thresholds, but we have been consistent and transparent in applying our pre-defined and per reviewed protocol. Although we made minor errors, we demonstrate that the effects are negligible and not affecting our conclusions. We are happy to correct such errors and to engage in debate on methodological and ethical issues. In terms of clinical implications, we are advocating that clinicians, patients and their relatives should weight carefully risks and benefits of methylphenidate. Clinical experience seems to suggest that there are people who benefit from this medication. Our systematic review does, however, raise questions regarding the overall quality of the methylphenidate trials.
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Affiliation(s)
- O J Storebø
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, Faculty of Health Science, University of Southern Denmark, Denmark
| | - M Zwi
- Whittington Health, Islington CAMHS, London, UK
| | - H B Krogh
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
| | | | - M Holmskov
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
| | - D Gillies
- Mental Health, Western Sydney Local Health District, Parramatta, Australia
| | - C Groth
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | - E Simonsen
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
- Clinical Institute, University of Copenhagen, Copenhagen, Denmark
| | - C Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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133
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Roy A, Hechtman L, Arnold LE, Sibley MH, Molina BSG, Swanson JM, Howard AL. Childhood Factors Affecting Persistence and Desistence of Attention-Deficit/Hyperactivity Disorder Symptoms in Adulthood: Results From the MTA. J Am Acad Child Adolesc Psychiatry 2016; 55:937-944.e4. [PMID: 27806861 PMCID: PMC5117682 DOI: 10.1016/j.jaac.2016.05.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/02/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine childhood factors that predict attention-deficit/hyperactivity disorder (ADHD) persistence and desistence in adulthood. METHOD Regression analyses were used to determine associations between childhood factors and adult ADHD symptom persistence in 453 participants (mean age, 25 years) from the Multimodal Treatment Study of Children with ADHD (MTA). Childhood IQ, total number of comorbidities, child-perceived parenting practices, child-perceived parent-child relationships, parental mental health problems, marital problems of parents, household income levels, and parental education were assessed at a mean age of 8 years in all participants. Adult ADHD persistence was defined using DSM-5 symptom counts either with or without impairment, as well as mean ADHD symptom scores on the Conners' Adult ADHD Rating Scale (CAARS). Age, sex, MTA site, and childhood ADHD symptoms were covaried. RESULTS The most important childhood predictors of adult ADHD symptom persistence were initial ADHD symptom severity (odds ratio [OR] = 1.89, standard error [SE] = 0.28, p = .025), comorbidities (OR = 1.19, SE = 0.07, p = .018), and parental mental health problems (OR = 1.30, SE = 0.09, p = .003). Childhood IQ, socioeconomic status, parental education, and parent-child relationships showed no associations with adult ADHD symptom persistence. CONCLUSION Initial ADHD symptom severity, parental mental health, and childhood comorbidity affect persistence of ADHD symptoms into adulthood. Addressing these areas early may assist in reducing adult ADHD persistence and functioning problems.
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Affiliation(s)
- Arunima Roy
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada; Interdisciplinary Centre Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada.
| | | | | | | | - James M Swanson
- Child Development Center, School of Medicine, University of California, Irvine
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Tasgin EC, Oner O, Yurtbasi P, Munir K. Effects of maternal symptom ratings and other clinical features on short-term treatment response to OROS methylphenidate in children and adolescents with ADHD in a naturalistic clinical setting. KLINIK PSIKOFARMAKOLOJI BULTENI = BULLETIN OF CLINICAL PSYCHOPHARMACOLOGY 2016; 26:126-133. [PMID: 27746700 DOI: 10.5455/bcp.20150703013708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effect of Attention Deficit Hyperactivity Disorder (ADHD), antisocial behavior and anxiety/depression ratings of mothers, and child and adolescents' age, gender, ADHD subtype, and comorbidity on one-month drug treatment response to OROS methylphenidate in ADHD in a naturalistic setting. METHODS The analyses included 223 subjects (191 boys, 32 girls; age 6-15 years, mean: 9.4) treated with OROS methylphenidate (18-72 mg/day, mean: 31 mg/d; 0.4-1.4 mg/kg/d) for one-month. Treatment response was defined as larger than 25% or more decrease in pre-treatment the Conners Parent Rating Scale (CPRS) or the Conners Teacher Rating Scale (CTRS) total scores and the Clinical Global Impression improvement with drug treatment 3 (minimally improved) or higher. Maternal ADHD, antisocial behavior and anxiety/depression ratings were obtained by the Adult Self Rating (ASR). Logistic regression analyses were computed in order to calculate the effects of gender; age; ADHD subtype; comorbid anxiety disorder, learning disorder, oppositional defiant/conduct disorder; maternal ASR Anxiety/Depression, ADHD and Antisocial scores. RESULTS 35.2% of subjects had statistically significant 25% or more decrease in pretreatment CPRS total scores and 38.6% of subjects had statistically significant 25% or more decrease in pretreatment CTRS total scores. The subjects with comorbid anxiety disorder had the poorest drug response. Maternal self-reported antisocial and anxiety/depressive symptomatology were statistically significantly associated with worse response to treatment in terms of CPRS (respectively, OR=0.83, 95% CI: 0.75-0.92, p<0.01; OR=0.95, 95% CI: 0.9-0.99, p<0.05) and CTRS total scores (OR=0.9, 95% CI: 0.82-0.99, OR=0.95, 95% CI: 0.91-1, p<0.05). Baseline rating scores were also important predictors of drug treatment response. Effects of age, gender and maternal ADHD were not statistically significant. CONCLUSION ADHD children and adolescents with comorbid anxiety disorders and those whose mothers have more self-reports of antisocial and depressive symptoms showed less favorable short-term response to OROS-MPH. These subjects may require further attention and additional interventions to augment treatment with OROS methylphenidate.
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Affiliation(s)
- Esra Cop Tasgin
- Yenimahalle Research and Training Hospital, Department of Child and Adolescent Psychiatry, Ankara, Turkey
| | - Ozgur Oner
- Ankara University School of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey
| | - Pinar Yurtbasi
- Turgut Ozal University School of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey
| | - Kerim Munir
- Harvard Medical School, Children's Hospital, Boston, MA, USA
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135
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McCracken JT, McGough JJ, Loo SK, Levitt J, Del'Homme M, Cowen J, Sturm A, Whelan F, Hellemann G, Sugar C, Bilder RM. Combined Stimulant and Guanfacine Administration in Attention-Deficit/Hyperactivity Disorder: A Controlled, Comparative Study. J Am Acad Child Adolesc Psychiatry 2016; 55:657-666.e1. [PMID: 27453079 PMCID: PMC4976782 DOI: 10.1016/j.jaac.2016.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/14/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Because models of attention-deficit/hyperactivity disorder (ADHD) therapeutics emphasize benefits of both enhanced dopaminergic and noradrenergic signaling, strategies to enhance D1 and α2A agonism may yield enhanced clinical and cognitive responses. This study tested the hypothesis that combined effects of a dopamine and noradrenergic agonist, d-methylphenidate extended-release (DMPH) with guanfacine (GUAN), an α2A receptor agonist, would be clinically superior to either monotherapy and would have equal tolerability. METHOD An 8-week, double-blind, 3-arm, comparative trial randomized 7- to 14-year-olds with DSM-IV ADHD to GUAN (1-3 mg/day), DMPH (5-20 mg/day), or a combination (COMB) with fixed-flexible dosing. Outcome measures were the ADHD Rating Scale IV (ADHD-RS-IV) and the Clinical Global Impression-Improvement (CGI-I) scale. Data on adverse events and safety measures were obtained. RESULTS A total of 207 participants were randomized and received drug. Analyses showed significant treatment group main effects for ADHD-RS-IV ADHD total (p = .0001) and inattentive symptoms (p = .0001). COMB demonstrated small but consistently greater reductions in ADHD-RS-IV Inattentive subscale scores versus monotherapies (DMPH: p = .05; f(2) = .02; and GUAN: p = .02; f(2) = .02), and was associated with a greater positive response rate by CGI-I (p = .01). No serious cardiovascular events occurred. Sedation, somnolence, lethargy, and fatigue were greater in both guanfacine groups. All treatments were well tolerated. CONCLUSION COMB showed consistent evidence of clinical benefits over monotherapies, possibly reflecting advantages of greater combined dopaminergic and α2A agonism. Adverse events were generally mild to moderate, and COMB treatment showed no differences in safety or tolerability. CLINICAL TRIAL REGISTRATION INFORMATION Single Versus Combination Medication Treatment for Children With Attention Deficit Hyperactivity Disorder (Project1); http://clinicaltrials.gov/; NCT00429273.
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Affiliation(s)
- James T. McCracken
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - James J. McGough
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Sandra K. Loo
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Jennifer Levitt
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Melissa Del'Homme
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Jennifer Cowen
- Semel Institute for Neuroscience and Human Behavior at UCLA
| | | | - Fiona Whelan
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Gerhard Hellemann
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA
| | - Catherine Sugar
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.,UCLA School of Public Health
| | - Robert M. Bilder
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.,UCLA College of Letters and Science
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136
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Briars L, Todd T. A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. J Pediatr Pharmacol Ther 2016; 21:192-206. [PMID: 27453697 DOI: 10.5863/1551-6776-21.3.192] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common psychological diagnosis in children. This disorder impacts children and adolescents in all areas of life, including academic performance, extracurricular activities, and social interactions. ADHD can continue into adulthood where unemployment and substance abuse has been described. Although behavioral therapy is recommended for all patients with ADHD, medication management typically is initiated soon after diagnosis. Psychostimulants remain the primary medication of choice. This review focuses on the clinical use of psychostimulant medication in children and adolescents. The pharmacodynamic and pharmacokinetic differences between the newest long-acting formulations as well as commonly encountered adverse drug reactions, with suggested management strategies, will be highlighted. Non-stimulant therapy with atomoxetine or alpha2-adrenergic agonists is also reviewed. These agents may be warranted for patients who cannot tolerate psychostimulant therapy or have a comorbid condition. Finally, the 8-year multimodal treatment study results are also discussed.
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Affiliation(s)
- Leslie Briars
- Department of Pharmacy Practice, The University of Illinois at Chicago College of Pharmacy, Chicago, Illinois
| | - Timothy Todd
- Department of Pharmacy Practice, Midwestern University, Downers Grove, Illinois
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137
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Acosta MT, Swanson J, Stehli A, Molina BSG, Martinez AF, Arcos-Burgos M, Muenke M. ADGRL3 (LPHN3) variants are associated with a refined phenotype of ADHD in the MTA study. Mol Genet Genomic Med 2016; 4:540-7. [PMID: 27652281 PMCID: PMC5023939 DOI: 10.1002/mgg3.230] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022] Open
Abstract
Background ADHD is the most common neuropsychiatric condition affecting individuals of all ages. Long‐term outcomes of affected individuals and association with severe comorbidities as SUD or conduct disorders are the main concern. Genetic associations have been extensively described. Multiple studies show that intronic variants harbored in the ADGRL3 (LPHN3) gene are associated with ADHD, especially associated with poor outcomes. Methods In this study, we evaluated this association in the Multimodal Treatment Study of children with ADHD (MTA), initiated as a 14‐month randomized clinical trial of 579 children diagnosed with DSM‐IV ADHD‐Combined Type (ADHD‐C), that transitioned to a 16‐year prospective observational follow‐up, and 289 classmates added at the 2‐year assessment to serve as a local normative comparison group (LNCG). Diagnostic evaluations at entry were based on the Diagnostic Interview Schedule for Children‐Parent (DISC‐P), which was repeated at several points over the years. For an add‐on genetic study, blood samples were collected from 232 in the MTA group and 139 in the LNCG. Results For the 205 MTA participants, 14.6% retained the DISC‐P diagnosis of ADHD‐C in adolescence. For 127 LNCG participants, 88.2% remained undiagnosed by the DISC‐P. We genotyped 15 polymorphic SNP markers harbored in the ADGRL3 gene, and compared allele frequencies for the 30 cases with continued diagnosis of ADHD‐C in adolescence to the other participants. Replication of the association of rs2345039 ADGRL3 variant was observed (P value = 0.004, FDR corrected = 0.03; Odds ratio = 2.25, upper CI 1.28–3.97). Conclusion The detection of susceptibility conferred by ADGRL3 variants in the extreme phenotype of continued diagnosis of ADHD‐C from childhood to adolescence provides additional support that the association of ADGRL3 and ADHD is not spurious. Exploring genetic effects in longitudinal cohorts, in which refined, age‐dependent phenotypes are documented, is crucial to understand the natural history of ADHD.
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Affiliation(s)
- Maria T Acosta
- Medical Genetics BranchNational Human Genome Research InstituteNational Institutes of HealthBethesdaMaryland; Department of Pediatric and NeurologyGeorge Washington UniversityChildren's National Medical CenterWashingtonDistrict of Columbia
| | - James Swanson
- Department of PsychiatryFlorida International UniversityMiamiFlorida; Department of PediatricsUniversity of California at IrvineIrvineCalifornia
| | - Annamarie Stehli
- Department of Pediatrics University of California at Irvine Irvine California
| | - Brooke S G Molina
- Departments of Psychiatry and Psychology University of Pittsburgh Pittsburgh Pennsylvania
| | | | - Ariel F Martinez
- Medical Genetics Branch National Human Genome Research Institute National Institutes of Health Bethesda Maryland
| | - Mauricio Arcos-Burgos
- Genomics and Predictive Medicine Genome Biology Department John Curtin School of Medical Research ANU College of Medicine, Biology and Environment The Australian National University Canberra ACT Australia
| | - Maximilian Muenke
- Medical Genetics Branch National Human Genome Research Institute National Institutes of Health Bethesda Maryland
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138
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dosReis S, Ng X, Frosch E, Reeves G, Cunningham C, Bridges JFP. Using Best-Worst Scaling to Measure Caregiver Preferences for Managing their Child's ADHD: A Pilot Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:423-31. [PMID: 25392024 DOI: 10.1007/s40271-014-0098-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Management of attention-deficit/hyperactivity disorder (ADHD) is a trade-off between caregivers' concerns about the benefits versus the risks of evidence-based treatment. Few studies have used choice-based methods to assess what treatment attributes matter most to caregivers. OBJECTIVE The aim was to develop and to pilot an instrument to elicit caregivers' preferences for evidence-based management of their child's ADHD. METHODS Mixed methods were used to develop a Best-Worst Scaling (BWS) instrument, and quantitative methods were used to pilot the instrument. Primary caregivers of children with ADHD from two community organizations were recruited for the development (n = 21) and pilot (n = 37) phase. The instrument was a BWS case 2, where 18 management profiles are presented one at a time, with respondents indicating the one best and one worst feature of each profile. Profiles were developed using a main effects orthogonal array. The mean of best-minus-worse scores was estimated, and attribute importance was based on the sum of maximum minus minimum scores for each attribute. Feasibility of eliciting stated preferences was evaluated with t tests and 95 % confidence intervals. RESULTS Seven attributes (medication, therapy, school, caregiver training, provider specialty, provider communication, and out-of-pocket costs) with three levels each were identified. All mean scores were significant except for pediatrician management of the child's ADHD (p = 0.089). Caregiver training had the highest relative importance, followed by medication and provider communication. CONCLUSIONS The BWS instrument was a relatively simple measure, caregivers completed it independently, and it distinguished the relative importance of different attributes in managing a child's ADHD.
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Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
| | - Xinyi Ng
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
| | - Emily Frosch
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gloria Reeves
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - John F P Bridges
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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139
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Abstract
The Pediatric Symptom Checklist (PSC) is a widely used, parent-completed measure of children's emotional and behavioral functioning. Previous research has shown that the PSC and its subscales are responsive to patient progress over the course of psychiatric treatment. In this naturalistic study, parents and clinicians of 1736 patients aged 17 or younger completed standardized measures at intake and 3-month follow-up appointments. We assessed the 5-item PSC Attention Subscale (PSC-AS) as a longitudinal measure of attention-related symptoms in routine outpatient psychiatry treatment. Secondarily, we compared PSC-AS scores with clinician-reported diagnoses, psychomotor excitation symptoms, and overall functioning. Change scores on the PSC-AS were larger among patients with ADHD diagnoses than those with non-ADHD diagnoses. Comparisons between PSC-AS scores and clinician reports also showed acceptable levels of agreement. Given its effectiveness in tracking attention-related symptoms, the PSC may be particularly useful as a quality assurance or treatment outcome measure for clinicians treating ADHD.
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Parletta N, Niyonsenga T, Duff J. Omega-3 and Omega-6 Polyunsaturated Fatty Acid Levels and Correlations with Symptoms in Children with Attention Deficit Hyperactivity Disorder, Autistic Spectrum Disorder and Typically Developing Controls. PLoS One 2016; 11:e0156432. [PMID: 27232999 PMCID: PMC4883772 DOI: 10.1371/journal.pone.0156432] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/15/2016] [Indexed: 12/27/2022] Open
Abstract
Background There is evidence that children with Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum Disorder (ASD) have lower omega-3 polyunsaturated fatty acid (n-3 PUFA) levels compared with controls and conflicting evidence regarding omega-6 (n-6) PUFA levels. Objectives This study investigated whether erythrocyte n-3 PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were lower and n-6 PUFA arachidonic acid (AA) higher in children with ADHD, ASD and controls, and whether lower n-3 and higher n-6 PUFAs correlated with poorer scores on the Australian Twin Behaviour Rating Scale (ATBRS; ADHD symptoms) and Test of Variable Attention (TOVA) in children with ADHD, and Childhood Autism Rating Scale (CARS) in children with ASD. Methods Assessments and blood samples of 565 children aged 3–17 years with ADHD (n = 401), ASD (n = 85) or controls (n = 79) were analysed. One-way ANOVAs with Tukey’s post-hoc analysis investigated differences in PUFA levels between groups and Pearson’s correlations investigated correlations between PUFA levels and ATBRS, TOVA and CARS scores. Results Children with ADHD and ASD had lower DHA, EPA and AA, higher AA/EPA ratio and lower n-3/n-6 than controls (P<0.001 except AA between ADHD and controls: P = 0.047). Children with ASD had lower DHA, EPA and AA than children with ADHD (P<0.001 for all comparisons). ATBRS scores correlated negatively with EPA (r = -.294, P<0.001), DHA (r = -.424, P<0.001), n-3/n-6 (r = -.477, P<0.001) and positively with AA/EPA (r = .222, P <.01). TOVA scores correlated positively with DHA (r = .610, P<0.001), EPA (r = .418, P<0.001) AA (r = .199, P<0.001), and n-3/n-6 (r = .509, P<0.001) and negatively with AA/EPA (r = -.243, P<0.001). CARS scores correlated significantly with DHA (r = .328, P = 0.002), EPA (r = -.225, P = 0.038) and AA (r = .251, P = 0.021). Conclusions Children with ADHD and ASD had low levels of EPA, DHA and AA and high ratio of n-6/n-3 PUFAs and these correlated significantly with symptoms. Future research should further investigate abnormal fatty acid metabolism in these disorders.
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Affiliation(s)
- Natalie Parletta
- Centre for Population Health Research, School of Health Sciences,University of South Australia, Adelaide, Australia
| | - Theophile Niyonsenga
- Centre for Population Health Research, School of Health Sciences,University of South Australia, Adelaide, Australia
| | - Jacques Duff
- Behavioural Neurotherapy Clinic, Doncaster, Victoria, Australia
- Australian Autism ADHD Foundation, Victoria, Australia
- * E-mail:
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141
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Hunter N, Barsky TV. Transactional Experiences of Existential Anxiety as a Barrier to Effective Humanistic Intervention. JOURNAL OF HUMANISTIC PSYCHOLOGY 2016. [DOI: 10.1177/0022167816646671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
There are some who criticize mainstream mental health approaches and point out that individuals in distress appear to be getting worse, as opposed to better, while in treatment. Ex-patients often advocate for a person-centered, humanistic approach to working with emotional distress, while clinicians tend to offer a disease-based, deficit-focused model. This article is an exploration of the dynamics between patients and professionals that may be contributing to conflicting perspectives on what constitutes helpful intervention. Specifically, concepts of terror management theory are used to explore how the existential anxieties experienced both by individuals with serious emotional difficulties as well as their treating clinicians, which are consciously or unconsciously avoided in treatment, can reciprocally trigger distressing anxiety in the other. Suggestions are offered as to what could help mitigate this existential stalemate in the psychotherapeutic context.
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Affiliation(s)
- Noel Hunter
- Long Island University–Post, Brookville, NY, USA
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142
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Bushe C, Day K, Reed V, Karlsdotter K, Berggren L, Pitcher A, Televantou F, Haynes V. A network meta-analysis of atomoxetine and osmotic release oral system methylphenidate in the treatment of attention-deficit/hyperactivity disorder in adult patients. J Psychopharmacol 2016; 30:444-58. [PMID: 27005307 DOI: 10.1177/0269881116636105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The lack of head-to-head clinical studies powered to compare atomoxetine and osmotic release oral system (OROS) methylphenidate necessitates treatment comparison by methods that include indirect evidence such as network meta-analysis (NMA). A NMA assessing the relative treatment effects of atomoxetine and OROS methylphenidate in adults with attention-deficit/hyperactivity disorder (ADHD) was conducted. Studies were identified by systematic literature review. Analyses summarised improvements in efficacy, measured by ADHD-specific scales, using Cohen'sdto calculate the standardised mean difference (SMD), and all cause discontinuations. Results showed effect sizes (SMD, 95% credible interval (CrI)) relative to placebo that did not differ significantly between atomoxetine (0.46, 0.36-0.56) and OROS methylphenidate (0.51, 0.40-0.63) in clinical studies of up to 12 weeks' duration (SMD, 95% CrI for atomoxetine versus OROS methylphenidate: -0.05, -0.18-0.08). Patients treated with these medications responded better than those given placebo across all analyses. There was also no significant difference in discontinuation rates between atomoxetine and OROS methylphenidate (odds ratio, 95% CrI: 0.85, 0.53-1.35). Between-study heterogeneity was low overall. Results of this NMA suggest that the efficacy of atomoxetine and OROS methylphenidate in adults does not differ significantly. Clinical guidelines may require amendment to reflect these recent data.
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Affiliation(s)
| | - Kathleen Day
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, USA
| | | | | | | | | | | | - Virginia Haynes
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, USA
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143
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Nix RL, Bierman KL, Heinrichs BS, Gest SD, Welsh JA, Domitrovich CE. The randomized controlled trial of Head Start REDI: Sustained effects on developmental trajectories of social-emotional functioning. J Consult Clin Psychol 2016; 84:310-22. [PMID: 26752586 PMCID: PMC4801712 DOI: 10.1037/a0039937] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study assessed the sustained effects of Head Start REDI (Research-based, Developmentally Informed), a randomized controlled preschool preventive intervention, on children's developmental trajectories of social-emotional functioning into elementary school. METHOD Twenty-five Head Start centers with 44 classrooms were randomly assigned to deliver Head Start REDI or Head Start as usual. Head Start REDI featured an integrated language-emergent literacy and social-emotional skills curriculum and enhanced support for positive teaching practices. The 356 4-year-old children (54% girls; 25% African American; 17% Latino; 70% living in poverty) in those centers and classrooms were followed for 5 years (from preschool through third grade; 91% retention rate). Each year, teachers rated multiple domains of social-emotional functioning. Person-oriented latent class growth models were used to identify the different developmental trajectories of social-emotional functioning that children followed. RESULTS Tests of proportions revealed that children who had been in the Head Start REDI intervention were statistically significantly more likely than children in the control condition to follow the most optimal developmental trajectories of social competence, aggressive-oppositional behavior, learning engagement, attention problems, student-teacher closeness, and peer rejection (odds ratio = 1.60-1.93). CONCLUSIONS These findings suggest that enriching Head Start with evidence-based curriculum components and teaching practices can have long-lasting benefits for children's social-emotional functioning. These findings elucidate how high-quality preschool experiences promote core competencies that are critical to the school success of children living in poverty.
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Affiliation(s)
- Robert L Nix
- Bennett Pierce Prevention Research Center, Pennsylvania State University
| | | | | | - Scott D Gest
- Department of Human Development and Family Studies, Pennsylvania State University
| | - Janet A Welsh
- Bennett Pierce Prevention Research Center, Pennsylvania State University
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144
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Hoza B, Smith AL, Shoulberg EK, Linnea KS, Dorsch TE, Blazo JA, Alerding CM, McCabe GP. A randomized trial examining the effects of aerobic physical activity on attention-deficit/hyperactivity disorder symptoms in young children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:655-67. [PMID: 25201345 DOI: 10.1007/s10802-014-9929-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The goal of this study was to compare the effects of before school physical activity (PA) and sedentary classroom-based (SC) interventions on the symptoms, behavior, moodiness, and peer functioning of young children (M age = 6.83) at risk for attention-deficit/hyperactivity disorder (ADHD-risk; n = 94) and typically developing children (TD; n = 108). Children were randomly assigned to either PA or SC and participated in the assigned intervention 31 min per day, each school day, over the course of 12 weeks. Parent and teacher ratings of ADHD symptoms (inattention, hyperactivity/impulsivity), oppositional behavior, moodiness, behavior toward peers, and reputation with peers, were used as dependent variables. Primary analyses indicate that the PA intervention was more effective than the SC intervention at reducing inattention and moodiness in the home context. Less conservative follow-up analyses within ADHD status and intervention groups suggest that a PA intervention may reduce impairment associated with ADHD-risk in both home and school domains; interpretive caution is warranted, however, given the liberal approach to these analyses. Unexpectedly, these findings also indicate the potential utility of a before school SC intervention as a tool for managing ADHD symptoms. Inclusion of a no treatment control group in future studies will enable further understanding of PA as an alternative management strategy for ADHD symptoms.
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Affiliation(s)
- Betsy Hoza
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405, USA,
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145
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Boyer BE, Doove LL, Geurts HM, Prins PJM, Van Mechelen I, Van der Oord S. Qualitative Treatment-Subgroup Interactions in a Randomized Clinical Trial of Treatments for Adolescents with ADHD: Exploring What Cognitive-Behavioral Treatment Works for Whom. PLoS One 2016; 11:e0150698. [PMID: 26977602 PMCID: PMC4792426 DOI: 10.1371/journal.pone.0150698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/18/2016] [Indexed: 12/18/2022] Open
Abstract
Objective This study explored qualitative treatment-subgroup interactions within data of a RCT with two cognitive behavioral treatments (CBT) for adolescents with ADHD: a planning-focused (PML) and a solution-focused CBT (SFT). Qualitative interactions imply that which treatment is best differs across subgroups of patients, and are therefore most relevant for personalized medicine. Methods Adolescents with ADHD (N = 159) received either PML or SFT. Pre-, post- and three-month follow-up data were gathered on parent-rated ADHD symptoms and planning problems. Pretreatment characteristics were explored as potential qualitative moderators of pretest to follow-up treatment effects, using an innovative analyses technique (QUINT; Dusseldorp & Van Mechelen, 2014). In addition, qualitative treatment-subgroup interactions for the therapeutic changes from pre- to posttest and from post- to follow-up test were investigated. Results For the entire time span from pretest to follow-up only a quantitative interaction was found, while from posttest to follow-up qualitative interactions were found: Adolescents with less depressive symptoms but more anxiety symptoms showed more improvement when receiving PML than SFT, while for other adolescents the effects of PML and SFT were comparable. Discussion Whereas subgroups in both treatments followed different trajectories, no subgroup was found for which SFT outperformed PML in terms of the global change in symptoms from pretest to three months after treatment. This implies that, based on this exploratory study, there is no need for personalized treatment allocation with regard to the CBTs under study for adolescents with ADHD. However, for a subgroup with comorbid anxiety symptoms but low depression PML clearly appears the treatment of preference. Trial Registration Nederlands Trial Register NTR2142
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Affiliation(s)
- Bianca E. Boyer
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Dutch Autism & ADHD research center (d’Arc), Department of Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisa L. Doove
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Hilde M. Geurts
- Centre for Cognitive Science, University of Amsterdam, Amsterdam, The Netherlands
- Dutch Autism & ADHD research center (d’Arc), Department of Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Pier J. M. Prins
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Cognitive Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Iven Van Mechelen
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Saskia Van der Oord
- Clinical Psychology, KU Leuven, Leuven, Belgium
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Cognitive Science, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
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146
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Baijot S, Slama H, Söderlund G, Dan B, Deltenre P, Colin C, Deconinck N. Neuropsychological and neurophysiological benefits from white noise in children with and without ADHD. Behav Brain Funct 2016; 12:11. [PMID: 26979812 PMCID: PMC4791764 DOI: 10.1186/s12993-016-0095-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background Optimal stimulation theory and moderate brain arousal (MBA) model hypothesize that extra-task stimulation (e.g. white noise) could improve cognitive functions of children with attention-deficit/hyperactivity disorder (ADHD). We investigate benefits of white noise on attention and inhibition in children with and without ADHD (7–12 years old), both at behavioral and at neurophysiological levels. Methods Thirty children with and without ADHD performed a visual cued Go/Nogo task in two conditions (white noise or no-noise exposure), in which behavioral and P300 (mean amplitudes) data were analyzed. Spontaneous eye-blink rates were also recorded and participants went through neuropsychological assessment. Two separate analyses were conducted with each child separately assigned into two groups (1) ADHD or typically developing children (TDC), and (2) noise beneficiaries or non-beneficiaries according to the observed performance during the experiment. This latest categorization, based on a new index we called “Noise Benefits Index” (NBI), was proposed to determine a neuropsychological profile positively sensitive to noise. Results Noise exposure reduced omission rate in children with ADHD, who were no longer different from TDC. Eye-blink rate was higher in children with ADHD but was not modulated by white noise. NBI indicated a significant relationship between ADHD and noise benefit. Strong correlations were observed between noise benefit and neuropsychological weaknesses in vigilance and inhibition. Participants who benefited from noise had an increased Go P300 in the noise condition. Conclusion The improvement of children with ADHD with white noise supports both optimal stimulation theory and MBA model. However, eye-blink rate results question the dopaminergic hypothesis in the latter. The NBI evidenced a profile positively sensitive to noise, related with ADHD, and associated with weaker cognitive control.
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Affiliation(s)
- Simon Baijot
- Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Campus du Solbosch CP 191, Avenue F.D. Roosevelt 50, CP 151, 1050, Brussels, Belgium. .,Research Unit in Cognitive Neurosciences (UNESCOG), Université Libre de Bruxelles (ULB), 1050, Brussels, Belgium. .,Department of Neurology, Queen Fabiola Children's University Hospital (HUDERF), Université Libre de Bruxelles (ULB), Avenue Jean-Joseph Crocq, 15, 1020, Brussels, Belgium.
| | - Hichem Slama
- Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Campus du Solbosch CP 191, Avenue F.D. Roosevelt 50, CP 151, 1050, Brussels, Belgium.,Research Unit in Cognitive Neurosciences (UNESCOG), Université Libre de Bruxelles (ULB), 1050, Brussels, Belgium.,Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Université Libre de Bruxelles (ULB), 1050, Brussels, Belgium.,Department of Clinical and Cognitive Neuropsychology, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium
| | - Göran Söderlund
- Faculty of Teacher Education and Sports, Sogn og Fjordane, University College, Sogndal, Norway
| | - Bernard Dan
- Department of Neurology, Queen Fabiola Children's University Hospital (HUDERF), Université Libre de Bruxelles (ULB), Avenue Jean-Joseph Crocq, 15, 1020, Brussels, Belgium.,Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Paul Deltenre
- Laboratory of Cognitive and Sensory Neurophysiology, CHU Brugmann, Université Libre de Bruxelles (ULB), Place Van Gehuchten, 4, 1020, Brussels, Belgium
| | - Cécile Colin
- Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Campus du Solbosch CP 191, Avenue F.D. Roosevelt 50, CP 151, 1050, Brussels, Belgium.,Research Unit in Cognitive Neurosciences (UNESCOG), Université Libre de Bruxelles (ULB), 1050, Brussels, Belgium.,Laboratory of Cognitive and Sensory Neurophysiology, CHU Brugmann, Université Libre de Bruxelles (ULB), Place Van Gehuchten, 4, 1020, Brussels, Belgium
| | - Nicolas Deconinck
- Department of Neurology, Queen Fabiola Children's University Hospital (HUDERF), Université Libre de Bruxelles (ULB), Avenue Jean-Joseph Crocq, 15, 1020, Brussels, Belgium
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147
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Correction to "The Effectiveness and Tolerability of Central Nervous System Stimulants in School-Age Children with Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder across Home and School". J Child Adolesc Psychopharmacol 2016:cap.2015.0053.cxn. [PMID: 26938370 DOI: 10.1089/cap.2015.0053.cxn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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148
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Baweja R, Belin PJ, Humphrey HH, Babocsai L, Pariseau ME, Waschbusch DA, Hoffman MT, Akinnusi OO, Haak JL, Pelham WE, Waxmonsky JG. The Effectiveness and Tolerability of Central Nervous System Stimulants in School-Age Children with Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder Across Home and School. J Child Adolesc Psychopharmacol 2016; 26:154-63. [PMID: 26771437 PMCID: PMC4800382 DOI: 10.1089/cap.2015.0053] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study examines the effectiveness and tolerability of stimulants in children with attention-deficit/hyperactivity disorder (ADHD) and disruptive mood dysregulation disorder (DMDD). METHODS To be eligible, participants had to meet Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV) criteria for the combined subtype of ADHD and National Institute of Mental Health (NIMH) severe mood dysregulation criteria. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) DMDD criteria were retrospectively assessed after the study was completed. An open-label medication trial lasting up to 6 weeks was completed to optimize the central nervous system (CNS) stimulant dose. Measures of affective symptoms, ADHD symptoms and other disruptive behaviors, impairment, and structured side effect ratings were collected before and after the medication trial. RESULTS Optimization of stimulant medication was associated with a significant decline in depressive symptoms on the Childhood Depression Rating Score-Revised Scale (p<0.05, Cohen's d=0.61) and Mood Severity Index score (p<0.05, Cohen's d=0.55), but not in manic-like symptoms on the Young Mania Rating Scale. There was a significant reduction in ADHD (p<0.05, Cohen's d=0.95), oppositional defiant disorder (ODD) (p<0.05, Cohen's d=0.5), and conduct disorder (CD) symptoms (p<0.05, Cohen's d=0.65) as rated by parents. There was also a significant reduction in teacher-rated ADHD (p<0.05, Cohen's d=0.33) but not in ODD symptoms. Medications were well tolerated and there was no increase in side effect ratings seen with dose optimization. Significant improvement in functioning was reported by clinicians and parents (all p's<0.05), but youth still manifested appreciable impairment at end-point. CONCLUSIONS CNS simulants were well tolerated by children with ADHD comorbid with a diagnosis of DMDD. CNS stimulants were associated with clinically significant reductions in externalizing symptoms, along with smaller improvements in mood. However, most participants still exhibited significant impairment, suggesting that additional treatments may be needed to optimize functioning.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Peter J. Belin
- Center for Children and Families, Florida International University, Miami, Florida
| | - Hugh H. Humphrey
- Department of Psychiatry, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Lysett Babocsai
- Center for Children and Families, Florida International University, Miami, Florida
| | - Meaghan E. Pariseau
- Department of School and Counseling Psychology, SUNY Buffalo, Buffalo, New York
| | - Daniel A. Waschbusch
- Department of Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania
| | - Martin T. Hoffman
- Department of Pediatrics, SUNY Buffalo School of Medicine, Buffalo, New York
| | | | - Jenifer L. Haak
- Department of Psychiatry, SUNY Buffalo School of Medicine, Buffalo, New York
| | - William E. Pelham
- Center for Children and Families, Florida International University, Miami, Florida
| | - James G. Waxmonsky
- Department of Psychiatry, Penn State University College of Medicine, Hershey, Pennsylvania
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149
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A Randomized Clinical Trial of an Integrative Group Therapy for Children With Severe Mood Dysregulation. J Am Acad Child Adolesc Psychiatry 2016; 55:196-207. [PMID: 26903253 PMCID: PMC4764804 DOI: 10.1016/j.jaac.2015.12.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Nonepisodic irritability is a common and impairing problem, leading to the development of the diagnoses severe mood dysregulation (SMD) and disruptive mood dysregulation disorder (DMDD). No psychosocial therapies have been formally evaluated for either, with medication being the most common treatment. This study examined the feasibility and efficacy of a joint parent-child intervention for SMD. METHOD A total of 68 participants aged 7 to 12 years with attention-deficit/hyperactivity disorder (ADHD) and SMD were randomly assigned to the 11-week therapy or community-based psychosocial treatment. All participants were first stabilized on psychostimulant medication by study physicians. Of the participants, 56 still manifested impairing SMD symptoms and entered the therapy phase. Masked evaluators assessed participants at baseline, midpoint, and endpoint, with therapy participants reassessed 6 weeks later. RESULTS All but 2 therapy participants attended the majority of sessions (n = 29), with families reporting high levels of satisfaction. The primary outcome of change in mood symptoms using the Mood Severity Index (MSI) did not reach significance except in the subset attending the majority of sessions (effect size = 0.53). Therapy was associated with significantly greater improvement in parent-rated irritability (effect size = 0.63). Treatment effects for irritability but not MSI diminished after therapy stopped. Little impact on ADHD symptoms was seen. Results may not be generalizable to youth with SMD and comorbidities different from those seen in this sample of children with ADHD, and are limited by the lack of a gold standard for measuring change in SMD symptoms. CONCLUSION While failing to significantly improve mood symptoms versus community treatment, the integrative therapy was found to be a feasible and efficacious treatment for irritability in participants with SMD and ADHD. CLINICAL TRIAL REGISTRATION INFORMATION Group-Based Behavioral Therapy Combined With Stimulant Medication for Treating Children With Attention Deficit Hyperactivity Disorder and Impaired Mood; http://clinicaltrials.gov/; NCT00632619.
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150
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Clarke CS, Bannon F, Skokauskas N. EEG neurofeedback for inattention in children with Attention Deficit Hyperactivity Disorder (ADHD). Hippokratia 2016. [DOI: 10.1002/14651858.cd009207.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ciaran S Clarke
- Health Service Executive; Child and Adolescent Psychiatry; James Joyce Street Dublin 1 Ireland
| | - Finian Bannon
- Queen's University Belfast; Northern Ireland Cancer Registry, Centre for Public Health; Mulhouse Building Grosvenor Road Belfast Northern Ireland UK BT12 6BJ
| | - Norbertas Skokauskas
- Children's University Hospital; Department of Psychiatry; Temple Street Dublin Ireland
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