201
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Egan V, Bull E, Trundle G. Individual differences, ADHD, adult pathological demand avoidance, and delinquency. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 105:103733. [PMID: 32682221 DOI: 10.1016/j.ridd.2020.103733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 04/01/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pathological Demand Avoidance (PDA) is a developmental disorder involving challenging behaviour clinically linked to Autism Spectrum Disorder (ASD). Many of the problematic features of PDA are often seen in persons with attention deficit hyperactivity disorder and impulsivity. ADHD and impulsivity are also common in the backgrounds of offenders. AIMS Method and procedure: We examined if self-reported ASD, ADHD, impulsivity, and general personality traits such as low conscientiousness and low emotional stability predicted self-reported PDA scores, and which constructs contributed to the prediction of delinquency, recruiting 132 participants (mean age 34.6 years, SD = 10.9, range 18-68), of whom 126 cases had complete data. OUTCOMES AND RESULTS Many of these constructs, but particularly ADHD (r = 0.71, p < 0.001) were significant correlates of PDA, the correlation between ASD and PDA was small, and did not predict PDA. Multiple regression indicated that a combination of higher attention deficit, antagonism, and lower emotional stability predicted 65 % of an individual's PDA score, but that their PDA score did not contribute to the prediction of delinquency. CONCLUSIONS AND IMPLICATIONS This research indicates that, for community adult populations, self-reported individual differences in ADHD, emotional instability, and antagonism appear to better predict PDA than ASD. The association PDA has with delinquency may reflect these constructs, which are also correlates of offending.
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Affiliation(s)
- Vincent Egan
- Centre for Forensic and Family Psychology, University of Nottingham, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK.
| | - Elinor Bull
- Centre for Forensic and Family Psychology, University of Nottingham, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK.
| | - Grace Trundle
- Centre for Forensic and Family Psychology, University of Nottingham, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK.
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202
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Aebi M, Winkler Metzke C, Steinhausen HC. Predictors and outcomes of self-reported dysregulation profiles in youth from age 11 to 21 years. Eur Child Adolesc Psychiatry 2020; 29:1349-1361. [PMID: 31758358 DOI: 10.1007/s00787-019-01444-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Abstract
Understanding the dysregulation profile (DP) consisting of high scores in aggression, attention problems, and anxious/depressed problems is still limited. The aims of the present study were threefold: (a) to analyze developmental trajectories of DP (b) to identify predictors of these trajectories, and (c) to study the outcome of DP in terms of mental disorders and criminal offenses in young adulthood. A sample of 402 individuals aged 11-14 years at baseline was followed up during adolescence and young adulthood. Latent class growth analysis was used to identify DP based on the youth self-report and the young adult self-report. Self-related cognitions, perceived parental behavior, life events and coping served as predictors, psychiatric diagnoses and criminal convictions in young adulthood as outcomes. There were three developmental trajectories representing high, moderate, and low DP subgroups with 9.2% of participants represented by the high DP subgroup. Among predictors, self-esteem (negative), self-awareness (positive), and high numbers of life events had the most consistent effect on high DP. Affective and anxiety disorders and any mental disorder were significant outcomes of the high DP subgroup in both sexes at the time of young adulthood. This first report on DP based on longitudinal self-reports shows that DP is stable for a sizeable proportion of youth during adolescence and young adulthood. The predictors for DP share some similarity with those predicting psychopathology in general. However, so far there seems to be no heightened risk for the development of crime in the concerned individuals.
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Affiliation(s)
- Marcel Aebi
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, Zurich, Switzerland. .,Department of Forensic Psychiatry, University Hospital of Psychiatry, Neptunstrasse 60, 8032, Zurich, Switzerland.
| | - Christa Winkler Metzke
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, Zurich, Switzerland
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, Zurich, Switzerland.,Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland.,Department of Child and Adolescent Mental Health, University of Southern Denmark, Odense, Denmark.,Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
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203
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Salmanian M, Mohammadi MR, Hooshyari Z, Mostafavi SA, Zarafshan H, Khaleghi A, Ahmadi A, Alavi SS, Shakiba A, Rahgozar M, Safavi P, Arman S, Delpisheh A, Mohammadzadeh S, Hosseini SH, Ostovar R, Hojjat SK, Armani A, Talepasand S, Amiri S. Prevalence, comorbidities, and sociodemographic predictors of conduct disorder: the national epidemiology of Iranian children and adolescents psychiatric disorders (IRCAP). Eur Child Adolesc Psychiatry 2020; 29:1385-1399. [PMID: 31811577 DOI: 10.1007/s00787-019-01448-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/20/2019] [Indexed: 11/28/2022]
Abstract
The aim was to evaluate the lifetime prevalence of conduct disorder according to sociodemographic characteristics, determine the sociodemographic predictors of conduct disorder, and estimate the rates of comorbidities of psychiatric disorders in children and adolescents with conduct disorder by age and gender. The National Epidemiology of Iranian Children and Adolescents Psychiatric Disorders was a cross-sectional, general population-based study on 30,532 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Iranian citizens aged 6-18 years who resided at least 1 year in each province were included, and children and adolescents with severe physical illnesses that prevented them to participate in the study were excluded. The sample weighting adjustment was used, since we had randomly selected the equal number of 1000 participants of each province from the urban and rural areas. Trained psychologists conducted diagnostic interviews with the adolescents and the children's parents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). In this study, 54 children aged 6-9 years (0.58%, CI 0.47-0.77), 64 adolescents aged 10-14 years (0.57%, CI 0.47-0.77), and 117 adolescents aged 15-18 years (1.22%, CI 0.96-1.44) met the criteria of the lifetime conduct disorder. Conduct disorder was significantly more common in boys than in girls, and was significantly less prevalent among those participants whose fathers had no history of psychiatric hospitalization. Of the participants with conduct disorder, 83.4% met the criteria for at least one other psychiatric disorder. Conduct disorder had a high rate of comorbidity with oppositional defiant disorder (54.89%, CI 48.50-61.12), attention-deficit/hyperactivity disorder (32.34%, CI 26.68-38.56), tobacco use (20.43%, CI 15.77-26.04), and depressive disorders (18.30%, CI 13.88-23.74). Because of using the diagnostic instrument, we found a low total rate of prevalence for conduct disorder; however, higher rates of it were observed among boys and adolescents. Further studies are needed to explore the nature of comorbidities of conduct disorder and to consider them in a large clinical population.
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Affiliation(s)
- Maryam Salmanian
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran.
| | - Zahra Hooshyari
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran
| | - Seyed Ali Mostafavi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran
| | - Hadi Zarafshan
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran
| | - Ameneh Ahmadi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran
| | - Seyyed Salman Alavi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran
| | - Alia Shakiba
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Ave, Tehran, Iran
| | - Mehdi Rahgozar
- Department of Statistics and Computer, Social Welfare and Rehabilitation University, Tehran, Iran
| | - Parvin Safavi
- Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Soroor Arman
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Delpisheh
- Department of Clinical Epidemiology, Faculty of Medicine Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Soleiman Mohammadzadeh
- Department of Psychiatry, Neuroscience Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Seyed Hamzeh Hosseini
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rahim Ostovar
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Kaveh Hojjat
- Addiction and Behavioral Sciences Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Alireza Armani
- Department of Psychiatry, Zanjan University of Medical Science, Zanjan, Iran
| | | | - Shahrokh Amiri
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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204
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Retz W, Rösler M, Fischer R, Ose C, Ammer R. Methylphenidate treatment of adult ADHD patients improves the degree of ADHD severity under routine conditions. J Neural Transm (Vienna) 2020; 127:1427-1434. [PMID: 32880706 PMCID: PMC7497302 DOI: 10.1007/s00702-020-02226-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/11/2020] [Indexed: 12/02/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is associated with substantial personal and social impairments. Besides psychosocial interventions, current guidelines recommend a therapy with methylphenidate (MPH). This prospective, non-interventional study aims to investigate the efficacy and tolerability of MPH treatment of adult ADHD patients in a real-world setting. 468 adult patients with newly diagnosed ADHD were observed for 12-14 weeks. Primary efficacy endpoint was the clinical global impression (CGI) by the physician. Secondary endpoints comprise patient evaluation (Wender-Reimherr self-report, WR-SR), safety, tolerability, and dosage of MPH. With a mean daily dose of 35.8 (±17.0) mg MPH, the population of patients being severely/most extremely ill or markedly ill decreased by 64% and 61%, respectively. According to physicians' assessment (CGI), 74.5% of patients were identified as treatment responders. The total score of patient-based assessment (WR-SR) improved by 23.5% (50.1 ± 40.3 points) with the most profound improvement in attention deficit (-30.0%), disorganization (-26.6%), and hyperactivity / unrest (-23.3%). Self-evaluation revealed a responder rate of 35.4%. In summary, MPH treatment improves the degree of ADHD severity under routine conditions. In addition, activities of daily living were facilitated when taking MPH. The rather poor responder rates determined by patient assessment as well as the comparatively low applied mean daily dose of 35.8 mg (median 40 mg) indicate sub-optimal dosing under routine conditions, not exploiting the full beneficial therapeutic potential of MPH.
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Affiliation(s)
- Wolfgang Retz
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Mainz, Mainz, Germany
| | - Michael Rösler
- Institut für Gerichtliche Psychologie und Psychiatrie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421 Homburg/Saar, Germany
| | - Roland Fischer
- MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Claudia Ose
- Institut für Medizinische Informatik, Zentrum für Klinische Studien Essen, Universitätsklinikum Essen, Biometrie und Epidemiologie, Essen, Germany
| | - Richard Ammer
- MEDICE Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
- Klinik für Innere Medizin, Universitätsklinikum Muenster, Muenster, Germany
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205
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Dachew BA, Scott JG, Mamun A, Alati R. Hypertensive disorders of pregnancy and emotional and behavioural problems in children: a longitudinal population-based study. Eur Child Adolesc Psychiatry 2020; 29:1339-1348. [PMID: 31758357 DOI: 10.1007/s00787-019-01443-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022]
Abstract
There is evidence that offspring of mothers who have hypertensive disorders of pregnancy (HDP) are at increased risk of adverse health outcomes. This study aims to examine the association between maternal HDP and emotional- and behavioural problems in offspring at age 11 years as reported by teachers and parents. The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, population-based study that has followed a cohort of offspring since their mothers were pregnant. Childhood emotional- and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ), completed by parents (n = 7196) and the child's teacher (n = 7411). Maternal preeclampsia, but not gestational hypertension, was associated with teacher-reported total behavioural difficulties (RR = 1.62; 95% CI 1.03-2.52) and internalising problems in children [peer problems (RR = 1.48; 95% CI 1.06-2.08) and emotional problems (RR = 1.68; 95% CI 1.13-2.51)]. No associations between preeclampsia and/or gestational hypertension and parent-reported emotional- and behaviour problems were observed. Our study showed that children exposed to preeclampsia had higher risk of teacher-reported total behavioural difficulties and internalising problems compared with unexposed children. The findings suggest emotional- and behavioural difficulties may not be evident in all settings, hence the importance of collecting evidence from multiple informants.
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Affiliation(s)
- Berihun Assefa Dachew
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Abdullah Mamun
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia
| | - Rosa Alati
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Indooroopilly, Brisbane, QLD, 4068, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
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206
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Hanisch C, Eichelberger I, Richard S, Doepfner M. Effects of a modular teacher coaching program on child attention problems and disruptive behavior and on teachers’ self-efficacy and stress. SCHOOL PSYCHOLOGY INTERNATIONAL 2020. [DOI: 10.1177/0143034320958743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Symptoms of attention-deficit/hyperactivity and oppositional defiant disorder are associated with a multitude of psychosocial developmental risks, e.g. academic underachievement. Various cognitive behavioral interventions have proven to be effective in reducing problem behavior in school settings. Drawing on this previous work and on our parent-focused preventive and therapeutic programs, we developed the school-based coaching for elementary school teachers of children with attention deficits or disruptive behavior problems (SCEP). Based on functional behavior assessment, SCEP addresses teachers of children with severe externalizing behavior problems in an individualized modular manner. It consists of a one-day training course and fortnightly one-to-one or team-coaching sessions. We analyzed the effects of SCEP in a within-subject control group design ( N = 60), with student attention problems and rule-breaking behavior during class as the primary outcome measure. SCEP was found to reduce problem behavior during lessons, with small to medium effect sizes ( d = 0.42–0.6). After the intervention, teachers reported changes in their use of praise and felt more confident managing the class ( d = 0.58). The results of SCEP are discussed in light of multi-tiered preventive approaches that suggest extensive individualized interventions based on functional behavior analysis for children with severe problem behavior.
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Affiliation(s)
| | | | | | - Manfred Doepfner
- University of Cologne, Germany; University Hospital of the University of Cologne, Germany
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207
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Akbary A, Heydari ST, Sarikhani Y, Vossoughi M, Tabrizi R, Akabri M, Movahhedian N, Mani A, Sadeghi-Bazargani H, Ostovar T, Bagheri Lankarani K. Association between Adult Attention-Deficit/Hyperactivity Disorder and Driving Behaviors among Iranian Motorcyclists. Bull Emerg Trauma 2020; 8:163-168. [PMID: 32944576 DOI: 10.30476/beat.2020.84937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective To investigate the association between attention-deficit/hyperactivity disorder (ADHD) score and driving behaviors among motorcycle drivers in Iran. Methods This multi-center cross-sectional study was conducted on 1747 motorcyclists in three cities of Iran. We used a random sampling method in this study and gathered data using two standard questionnaires. Data were presented using descriptive statistics, also t-test, and ANOVA used for analysis. Results The mean age of participants was 27.41±8.80 years. ADHD scores of the participants ranged from 0 to 87, with a mean score 31±15.86. All risky driving behaviors (RDBs) were significantly associated with a higher mean of ADHD score. For example, driving with illegal speed (p<0.001), not wearing a crash helmet (p=0.016), driving while exhausting (p<0.001), talking with other passengers (p<0.001), being fined by the police in the past year (p=0.028), and maneuvering while driving (p<0.001) were related to a higher mean of ADHD score. Conclusion All RDBs were significantly associated with the ADHD score among motorcyclists in Iran. In this regard, health care providers should inform people with ADHD about the negative consequences associated with driving and ADHD. Public health policymakers should consider management of ADHD through a comprehensive approach to improve driving performance and competencies among motorcyclists in order to decrease RDBs and traffic accidents.
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Affiliation(s)
- Ali Akbary
- Department of Psychiatry, Faculty of Medicine, Social Development & Health Promotion Research Centre, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Akabri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najmeh Movahhedian
- Oral and Maxillofacial Radiology Department, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Mani
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Statistics & Epidemiology Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tahereh Ostovar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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208
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Spring-Assisted Strip Craniectomy Versus Cranial Vault Remodeling: Long-Term Psychological, Behavioral, and Executive Function Outcomes. J Craniofac Surg 2020; 31:2101-2105. [DOI: 10.1097/scs.0000000000006806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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209
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Lees B, Mewton L, Stapinski LA, Teesson M, Squeglia LM. Association of prenatal alcohol exposure with preadolescent alcohol sipping in the ABCD study®. Drug Alcohol Depend 2020; 214:108187. [PMID: 32731083 PMCID: PMC7425867 DOI: 10.1016/j.drugalcdep.2020.108187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Early alcohol use initiation is one of the strongest predictors of alcohol use disorders. Identifying modifiable risk factors for problematic alcohol use can guide prevention initiatives. Globally, approximately 10% of women consume alcohol during pregnancy, however the impact of prenatal alcohol exposure (PAE) on offspring alcohol use patterns has been understudied. The aim of this study was to examine associations between PAE and preadolescent alcohol use behaviors. METHODS Cross-sectional data were utilized from 10,119 children aged 9.0-10.9 years (M = 9.9, SD = 0.6) enrolled in the Adolescent Brain Cognitive Development Study®, based in the United States. Linear mixed models tested associations between PAE and endorsement of non-religious alcohol sipping in offspring, when adjusting for confounding factors. RESULTS In total, 2675 (26.4 %) youth were prenatally exposed to alcohol. Among PAE youth, total standard drinks consumed during pregnancy ranged from 0.4-90.0 drinks (M = 26.8, SD = 24.5). Compared to unexposed youth, those with any alcohol exposure during early pregnancy (∼0-7 weeks) were 1.7 times (95 % CI 1.4-2.0, p < .0001) more likely to endorse sipping alcohol by ages 9-10, while youth with low-level doses of alcohol throughout the entire pregnancy were 2.9 times (95 % CI 1.9-4.6, p < .0001) more likely to endorse sipping, when adjusting for confounding factors. A dose-dependent association between total standard drinks consumed during pregnancy and youth sipping endorsement was observed (β = 0.2, 95 % CI 0.1-0.2, p < .0001). CONCLUSIONS This study shows that any alcohol use during pregnancy may play an important role in very early alcohol use experimentation among offspring by ages 9-10.
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Affiliation(s)
- Briana Lees
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia.
| | - Louise Mewton
- Centre for Healthy Brain Ageing, University of New South Wales, Australia
| | - Lexine A Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States
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210
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Madjar N, Gazoli R, Manor I, Shoval G. Contrasting effects of music on reading comprehension in preadolescents with and without ADHD. Psychiatry Res 2020; 291:113207. [PMID: 32559672 DOI: 10.1016/j.psychres.2020.113207] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 01/25/2023]
Abstract
Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are advised to study in quiet settings; yet, many professionals assert that environments devoid of external stimulus, are often unnecessary to facilitate optimal learning conditions. Empirical controlled trials examining this assertion are scarce. This study explored whether music improves reading performance of preadolescents with ADHD compared with typically developed (TD) peers, and its correlation with changes in heart rate variability (HRV), an autonomic nervous system indicator. After a pilot phase (N = 20; age = 12.05), additional independent sample of ADHD (n = 25; age = 10.28) and TD (n = 25; age = 10.44) preadolescents completed reading tasks under four conditions: without background music, with calm music without lyrics, calm music with lyrics, and rhythmic music with lyrics. Reading comprehension and mean-levels of HRV changes (before and during each task) were assessed using validated instruments. Reading comprehension significantly improved under the music conditions in ADHD group and deteriorated among TD. Differences in HRV changes were significant between groups, and explained reading performance. These findings suggest that music may improve attentive skills of preadolescents with ADHD, but not TD, and urge the need to identify an optimal fit between individual and contextual characteristics.
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Affiliation(s)
- Nir Madjar
- School of Education, Bar-Ilan University, Ramat-Gan, 5290002 Israel.
| | - Rami Gazoli
- School of Education, Bar-Ilan University, Ramat-Gan, 5290002 Israel
| | - Iris Manor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 6997801 Israel; Geha Mental Health Center, Petach-Tikvah, Israel
| | - Gal Shoval
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 6997801 Israel; Geha Mental Health Center, Petach-Tikvah, Israel
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211
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Roslyne Wilkinson H, Jones Bartoli A. Antisocial behaviour and teacher-student relationship quality: The role of emotion-related abilities and callous-unemotional traits. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2020; 91:482-499. [PMID: 32777094 DOI: 10.1111/bjep.12376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 07/10/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Childhood antisocial behaviour has been associated with poorer teacher-student relationship (TSR) quality. It is also well-established that youth with antisocial behaviour have a range of emotion-related deficits, yet the impact of these students' emotion-related abilities on the TSR is not understood. Furthermore, the addition of the Limited Prosocial Emotions Specifier in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) indicates that understanding the role of callous-unemotional (CU) traits for youth with antisocial behaviour problems is of particular importance. AIMS The aim of this study was to investigate the association between antisocial behaviour difficulties and the TSR by examining the influence of emotion-related abilities and CU traits. SAMPLE Twelve teachers from 10 primary schools provided anonymized information on 108 children aged 6-11 years. RESULTS Antisocial behaviour was associated with higher teacher-student conflict (but not closeness) as well as higher emotion lability/negativity and lower emotion understanding/empathy. Emotion lability/negativity was associated with higher teacher-student conflict (but not closeness), and emotion understanding/empathy was associated with lower teacher-student conflict and higher closeness. CU traits were associated with higher teacher-student conflict and lower teacher-student closeness (controlling for antisocial behaviour more broadly). We found no evidence of a moderating effect of CU traits or emotion-related abilities on the association between antisocial behaviour and TSR quality. CONCLUSIONS Interventions for behaviour difficulties should consider teacher-student relationships in the classroom. Strategies which aim to improve teacher-student closeness as well as reduce teacher-student conflict may be of particular value to students with high CU traits.
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Affiliation(s)
- Hannah Roslyne Wilkinson
- Department of Psychological Sciences, Centre for Brain and Cognitive Development, Birkbeck College, University of London, UK
| | - Alice Jones Bartoli
- Unit for School and Family Studies, Department of Psychology, Goldsmiths, University of London, UK
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212
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Russell D, Stein MA. Seizure risk, methylphenidate, and ADHD: reassuring news. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:409-410. [PMID: 32450119 DOI: 10.1016/s2352-4642(20)30136-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Douglas Russell
- University of Washington School of Medicine, Seattle, WA 98145-5005, USA.
| | - Mark A Stein
- University of Washington School of Medicine, Seattle, WA 98145-5005, USA
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213
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Eskander N. The Psychosocial Outcome of Conduct and Oppositional Defiant Disorder in Children With Attention Deficit Hyperactivity Disorder. Cureus 2020; 12:e9521. [PMID: 32905151 PMCID: PMC7465825 DOI: 10.7759/cureus.9521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders diagnosed in children below the age of 12 years. It is characterized by hyperactivity, inattention, and impulsive behavior. ADHD affects the social, academic, and psychological aspects of children and adolescents. Children with ADHD struggle with school tasks and performance. They have lower grades than their peers and have difficulties interacting with their friends. Oppositional defiant disorder (ODD) is a mental disorder characterized by disruptive behavior, a pattern of angry and irritable mood, argumentative, and vindictive behavior. Children with ODD struggle with forming friendships and have problems at school. Conduct disorder (CD) is divided into the childhood onset and the adolescent onset types. The childhood onset is associated with poor outcomes in adulthood, an increase in criminal behavior, violence, and progression to antisocial behavior. Children with CD are at increased risk for substance use disorders (SUD) and antisocial personality disorder. The current literature review is aiming to provide an overview of the psychosocial impact of comorbid ODD and CD in children with ADHD. The results of this study review showed the comorbidity of ODD and CD is very strong. ODD is a strong predictor of CD in boys. The presence of comorbid ODD and ADHD in children is a significant predictor of adolescent onset CD. The comorbidity of ADHD with ODD and CD worsens symptom severity and is associated with high psychosocial dysfunction. Children with ADHD and comorbid ODD and CD have difficulties with school, friends, and trouble with the police.
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Affiliation(s)
- Noha Eskander
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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214
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May F, Ford T, Janssens A, Newlove-Delgado T, Emma Russell A, Salim J, Ukoumunne OC, Hayes R. Attainment, attendance, and school difficulties in UK primary schoolchildren with probable ADHD. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2020; 91:442-462. [PMID: 32740914 DOI: 10.1111/bjep.12375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/08/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Among children aged 6-16, there is a clear association between attention-deficit/hyperactivity disorder (ADHD) symptoms and academic attainment. We wanted to know whether this association was replicated in younger children. AIMS To explore the relationship between children aged 4-8 with probable ADHD and their academic attainment and school attendance. Secondly, the study aimed to explore their behaviour within school and their reported attitudes towards school. SAMPLE A total of 1,152 children who were taking part in the Supporting Teachers and Children in Schools (STARS) cluster randomized controlled trial. METHODS ADHD status was established by using the Strengths and Difficulties Questionnaire predictive algorithm to identify children with probable ADHD. Using baseline data, random-effects regression models on ADHD status were fitted to attainment, attendance, special educational needs (SEN) provision, and attitudes towards school and classroom behaviour; models that were also fitted to attainment were evaluated again at 9, 18, and 30 months after baseline. RESULTS Children with probable ADHD (n = 47) were more likely than controls (n = 1,105) to have below-expected attainment in literacy (odds ratio (OR) 16.7, 95% CI 6.93-to-40.1), numeracy (OR 11.3, 95% CI 5.34-to-24.1) and to be identified as having SEN (OR-55.2, 95%-CI 22.1-to-137). Their attendance was poorer with more unauthorized absences (rate ratio (RR)-1.91, 95%-CI-1.57-to-2.31). They had more teacher-reported behavioural problems (mean difference (MD) 5.0, 95%-CI 4.6-to-5.4) and less positive attitudes towards school (MD -1.1, 95% CI -0.56 to -1.85). Poorer attainment in literacy and numeracy persisted at all follow-ups. CONCLUSIONS Children aged as young as 4 whose behaviour indicates probable ADHD struggle to cope at school in terms of academic attainment, attendance, classroom behaviour, and attitude towards school when compared to other children. Early identification and intervention to help these children manage in school are needed.
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Affiliation(s)
- Felix May
- Exeter Medical School, University of Exeter, UK
| | - Tamsin Ford
- Department of Psychiatry, Child and Adolescent Psychiatry, Cambridge, UK
| | - Astrid Janssens
- Department of Public Health, University of Southern Denmark, Odense C, Denmark.,University of Exeter Medical School, UK
| | - Tamsin Newlove-Delgado
- Child Mental Health Research Group, Institute of Health Research, College of Medicine and Health, Exeter, UK
| | - Abigail Emma Russell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, UK
| | - Javid Salim
- Exeter Medical School, University of Exeter, UK
| | | | - Rachel Hayes
- Child Mental Health Research Group, Institute of Health Research, College of Medicine and Health, Exeter, UK
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215
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Gin K, Stewart C, Jolley S. A systematic literature review of childhood externalizing psychopathology and later psychotic symptoms. Clin Psychol Psychother 2020; 28:56-78. [DOI: 10.1002/cpp.2493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Kimberley Gin
- King's College London, Department of Psychology Institute of Psychiatry Psychology and Neuroscience London UK
| | - Catherine Stewart
- South London and Maudsley NHS Foundation Trust United Kingdom of Great Britain and Northern Ireland London UK
| | - Suzanne Jolley
- King's College London, Department of Psychology Institute of Psychiatry Psychology and Neuroscience London UK
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216
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Murray AL, Booth T, Eisner M, Ribeaud D, McKenzie K, Murray G. An Analysis of Response Shifts in Teacher Reports Associated with the Use of a Universal School-Based Intervention to Reduce Externalising Behaviour. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:1265-1273. [PMID: 30847752 PMCID: PMC6881257 DOI: 10.1007/s11121-019-00999-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
School-based psychosocial interventions are a widely used approach to prevent or reduce externalising behaviour. However, evaluating the effects of such interventions is complicated by the fact that the interventions may not only change the target behaviour, but also the way that informants report on that behaviour. For example, teachers may become more aware of bullying behaviour after delivering lessons on the topic, resulting in increased teacher reports of the behaviour. In this study, we used multi-group confirmatory factor analysis to evaluate whether teachers exposed to the Promoting Alternative Thinking Strategies (PATHS) intervention changed the way they reported on child externalising behaviour. Using data from the z-proso study (802 participants; 51% male; 69 teachers), teacher reports of aggressive behaviour, attention deficit hyperactivity disorder and non-aggressive conduct disorder symptoms were compared pre- and post- intervention and across the intervention and control conditions. There was no evidence that teacher reporting was affected by exposure to the intervention. This helps bolster the interpretation of intervention effects as reflecting changes in child behaviour, rather than in the manner of informant reporting.
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Affiliation(s)
- Aja Louise Murray
- Institute of Criminology, University of Cambridge, Sidgwick Avenue, Cambridge, CB3 9DA, UK.
- Department of Psychology, University of Edinburgh, Edinburgh, Scotland.
| | - Tom Booth
- Department of Psychology, University of Edinburgh, Edinburgh, Scotland
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Sidgwick Avenue, Cambridge, CB3 9DA, UK
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zürich, Switzerland
| | - Karen McKenzie
- Department of Psychology, Northumbria University, Newcastle upon Tyne, England
| | - George Murray
- Department of Psychology, Northumbria University, Newcastle upon Tyne, England
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217
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Dekkers TJ, Rapport MD, Calub CA, Eckrich SJ, Irurita C. ADHD and hyperactivity: The influence of cognitive processing demands on gross motor activity level in children. Child Neuropsychol 2020; 27:63-82. [PMID: 32662360 DOI: 10.1080/09297049.2020.1793924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Excessive gross motor activity is a prominent feature of children with ADHD, and accruing evidence indicates that their gross motor activity is significantly higher in situations associated with high relative to low working memory processing demands. It remains unknown, however, whether children's gross motor activity rises to an absolute level or accelerates incrementally as a function of increasingly more difficult cognitive processing demands imposed on the limited capacity working memory (WM) system - a question of both theoretical and applied significance. The present investigation examined the activity level of 8- to 12-year-old children with ADHD (n = 36) and Typically Developing (TD) children (n = 24) during multiple experimental conditions: a control condition with no storage and negligible WM processing demands; a short-term memory (STM) storage condition; and a sequence of WM conditions that required both STM and incrementally more difficult higher-order cognitive processing. Relative to the control condition, all children, regardless of diagnostic status, exhibited higher levels of gross motor activity while engaged in WM tasks that required STM alone and STM combined with upper level cognitive processing demands, and children with ADHD were motorically more active under all WM conditions relative to TD children. The increase in activity as a consequence of cognitive demand was similar for all experimental conditions. Findings suggest that upregulation of physical movement rises and remains relatively stable to promote arousal related mechanisms when engaged in cognitive activities involving WM for all children, and to a greater extent for children with ADHD.
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Affiliation(s)
- Tycho J Dekkers
- Department of Psychology, University of Central Florida , Orlando, FL, USA.,Department of Psychology, University of Amsterdam , Amsterdam, The Netherlands.,Academic Center for Child and Adolescent Psychiatry, de Bascule , Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Free University Medical Center, Amsterdam UMC , Amsterdam, The Netherlands
| | - Mark D Rapport
- Department of Psychology, University of Central Florida , Orlando, FL, USA
| | - Catrina A Calub
- Department of Psychology, University of Central Florida , Orlando, FL, USA
| | - Samuel J Eckrich
- Department of Psychology, University of Central Florida , Orlando, FL, USA
| | - Carolina Irurita
- Department of Psychology, University of Central Florida , Orlando, FL, USA
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218
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Meyer J, Öster C, Ramklint M, Isaksson J. You are not alone – adolescents’ experiences of participation in a structured skills training group for ADHD. Scand J Psychol 2020; 61:671-678. [DOI: 10.1111/sjop.12655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/12/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Jenny Meyer
- Department of Neuroscience Uppsala University Uppsala Sweden
| | - Caisa Öster
- Department of Neuroscience Uppsala University Uppsala Sweden
| | - Mia Ramklint
- Department of Neuroscience Uppsala University Uppsala Sweden
| | - Johan Isaksson
- Department of Neuroscience Uppsala University Uppsala Sweden
- Department of Women's and Children's Health Karolinska Institute Center of Neurodevelopmental Disorders (KIND) Centre for Psychiatry ResearchKarolinska InstituteStockholm Health Care ServicesStockholm County Council Stockholm Sweden
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219
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Heikkala E, Ala-Mursula L, Taimela S, Paananen M, Vaaramo E, Auvinen J, Karppinen J. Accumulated unhealthy behaviors and psychosocial problems in adolescence are associated with labor market exclusion in early adulthood - a northern Finland birth cohort 1986 study. BMC Public Health 2020; 20:869. [PMID: 32503491 PMCID: PMC7275307 DOI: 10.1186/s12889-020-08995-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background The relevance of health-related behaviors to exclusion from the labor market in early adulthood remains poorly studied in relation to the magnitude of the problem. We explored whether adolescents’ accumulated unhealthy behaviors and psychosocial problems are associated with later labor market exclusion, and whether multisite musculoskeletal pain (MMSP) impacts these relations. Methods We gathered questionnaire data on unhealthy behaviors and psychosocial problems and MMSP among adolescents aged 15 to 16 belonging to the Northern Finland Birth Cohort 1986. The findings were combined with registry data on unemployment, employment and permanent work disability during a five-year follow-up between the ages of 25 and 29 (n = 6692). In the statistical modeling we used education, family leave and socioeconomic status of childhood family as potential confounders, as well as latent class and logistic regression analyses. Results The Externalizing behavior cluster associated with over one year of unemployment (RR 1.64, CI 1.25–2.14) and permanent work disability (OR 2.49, CI 1.07–5.78) in the follow-up among the men. The Sedentary cluster also associated with over one year (RR 1.41, CI 1.13–1.75) and under one year of unemployment (RR 1.25, CI 1.02–1.52) and no employment days (RR 1.93, CI 1.26–2.95) among the men. Obese male participants were at risk of over one year of unemployment (RR 1.50, CI 1.08–2.09) and no employment days (RR 1.93, CI 1.07–3.50). Among the women, the Multiple risk behavior cluster related significantly to over one year of unemployment (RR 1.77, CI 1.37–2.28). MMSP had no influence on the associations. Conclusions Unhealthy behavior patterns and psychosocial problems in adolescence have long-term consequences for exclusion from the labor market in early adulthood, especially among men. Simultaneously supporting psychological well-being and healthy behaviors in adolescence may reduce labor market inclusion difficulties in the early phase of working life.
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Affiliation(s)
- Eveliina Heikkala
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland. .,Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland.
| | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, Aapistie 5B, 90150, Oulu, Finland
| | - Simo Taimela
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Töölö hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.,Clinicum, Department of Orthopedics and Traumatology, University of Helsinki, PO Box 266, 00029 HUS, Helsinki, Finland
| | - Markus Paananen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland
| | - Eeva Vaaramo
- Intrastructure for Population Studies, Faculty of Medicine, University of Oulu, Aapistie 5B, 90150, Oulu, Finland
| | - Juha Auvinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland.,Oulunkaari Health Center, Piisilta 1, 90110, Ii, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Aapistie 5B, 90150, Oulu, Finland.,Finnish Institute of Occupational Health, Aapistie 1, 90220, Oulu, Finland
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220
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Sportliche Aktivität als mögliche Therapieoption bei ADHS. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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221
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Njuwa KF, Simo LP, Ntani LL, Forchin AN, Parviel C, Tianyi Tianyi FL, Nsah B, Agbor VN. Factors associated with symptoms of attention deficit hyperactivity disorder among medical students in Cameroon: a web-based cross-sectional study. BMJ Open 2020; 10:e037297. [PMID: 32385066 PMCID: PMC7228532 DOI: 10.1136/bmjopen-2020-037297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a chronic mental disorder that is associated with poor productivity, with a significant impact on the quality of life. OBJECTIVES To determine factors associated with symptoms of ADHD among medical students in Cameroon. DESIGN A web-based cross-sectional study. SETTING Participants were recruited through a social media platform, WhatsApp, from 24 June to 2 September 2018. PARTICIPANTS Medical students aged 18 years and older from seven medical schools in Cameroon. All non-medical students and all medical residents were excluded. RESULTS Data from a total of 491 eligible participants were analysed. The median age was 25 (IQR 21-25) years and 54% were of the participants were female. The prevalence of self-reported symptoms of ADHD was 24.4% (95% CI 20.6% to 28.3%). Histories of chronic disease (adjusted OR (AOR) 2.96; 95% CI 1.49 to 5.86, p=0.002), family history of ADHD (AOR 3.38; 95% CI 1.04 to 10.44, p=0.035), severe depression (AOR=3.49; 95% CI 1.82 to 6.77, p<0.001) and anxiety disorder (AOR 2.06; 95% CI 1.25 to 3.36, p=0.004) were found to be independently associated with the symptoms of ADHD. CONCLUSION ADHD may be a highly prevalent mental disorder among medical students, and is associated with severe depression, anxiety disorders and chronic diseases. There is a need to conduct a large-scale prospective cohort study with interviews to estimate the true prevalence and incidence of ADHD among medical students in Cameroon, and to determinant the risk factors associated with the disorder.
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Affiliation(s)
- Karl Fai Njuwa
- Graduate School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Larissa Pone Simo
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon, Bamenda, Cameroon
| | | | | | - Chirsir Parviel
- Department of Population Health, Université Catholique de l'Afrique Centrale, Yaounde, Cameroon
| | | | - Bernard Nsah
- Institute of Health Informatics, University College London, London, UK
| | - Valirie Ndip Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
- Department of Health Research, Health Education and Research Organisation (HERO), Buea, Cameroon
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222
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Fonagy P, Butler S, Cottrell D, Scott S, Pilling S, Eisler I, Fuggle P, Kraam A, Byford S, Wason J, Smith JA, Anokhina A, Ellison R, Simes E, Ganguli P, Allison E, Goodyer IM. Multisystemic therapy compared with management as usual for adolescents at risk of offending: the START II RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background
The Systemic Therapy for At Risk Teens (START) trial is a randomised controlled trial of multisystemic therapy (MST) compared with management as usual (MAU). The present study reports on long-term follow-up of the trial (to 60 months).
Objectives
The primary objective was to compare MST and MAU for the proportion of young people in each group with criminal convictions up to 60 months post baseline. Secondary outcomes included group comparisons of psychological and behavioural factors. An economic analysis was carried out to determine the cost-effectiveness of MST compared with MAU. Two qualitative studies were conducted to better understand the subjective experiences of the participants.
Design
Primary outcomes (collected up to 60 months) were collected using a centralised police database. Secondary outcomes were evaluated using self-report questionnaires completed by both young people and parents or carers at the 24-, 36- and 48-month follow-ups. Research assistants were blind to treatment allocation.
Setting
Participants were recruited from participating MST sites in nine areas of England. Secondary outcomes were typically collected within the family home.
Participants
A total of 684 families were recruited into the START trial and allocated randomly to a treatment group. Of these, 487 remained in the second phase of the trial. Young people were aged, on average, 13.8 years at baseline, with 63% male and 37% female.
Interventions
MST is a manualised programme for young people exhibiting antisocial behaviour and their families that uses principles from cognitive–behavioural and family therapy to provide an individualised approach. MAU content was not prespecified, but consisted of the standard care offered to young people who met eligibility for the trial.
Main outcome measures
Young people’s offending was evaluated using the Police National Computer. Secondary measures included validated self-report measures completed by both the young person and their parent or carer. The economic evaluation took a broad perspective and outcomes were assessed in terms of quality-adjusted life-years and offending.
Results
No significant differences were found in the proportion of offending between the groups (hazard ratio 1.03, 95% confidence interval 0.84 to 1.26; p = 0.78). No differences were found between the groups on secondary outcome measures, with a few exceptions that did not hold up consistently across the follow-up period. The economic analysis did not find evidence to support the cost-effectiveness of MST compared with MAU. Outcomes from the qualitative studies suggest that families mostly felt positive about MST, and that MST was associated with greater maturity in young men.
Limitations
Some intended evaluations were not possible to deliver. Selective attrition may have influenced the nature of the sample size. It is also unclear how representative the MAU services were of reality.
Future research
Recommendations are made for the evaluation of MST in populations with more severe behavioural problems, as well as for identifying and testing new moderators.
Conclusions
The results of the second phase of the START trial do not support the long-term superiority of MST to MAU, but elements of the intervention may be adapted successfully.
Trial registration
Current Controlled Trials ISRCTN77132214 and London South-East REC registration number 09/H1102/55.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 23. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Stephen Butler
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Ivan Eisler
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Peter Fuggle
- Anna Freud National Centre for Children and Families, London, UK
| | - Abdullah Kraam
- Univesity of Leeds and South West Yorkshire Partnership NHS Foundation Trust, Leeds, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - James Wason
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Jonathan A Smith
- Department of Psychological Sciences, School of Science, Birkbeck, University of London, London, UK
| | - Alisa Anokhina
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Rachel Ellison
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Elizabeth Simes
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Ian M Goodyer
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Brunkhorst-Kanaan N, Verdenhalven M, Kittel-Schneider S, Vainieri I, Reif A, Grimm O. The Quantified Behavioral Test-A Confirmatory Test in the Diagnostic Process of Adult ADHD? Front Psychiatry 2020; 11:216. [PMID: 32265761 PMCID: PMC7100366 DOI: 10.3389/fpsyt.2020.00216] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/05/2020] [Indexed: 11/13/2022] Open
Abstract
The differential diagnosis of attention deficit hyperactivity disorder (ADHD) in adulthood is complicated by comorbid disorders, but also by the overlapping of main symptoms such as inattentiveness, impulsivity, and hyperactivity with other disorders. Neuropsychological tests like continuous performance tests (CPT) try to solve this dilemma by objectively measurable parameters. We investigated in a cohort of n=114 patients presenting to an ADHD outpatient clinic how well a commercially available CPT test (QbTest®) can differentiate between patients with ADHD (n=94) and patients with a disconfirmed ADHD diagnosis (n=20). Both groups showed numerous comorbidities, predominantly depression (27.2% in the ADHD group vs. 45% in the non-ADHD group) and substance-use disorders (18.1% vs. 10%, respectively). Patients with ADHD showed significant higher activity (2.07 ± 1.23) than patients without ADHD (1.34 ± 1.27, dF=112; p=0.019), whereas for the other core parameters, inattention and impulsivity no differences could be found. Reaction time variability has been discussed as a typical marker for inattention in ADHD. Therefore, we investigated how well ex-Gaussian analysis of response time can differentiate between ADHD and other patients, showing, that it does not help to identify patients with ADHD. Even though patients with ADHD showed significantly higher activity, this parameter differed only poorly between patients (accuracy AUC 65% of an ROC-Curve). We conclude that CPTs do not help to identify patients with ADHD in a specialized outpatient clinic. The usability of this test for differentiating between ADHD and other psychiatric disorders is poor and a sophisticated analysis of reaction time did not decisively increase the test accuracy.
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Affiliation(s)
- Nathalie Brunkhorst-Kanaan
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Moritz Verdenhalven
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Isabella Vainieri
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
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224
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Krauser C, Scherer ZAP, Bueno GADS. Behavior Disorders: knowledge and actions of health professionals and social work. Rev Bras Enferm 2020; 73:e20180071. [PMID: 32049226 DOI: 10.1590/0034-7167-2018-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/08/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify the knowledge of professionals of mental health services and social work on Behavior Disorders (BD) in childhood and adolescence, and to analyze their actions in care for children and adolescents with such disorders. METHOD a qualitative, descriptive-exploratory study with 13 professionals from two mental health services and two tutorial councils. The data were collected in interviews and submitted to thematic content analysis. RESULTS three categories emerged from the interviews: "Knowledge about behavior disorders", which defines BD as deviations from normality and lack of limits. "Integrated and group care", which explains the integrated, multidisciplinary and group actions. "Specialized and legal care", which explains the actions through specialized, medical and judicial care. FINAL CONSIDERATIONS the results point out weaknesses and knowledge gaps of professionals, causing potential harm in the programming of effective actions, such as identification, referral and therapeutic planning.
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225
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Ghirardi L, Chen Q, Chang Z, Kuja-Halkola R, Skoglund C, Quinn PD, D’Onofrio BM, Larsson H. Use of medication for attention-deficit/hyperactivity disorder and risk of unintentional injuries in children and adolescents with co-occurring neurodevelopmental disorders. J Child Psychol Psychiatry 2020; 61:140-147. [PMID: 31625605 PMCID: PMC6980200 DOI: 10.1111/jcpp.13136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is often associated with other neurodevelopmental disorders (NDs) and with risky behaviors and adverse health outcomes, including injuries. Treatment with ADHD medication has been associated with reduced risk of injuries. However, it is unknown whether the association is present in individuals with co-occurring NDs. The aim of the present study was to estimate the association between ADHD medication use and unintentional injuries in Sweden in children and adolescents with ADHD, including those with co-occurring NDs. METHODS Using a linkage of several national registers via the unique personal identification number, we identified individuals with a diagnosis of ADHD and of other NDs, including autism spectrum disorder, intellectual disability, communication disorders, learning disorders and motor disorders. The primary outcome was unintentional injuries. Secondary outcome was traumatic brain injury (TBI). Individuals were followed from January 1st 2006 or their 5th birthday or the date of the first unintentional injury, whichever came last, to December 31st 2013 or their 18th birthday or death, whichever came first. We compared the rate of injuries during periods on-treatment with the rate of injuries during periods off-treatment within the same individual using stratified Cox regression to calculate hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS For children and adolescents with ADHD (N = 9,421) the rate of any unintentional injuries (HR = 0.85; 95% CI = 0.78-0.92) and TBIs (HR = 0.27; 95% CIs = 0.20-0.38) during medicated periods was lower than during non-medicated periods. Similar results were found among individuals with co-occurring NDs (N = 2,986), for unintentional injuries (HR = 0.88; 95% CI = 0.77-1.01) and for TBIs (HR = 0.27; 95% CI = 0.16-0.44). CONCLUSIONS Beneficial effects of ADHD medication may extend beyond reduction of ADHD core symptoms to prevention of unintentional injuries in children and adolescents, including individuals with co-occurring NDs.
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Affiliation(s)
- Laura Ghirardi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Skoglund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
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226
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Öster C, Ramklint M, Meyer J, Isaksson J. How do adolescents with ADHD perceive and experience stress? An interview study. Nord J Psychiatry 2020; 74:123-130. [PMID: 31613179 DOI: 10.1080/08039488.2019.1677771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) is linked to high levels of perceived stress in adult populations. Thus, it is not surprising that stress managing techniques are being included in treatment protocols for adults with ADHD. There is, however, a paucity of studies on perceived stress in adolescents with ADHD.Aims: This study aims to explore how adolescents with ADHD perceive and experience stress (and stressors) using a qualitative approach.Methods: Explorative interviews were conducted with 20 adolescents (Mean age: 16.30) diagnosed with ADHD in conjunction with group treatment therapy. Data were analysed using qualitative content analysis.Results: Stress and ADHD, as well as stress, anxiety and ill-health, were described as closely intertwined. The result is presented in four categories: stress is often present, triggers of stress, stress affects daily life, and stress can be handled and prevented. A relation was found between stress and feelings of helplessness, ill-health and anxiety. Stress was viewed as being out of proportion with reality and was driven by such factors as ADHD symptoms, school demands, unpredictable situations and relational problems. Several negative consequences of stress were reported, including postponing schoolwork and the tendency to give up. Some participants also reported performing better when stressed. Accepting help from others, practising acceptance, settling down and controlling oneself, and planning in advance were seen as helpful stress managing techniques.Conclusions: Stress should be considered among other problems related to ADHD. Psychoeducation about stress, stress managing techniques and coaching should be included in the treatment of adolescents with ADHD.
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Affiliation(s)
- Caisa Öster
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Jenny Meyer
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Johan Isaksson
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Women's and Children's Health, Pediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institute (KIND), Karolinska Institute, Stockholm, Sweden
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227
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González RA, Vélez-Pastrana MC, Blankers M, Bäcker A, Konstenius M, Holtmann M, Levin FR, Noack M, Kaye S, Demetrovics Z, van de Glind G, van den Brink W, Schellekens A. Onset and Severity of Early Disruptive Behavioral Disorders in Treatment-Seeking Substance Use Disorder Patients with and without Attention-Deficit/Hyperactivity Disorder. Eur Addict Res 2020; 26:211-222. [PMID: 32594079 DOI: 10.1159/000508653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022]
Abstract
AIMS This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD. METHODS We examined data from the 2nd International ADHD in Substance Use Disorders Prevalence Study, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the Conners Adult ADHD Diagnostic Interview for DSM-IV, the MINI International Neuropsychiatric Interview, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated. RESULTS Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD. CONCLUSIONS ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD.
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Affiliation(s)
- Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom, .,Centre for Psychiatry, Imperial College London, London, United Kingdom,
| | - María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, USA
| | - Matthijs Blankers
- Arkin Mental Health Care, Department of Research, Amsterdam, The Netherlands.,Trimbos institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda Bäcker
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maija Konstenius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Moritz Noack
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geurt van de Glind
- Radboudumc, Donders Centre for Medical Neuroscience, Department of Psychiatry, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnt Schellekens
- Radboudumc, Donders Centre for Medical Neuroscience, Department of Psychiatry, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
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228
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Wigal SB, Hopkins SC, Koblan KS, Childress A, Kent JM, Tsai J, Hsu J, Loebel A, Goldman R. Efficacy and Safety of Dasotraline in Children With ADHD: A Laboratory Classroom Study. J Atten Disord 2020; 24:192-204. [PMID: 31375051 PMCID: PMC8129465 DOI: 10.1177/1087054719864644] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: To evaluate the efficacy and safety of dasotraline for treatment of ADHD in children. Method: Children (ages 6-12 years; N = 112) with ADHD were randomized, double-blind, to 14 days of once-daily evening doses of dasotraline 4 mg or placebo. ADHD symptom severity was measured at baseline and Day 15 in seven, 30-min classroom sessions using the Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) and the Permanent Product Measure of Performance (PERMP) math test. Results: Significant improvement was observed for dasotraline versus placebo in the SKAMP-combined score (-3.2 vs. +2.0; p < .001; effect size = 0.85) and SKAMP and PERMP subscale scores. The three most common adverse events for dasotraline (vs. placebo) were insomnia (19.6% vs. 3.6%), headache (10.7% vs. 8.9%), and decreased appetite (10.7% vs. 3.6%). Conclusion: In this laboratory classroom study, dasotraline 4 mg was found to be an efficacious and generally well-tolerated treatment for ADHD in children aged 6 to 12 years.
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Affiliation(s)
| | | | | | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Inc., Las Vegas, NV, USA
| | | | - Joyce Tsai
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Jay Hsu
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Robert Goldman
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
- Robert Goldman, Sunovion Pharmaceuticals, Inc., 84 Waterford Drive, Marlborough, MA 01752-7010, USA.
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229
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Slobodin O. The Utility of the CPT in the Diagnosis of ADHD in Individuals with Substance Abuse: A Systematic Review. Eur Addict Res 2020; 26:283-294. [PMID: 32535592 DOI: 10.1159/000508041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early identification of attention-deficit/hyperactivity disorder (ADHD) in individuals with substance use disorders (SUD) is important because ADHD has an adverse effect on the development and course of SUD. Given the limited validity of self-report measures of ADHD in individuals with SUD, it is important to investigate the utility of the continuous performance test (CPT) in classifying ADHD in adults with SUD. OBJECTIVE This review aims to examine the quantitative similarities and differences in CPT performance of adults with ADHD, SUD, and their comorbidity to determine if a distinct neurocognitive profile exists for each. METHOD A systematic review of CPT studies that included patients with the comorbidity of ADHD and SUD and a comparison group of one of the disorders alone was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. RESULTS Eight studies were identified with sample sizes ranging from n = 17 to n = 386. The comorbidity of ADHD and SUD was, mostly, not associated with higher rates of commission and omission errors than either disorder alone. However, the comorbidity of ADHD and SUD was more likely to be associated with increased deficits in response time variability compared with individuals with ADHD alone. CONCLUSIONS This review highlights the shortage of large-scale CPT research involving patients with ADHD and SUD. The CPT might be sensitive to attentional deficits, but it lacks specificity for the classification of adult ADHD, SUD, or their comorbidity, and the CPT is thus not useful in discriminating comorbid ADHD and SUD from either disorder alone. Future CPT research should explore whether specific attentional deficits account for the development and persistence of SUD. Such research should also reach beyond traditional CPT measures and include other cognitive and behavioral deficits that were associated with ADHD, such as distractibility and hyperactivity.
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Affiliation(s)
- Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Israel,
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230
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Kopak AM. Behavioral health indicators and time-to-rearrest in an adult pre-arrest diversion program. BEHAVIORAL SCIENCES & THE LAW 2020; 38:66-76. [PMID: 32065470 DOI: 10.1002/bsl.2452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
Several states have recently adopted legislation in support of pre-arrest diversion programs that give police the authority to refer adults with behavioral health needs to treatment providers instead of placing them under arrest and booking them into local jails. The Adult Civil Citation program has been operating since 2013 to divert adults accused for the first time of a misdemeanor offense to a community behavioral health provider with the primary goal of addressing underlying needs that are likely to be associated with future criminal justice contact. The current study analyzed data from a sample of 1,071 adults who participated in the program to assess the impact of behavioral health indicators on time-to-rearrest. Adults who presented greater behavioral health needs were more likely to come into subsequent contact with police, but these indications did not influence the amount of time that lapsed between program participation and rearrest events.
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Affiliation(s)
- Albert M Kopak
- Department of Criminology & Criminal Justice, Western Carolina University, Cullowhee, NC, USA
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231
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Moggi F, Schorno D, Soravia LM, Mohler-Kuo M, Estévez-Lamorte N, Studer J, Gmel G. Screened Attention Deficit/Hyperactivity Disorder as a Predictor of Substance Use Initiation and Escalation in Early Adulthood and the Role of Self-Reported Conduct Disorder and Sensation Seeking: A 5-Year Longitudinal Study with Young Adult Swiss Men. Eur Addict Res 2020; 26:233-244. [PMID: 32564034 PMCID: PMC7592926 DOI: 10.1159/000508304] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and sensation seeking (SS) have been consistently related to a higher risk of substance use (SU) and substance use disorder (SUD). OBJECTIVES To investigate the relationship between ADHD and prevalence rates in males at age 20 and age 25, the initiation of SU and SUD after age 20, and the escalation of SU from age 20 to age 25, and to explore the role of CD and SS in the relation of ADHD with SU and SUD initiation and escalation. METHOD Data were obtained as part of the Cohort Study on Substance Use Risk Factors (C-SURF), which focused on young Swiss men aged 20 years at baseline and 25 years at follow-up. RESULTS Participants who screened positive for ADHD at baseline exhibited a higher rate of SU and SUD than participants who screened negative. The presence of ADHD symptoms at age 20 predicted initiation of all SU between age 20 and age 25, except for alcohol and smoking. After controlling for self-reported CD and SS, ADHD still predicted this late initiation of use of hallucinogens, meth-/amphetamines, and ecstasy/MDMA; non-medical use of ADHD medication and sedatives, and alcohol use disorder (AUD). No escalation of weekly drinking and smoking or annual cannabis use was observed from age 20 to age 25. CONCLUSION Screened-positive ADHD is an independent predictor of late SU and AUD, along with self-reported CD and SS. From a public health perspective, identifying ADHD is not only important in childhood and adolescence but also in early adulthood to guide specific interventions to lower risks of drug use initiation and the development of AUD in early adulthood.
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Affiliation(s)
- Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,*Prof. Franz Moggi, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, CH–3000 Bern 60 (Switzerland),
| | - Deborah Schorno
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Leila Maria Soravia
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,Südhang Clinic, Research Deparment, Kirchlindach, Switzerland
| | - Meichun Mohler-Kuo
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Natialia Estévez-Lamorte
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Swiss Institute for the Prevention of Alcohol and Drug Problems, Research Department, Lausanne, Switzerland,Center for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada,University of the West of England, Faculty of Health and Social Sciences, Bristol, United Kingdom
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232
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Bellato A, Arora I, Hollis C, Groom MJ. Is autonomic nervous system function atypical in attention deficit hyperactivity disorder (ADHD)? A systematic review of the evidence. Neurosci Biobehav Rev 2020; 108:182-206. [DOI: 10.1016/j.neubiorev.2019.11.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 12/26/2022]
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233
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Icick R, Moggi F, Slobodin O, Dom G, Mathys F, van den Brink W, Levin FR, Blankers M, Kaye S, Demetrovics Z, van de Glind G, Velez-Pastrana MC, Schellekens ASA. Attention Deficit/Hyperactivity Disorder and Global Severity Profiles in Treatment-Seeking Patients with Substance Use Disorders. Eur Addict Res 2020; 26:201-210. [PMID: 32570249 DOI: 10.1159/000508546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Comorbid attention deficit/hyperactivity disorder (ADHD) is present in 15-25% of all patients seeking treatment for substance use disorders (SUDs). Some studies suggest that comorbid ADHD increases clinical severity related to SUDs, other psychiatric comorbidities, and social impairment, but could not disentangle their respective influences. OBJECTIVES To investigate whether comorbid adult ADHD in treatment-seeking SUD patients is associated with more severe clinical profiles in these domains assessed altogether. METHODS Treatment-seeking SUD patients from 8 countries (N = 1,294: 26% females, mean age 40 years [SD = 11 years]) were assessed for their history of DSM-IV ADHD, SUDs, and other psychiatric conditions and sociodemographic data. SUD patients with and without comorbid ADHD were compared on indicators of severity across 3 domains: addiction (number of SUD criteria and diagnoses), psychopathological complexity (mood disorders, borderline personality disorder, lifetime suicidal thoughts, or behavior), and social status (education level, occupational and marital status, and living arrangements). Regression models were built to account for confounders for each severity indicator. RESULTS Adult ADHD was present in 19% of the SUD patients. It was significantly associated with higher SUD severity, more frequent comorbid mood or borderline personality disorder, and less frequent "married" or "divorced" status, as compared with the absence of comorbid ADHD. ADHD comorbidity was independently associated with a higher number of dependence diagnoses (OR = 1.97) and more psychopathology (OR = 1.5), but not marital status. CONCLUSIONS In treatment-seeking SUD patients, comorbid ADHD is associated with polysubstance dependence, psychopathological complexity, and social risks, which substantiates the clinical relevance of screening, diagnosing, and treating ADHD in patients with SUDs.
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Affiliation(s)
- Romain Icick
- Integrative Neurobiology of Cholinergic Systems, CNRS UMR 3571, Institut Pasteur, Paris, France, .,Assistance Publique - Hôpitaux de Paris, University Hospital Saint-Louis - Lariboisière - Fernand Widal, Paris, France, .,INSERM UMR-S1144, Paris, France, .,Paris University, Paris, France,
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Israel
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium
| | - Frieda Mathys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam Institute for Addiction Research - Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute - Columbia University Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Matthijs Blankers
- Trimbos, Netherlands Institute of Mental Health and Addiction, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geurt van de Glind
- Psychiater Radboudumc, Donders Centre for Neuroscience, Afdeling Psychiatrie Wetenschappelijk, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | - Arnt S A Schellekens
- Psychiater Radboudumc, Donders Centre for Neuroscience, Afdeling Psychiatrie Wetenschappelijk, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
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Nystrand C, Feldman I, Enebrink P, Sampaio F. Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children. PLoS One 2019; 14:e0225503. [PMID: 31790442 PMCID: PMC6886776 DOI: 10.1371/journal.pone.0225503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems. METHODS A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5-12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other. RESULTS Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy. CONCLUSIONS Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.
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Affiliation(s)
- Camilla Nystrand
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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235
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The validity of conduct disorder symptom profiles in high-risk male youth. Eur Child Adolesc Psychiatry 2019; 28:1537-1546. [PMID: 31004293 DOI: 10.1007/s00787-019-01339-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/15/2019] [Indexed: 01/03/2023]
Abstract
Conduct disorder (CD) is a heterogeneous pattern of rule-breaking and aggressive symptoms. Until now it has been unclear whether valid, clinically useful symptom profiles can be defined for populations in youth at high-risk of CD. Interview-based psychiatric disorders, CD symptoms and officially recorded offences were assessed in boys from a detention facility and a forensic psychiatric hospital (N = 281; age 11.2-21.3 years). We used latent class analyses (LCA) to examine CD subtypes and their relationships with comorbid psychiatric disorders, suicidality, and criminal recidivism. LCA revealed five CD subtypes: no CD, mild aggressive CD, mild covert CD, moderate CD, and severe CD. The severe and, to a lesser degree, the moderate CD subtype were related to comorbid attention deficit hyperactivity disorder, substance use disorder, affective disorder, and suicidality. Time to violent criminal re-offending was predicted by severe CD (OR 5.98, CI 2.5-13.80) and moderate CD (OR 4.18, CI 1.89-9.21), but not by any other CD subtype in multivariate Cox regressions (controlling for age, low socioeconomic status and foreign nationality). These results confirm the existence of different CD symptom profiles in a high-risk group. Additional variable-oriented analyses with CD symptom count and aggressive/rule-breaking CD-dimensions further supported a dimensional view and a dose-response relationship of CD and criminal recidivism. Classifying high-risk young people according to the number of aggressive and rule-breaking CD symptoms is of major clinical importance and may provide information about risk of violent recidivism.
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236
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Sun S, Kuja-Halkola R, Faraone SV, D’Onofrio BM, Dalsgaard S, Chang Z, Larsson H. Association of Psychiatric Comorbidity With the Risk of Premature Death Among Children and Adults With Attention-Deficit/Hyperactivity Disorder. JAMA Psychiatry 2019; 76:1141-1149. [PMID: 31389973 PMCID: PMC6686979 DOI: 10.1001/jamapsychiatry.2019.1944] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE A previous register-based study reported elevated all-cause mortality in attention-deficit/hyperactivity disorder (ADHD), but cause-specific risks and the potential associations of psychiatric comorbidities remain unknown. OBJECTIVES To investigate the all-cause and cause-specific mortality risks in ADHD and to explore the potential role of psychiatric comorbidities. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used Swedish national registers to identify 2 675 615 individuals born in Sweden from January 1, 1983, through December 31, 2009, as the study population, among whom 86 670 individuals (3.2%) received a diagnosis of ADHD during follow-up. Follow-up was completed December 31, 2013, and data were analyzed from October 2018 through March 2019. EXPOSURES Attention-deficit/hyperactivity disorder identified by first clinical diagnosis or first prescription of ADHD medications as recorded in Swedish registers. Clinical diagnosis of psychiatric comorbidity was available in the National Patient Register. MAIN OUTCOMES AND MEASURES All-cause and cause-specific mortalities and hazard ratios (HRs) using Cox proportional hazards regression models. RESULTS In the overall cohort of 2 675 615 individuals, 1 374 790 (51.4%) were male (57 919 with an ADHD diagnosis) and 1 300 825 (48.6%) were female (28 751 with an ADHD diagnosis). Mean (SD) age at study entry was 6.4 (5.6) years. During follow-up, 424 individuals with ADHD and 6231 without ADHD died, resulting in mortality rates of 11.57 and 2.16 per 10 000 person-years, respectively. The association was stronger in adulthood (HR, 4.64; 95% CI, 4.11-5.25) compared with childhood (HR, 1.41; 95% CI, 0.97-2.04) and increased substantially with the number of psychiatric comorbidities with ADHD (HR for individuals with only ADHD, 1.41 [95% CI, 1.01-1.97]; HR for those with ≥4 comorbidities, 25.22 [95% CI, 19.60-32.46]). In adulthood, when adjusting for early-onset psychiatric comorbidity, the association between ADHD and risk of death due to natural causes was attenuated substantially and was no longer statistically significant (HR, 1.32; 95% CI, 0.94-1.85). When adjusting for later-onset psychiatric disorders, the association was attenuated to statistical nonsignificance for death due to suicide (HR, 1.13; 95% CI, 0.88-1.45) but remained statistically significant for death caused by unintentional injury (HR, 2.14; 95% CI, 1.71-2.68) or other external causes (HR, 1.75; 95% CI, 1.23-2.48). CONCLUSIONS AND RELEVANCE Psychiatric comorbidity appears to play an important role in all-cause and cause-specific mortality risks in ADHD. In adulthood, early-onset psychiatric comorbidity contributed primarily to the association with death due to natural causes, whereas later-onset psychiatric comorbidity mainly influenced death due to unnatural causes, including suicide and unintentional injury. These findings suggest that health care professionals should closely monitor specific psychiatric comorbidities in individuals with ADHD to identify high-risk groups for prevention efforts.
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Affiliation(s)
- Shihua Sun
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stephen V. Faraone
- Department of Psychiatry, State University of New York (SUNY) Upstate Medical University, Syracuse,Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Søren Dalsgaard
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,iPSYCH–The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark,Department for Child and Adolescent Psychiatry, Hospital of Telemark, Kragerø, Norway
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
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237
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Gardner MJ, Thomas HJ, Erskine HE. The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2019; 96:104082. [PMID: 31374447 DOI: 10.1016/j.chiabu.2019.104082] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Child maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders. METHODS Published cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment. RESULTS All forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14-2.87]; sexual abuse [OR = 2.11, 1.83-2.44]; physical abuse [OR = 1.78, 1.57-2.01]; emotional abuse [OR = 2.35, 1.74-3.18]; neglect [OR = 1.65, 1.35-2.02]; and exposure to IPV [OR = 1.68, 1.34-2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders ('any child maltreatment' [OR = 1.68, 1.33-2.4]; sexual abuse [OR = 1.90, 1.6-2.25]; physical abuse [OR = 1.56, 1.39-1.76]; and neglect [OR = 1.34, 1.09-1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD). CONCLUSIONS There is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.
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Affiliation(s)
- M J Gardner
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia.
| | - H J Thomas
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
| | - H E Erskine
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, Wacol, Queensland, Australia; The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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238
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Healy C, Gordon AA, Coughlan H, Clarke M, Kelleher I, Cannon M. Do childhood psychotic experiences improve the prediction of adolescent psychopathology? A longitudinal population-based study. Early Interv Psychiatry 2019; 13:1245-1251. [PMID: 30488567 DOI: 10.1111/eip.12762] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/14/2018] [Accepted: 11/04/2018] [Indexed: 12/19/2022]
Abstract
AIMS (a) To investigate the utility of childhood PE as a predictor of adolescent psychopathology while accounting for three known risk factors: childhood mental disorder; traumatic experiences and poor childhood functioning, and (b) to investigate the additive effects of including childhood PE in predictive clinical model of adolescent psychopathology. METHOD The study sample comprised of 86 Irish youths who completed two waves of the "Adolescent Brain Development" study (baseline age: 11.7 and follow-up age: 15.7). At baseline, participants completed a clinical interview assessing for PE, mental disorders, traumatic experiences and global functioning in childhood. The internalizing and externalizing problems sub-scales from the Youth Self Report questionnaire were used as follow-up outcomes variables in adolescence. RESULTS Logistic regression analyses revealed that childhood PE was the only predictor significantly associated with both internalizing (univariate OR: 7.58, CI: 2.59-22.15; multivariate OR: 5.43, CI: 1.53-19.29) and externalizing (univariate OR: 11.76, CI: 3.70-37.41; multivariate OR: 30.39, CI: 5.28-174.80) problems in adolescence. All predictive models with PE significantly predicted adolescent outcomes (area under the curve range: 0.70-0.81; all P < 0.05) and adding PE to the models improved the predictive value for externalizing problems (P = 0.02). CONCLUSION Childhood PE is a powerful predictor of adolescent psychopathology, particularly for externalizing problems. Routine assessment of PE and targeted support for children who report PE may reduce the incidence of mental disorder in adolescence.
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Affiliation(s)
- Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Aoife A Gordon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
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239
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Mental health problems and school performance in first graders: results of the prospective cohort study ikidS. Eur Child Adolesc Psychiatry 2019; 28:1341-1352. [PMID: 30809713 DOI: 10.1007/s00787-019-01296-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 02/12/2019] [Indexed: 12/16/2022]
Abstract
We aimed to estimate unbiased effects of mental health problems (MHPs) on school performance in first graders, with an emphasis on rigorous adjustment for potential confounders. A population-based prospective cohort study was performed in the area of Mainz-Bingen (Germany). In 2015, all preschoolers were approached, and the presence and type of MHP (externalising/internalising) and other physical chronic health conditions were identified by the preschool health examination and study-specific questionnaires. At the end of the first grade, school performance (reading, writing, numeracy, and science) was assessed by the class teacher and rated on a four-item scale ranging from - 8 to + 8. Of 3683 children approached, 2003 (54%) were enrolled. School performance was available for 1462 children (51% boys, mean age 7.3 years). Of these, 41% had signs of at least one MHP. Compared to children without indications of mental and physical chronic health conditions, children with MHPs had lower school performance scores [adjusted mean difference - 0.98, 95% CI (- 1.35; - 0.61); P < 0.001]. Regarding the type of MHP, externalising MHPs were associated with poor school performance [adjusted mean difference - 1.44, 95% CI (- 1.83; - 1.05); P < 0.001], while internalising MHPs were not. Children with hyperactivity inattention problems were most affected [adjusted mean difference - 1.96, 95% CI (- 2.36; - 1.56); P < 0.001]. Externalising MHPs and in particular hyperactivity inattention problems may already affect school performance in early primary school. Identification of children with externalising MHPs prior to school entry may help to prevent impaired academic achievement in affected children.
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240
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Evans SC, Cooley JL, Blossom JB, Pederson CA, Tampke EC, Fite PJ. Examining ODD/ADHD Symptom Dimensions as Predictors of Social, Emotional, and Academic Trajectories in Middle Childhood. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 49:912-929. [PMID: 31454272 DOI: 10.1080/15374416.2019.1644645] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The goal of this article is to investigate the symptom dimensions of oppositional defiant disorder (ODD; irritability, defiance) and attention deficit/hyperactivity disorder (ADHD; inattention, hyperactivity-impulsivity) as predictors of academic performance, depressive symptoms, and peer functioning in middle childhood. Children (N = 346; 51% female) were assessed via teacher-report on measures of ODD/ADHD symptoms at baseline (Grades K-2) and academic performance, depressive symptoms, peer rejection, and victimization on 7 occasions over 4 school years (K-2 through 3-5). Self-report and grade point average data collected in Grades 3-5 served as converging outcome measures. Latent growth curve and multiple regression models were estimated using a hierarchical/sensitivity approach to assess robustness and specificity of effects. Irritability predicted higher baseline depressive symptoms, peer rejection, and victimization, whereas defiance predicted higher baseline peer rejection; however, none of these ODD-related effects persisted 3 years later to Grades 3-5. In contrast, inattention predicted persistently poorer academic performance, persistently higher depressive symptoms, and higher baseline victimization; hyperactivity-impulsivity predicted subsequent peer rejection and victimization in Grades 3-5. In converging models, only inattention emerged as a robust predictor of 3-year outcomes (viz., grade point average, depressive symptoms, peer rejection, and relational victimization). Broadly, ODD dimensions-particularly irritability-may be linked to acute disturbances in social-emotional functioning in school-age children, whereas ADHD dimensions may predict more persistent patterns of peer, affective, and academic problems. By examining all 4 ODD/ADHD symptom dimensions simultaneously, the present analyses offer clarity and specificity regarding which dimensions affect what outcomes, and when. Findings underscore the importance of multidimensional approaches to research, assessment, and intervention.
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Affiliation(s)
| | - John L Cooley
- Developmental Psychobiology Research Group, Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Jennifer B Blossom
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | | | | | - Paula J Fite
- Clinical Child Psychology Program, University of Kansas
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241
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Chen VCH, Chan HL, Wu SI, Lee M, Lu ML, Liang HY, Dewey ME, Stewart R, Lee CTC. Attention-Deficit/Hyperactivity Disorder and Mortality Risk in Taiwan. JAMA Netw Open 2019; 2:e198714. [PMID: 31390039 PMCID: PMC6686778 DOI: 10.1001/jamanetworkopen.2019.8714] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Few studies have investigated levels of mortality in patients with attention-deficit/hyperactivity disorder (ADHD), and findings have been inconsistent and lacking information on specific causes of deaths. OBJECTIVE To investigate the association between ADHD and causes of death in Taiwan. DESIGN, SETTING, AND PARTICIPANTS A nationwide population-based cohort study was conducted using a cross-national Taiwanese registry. The ADHD group comprised 275 980 individuals aged 4 to 44 years with a new diagnosis between January 1, 2000, and December 31, 2012. All individuals with ADHD were compared with 1 931 860 sex- and age-matched controls without ADHD. EXPOSURES The association between ADHD and mortality was analyzed using a Cox regression model that controlled for sex, age, residence, insurance premium, outpatient visits, congenital anomaly, intellectual disability, depression disorder, autism, substance use disorder, conduct disorder, and oppositional defiant disorder. The analysis of suicide, unintentional injury, homicide, and natural-cause mortality was performed by a competing risk adjusted Cox regression controlling for other causes of mortality and potential confounding factors. MAIN OUTCOMES AND MEASURES Data on mortality from all causes, suicide, unintentional injury, homicide, and natural causes collected from a national mortality database. RESULTS There were 275 980 individuals with ADHD and 1 931 860 comparison individuals without ADHD in this study. Sex and age at index date were matched. The mean (SD) age was 9.61 (5.74) years for both groups. Most of the participants were male (209 406 in the ADHD group; 1 465 842 in the non-ADHD group; 75.88% for both groups). A total of 4321 participants from both cohorts died during the follow-up period (15.1 million person-years), including 727 (0.26%) from the ADHD group and 3594 (0.19%) from the non-ADHD group. Of those who died, 546 (75.1%) in the ADHD group and 2852 (79.4%) in the non-ADHD group were male. After adjusting for potential confounders, compared with the non-ADHD group, patients with ADHD showed higher overall mortality (adjusted hazard ratio, 1.07; 95% CI, 1.00-1.17) and higher injury-cause mortality from suicide (adjusted hazard ratio, 2.09; 95% CI, 1.62-2.71), unintentional injury (adjusted hazard ratio, 1.30; 95% CI, 1.10-1.52), and homicide (adjusted hazard ratio, 2.00; 95% CI, 1.09-3.68). No increased risk of natural-cause mortality was observed after adjustment. CONCLUSIONS AND RELEVANCE In this study, ADHD was associated with higher injury-cause mortality, particularly that due to suicide, unintentional injury, and homicide. Although the risk of injury mortality was significantly higher in patients with ADHD than in the non-ADHD group, the absolute risk of mortality was low.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry, Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital at Chiayi, Puzi, Taiwan
- Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Lin Chan
- Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung University and Chang Gung Memorial Hospital at Chiayi, Puzi, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Yi Liang
- Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Michael E. Dewey
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Charles Tzu-Chi Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
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242
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Whitten T, Laurens KR, Tzoumakis S, Kaggodaarachchi S, Green MJ, Harris F, Carr VJ, Dean K. The influence of parental offending on the continuity and discontinuity of children's internalizing and externalizing difficulties from early to middle childhood. Soc Psychiatry Psychiatr Epidemiol 2019; 54:965-975. [PMID: 30756149 DOI: 10.1007/s00127-019-01670-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/04/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Although parental criminal offending is a recognized risk factor for conduct problems among offspring, its impact on the continuity and discontinuity of children's behavioural and emotional difficulties during the early development is less well known. We used data from a large, population-based record-linkage project to examine the relationship between parental offending and the continuity and discontinuity of children's conduct, attentional, and emotional difficulties from early to middle childhood while also considering the role of timing of the parental offending exposure. METHOD Data for 19,208 children and their parents were drawn from the New South Wales Child Development Study. Multinomial regression analyses tested associations between mother's and father's history and timing of any and violent offending, and patterns of continuity or discontinuity in offspring emotional, conduct, and attentional difficulties between ages 5 and 11 years. RESULTS Maternal and paternal offending each conferred a significantly increased risk of all the patterns of developmental difficulties, including those limited to age 5 only (remitting problems), to age 11 only (incident problems), and to difficulties present at both ages 5 and 11 years (persisting problems). Greatest odds were observed for persisting conduct problems. Paternal offending that continued through early and middle childhood had the greatest association with child difficulties, while the timing of maternal offending had a less prominent effect on child developmental difficulties. CONCLUSION Parental offending is a strong risk factor for early and pervasive behavioural and emotional problems in offspring, and may be a key indicator of high risk for later antisocial behaviour.
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Affiliation(s)
- Tyson Whitten
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Stacy Tzoumakis
- School of Social Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
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243
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The relation between the age at diagnosis of problem behaviors related to aggression and distal outcomes in Swedish children. Eur Child Adolesc Psychiatry 2019; 28:899-911. [PMID: 30413982 DOI: 10.1007/s00787-018-1250-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/31/2018] [Indexed: 01/02/2023]
Abstract
Severe childhood aggressive behaviors are known to predict negative outcomes later in life; however, little is known about the effect of when in childhood aggression problems are diagnosed. While an earlier first diagnosis of problematic aggressive behavior might be associated with increased severity and, thus, worse outcomes, it is also possible that an earlier diagnosis affords an earlier start of treatment programs or indicates that greater attention is being paid to behavioral problems, thus resulting in attenuation of the severity of childhood aggression's impact on distal outcomes. The current study analyzed data from the population-based Swedish Data Registries, which include data on all children formally diagnosed by the Swedish medical system with a wide range of aggression problems between ages 8 and 18 (N = 5816) during the years 1987-2013, along with a matched control. Time-to-event analyses investigated whether the age at time of diagnosis affects later life outcomes while controlling for relevant confounders. Results show that for both boys and girls, those with a later diagnosis had lower average incomes (regression coefficient b = - 0.055, p < 0.005) and a higher probability of having a criminal record (odds ratio 1.126, p < 0.005) than children with earlier diagnoses. The effect on suicide attempts was not significant after correcting for multiple testing (odds ratio 1.264, p = 0.016). Grade score was not significantly affected. The results warrant further research concerning the potential advantage of earlier diagnoses, especially concerning generalizability beyond the Swedish population.
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244
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DeLisi M, Drury AJ, Elbert MJ. The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Compr Psychiatry 2019; 92:1-6. [PMID: 31079021 DOI: 10.1016/j.comppsych.2019.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/30/2019] [Accepted: 04/13/2019] [Indexed: 11/17/2022] Open
Abstract
Antisocial Personality Disorder (ASPD) is a severe personality disorder with robust associations with crime and violence, but its precise etiology is unknown. Drawing on near-population of federal correctional clients in the Midwestern United States, the current study examined antecedent background factors spanning adverse childhood experiences and childhood psychopathology. Greater adverse childhood experiences were associated with ASPD diagnosis with physical abuse showing associations with ASPD symptoms and sexual abuse with lifetime diagnosis for ASPD. Conduct Disorder was strongly linked to ASPD; however, Oppositional Defiant Disorder and ADHD had null associations. Given the role of environmental factors in the development of ASPD, greater criminological attention should be devoted to understanding how assorted forms of abuse and neglect coupled with childhood psychopathology contribute to ASPD especially given its linkages to severe criminal offending.
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Affiliation(s)
- Matt DeLisi
- Iowa State University, United States of America.
| | - Alan J Drury
- U.S. Probation and Pretrial Services, United States of America
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245
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Fairchild G, Hawes DJ, Frick PJ, Copeland WE, Odgers CL, Franke B, Freitag CM, De Brito SA. Conduct disorder. Nat Rev Dis Primers 2019; 5:43. [PMID: 31249310 DOI: 10.1038/s41572-019-0095-y] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
Conduct disorder (CD) is a common and highly impairing psychiatric disorder that usually emerges in childhood or adolescence and is characterized by severe antisocial and aggressive behaviour. It frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and often leads to antisocial personality disorder in adulthood. CD affects ~3% of school-aged children and is twice as prevalent in males than in females. This disorder can be subtyped according to age at onset (childhood-onset versus adolescent-onset) and the presence or absence of callous-unemotional traits (deficits in empathy and guilt). The aetiology of CD is complex, with contributions of both genetic and environmental risk factors and different forms of interplay among the two (gene-environment interaction and correlation). In addition, CD is associated with neurocognitive impairments; smaller grey matter volume in limbic regions such as the amygdala, insula and orbitofrontal cortex, and functional abnormalities in overlapping brain circuits responsible for emotion processing, emotion regulation and reinforcement-based decision-making have been reported. Lower hypothalamic-pituitary-adrenal axis and autonomic reactivity to stress has also been reported. Management of CD primarily involves parent-based or family-based psychosocial interventions, although stimulants and atypical antipsychotics are sometimes used, especially in individuals with comorbid ADHD.
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Affiliation(s)
| | - David J Hawes
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Paul J Frick
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA and Institute for Learning Science and Teacher Education, Australian Catholic University, Brisbane, Queensland, Australia
| | | | - Candice L Odgers
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, CA, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Stephane A De Brito
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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246
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Storebø OJ, Elmose Andersen M, Skoog M, Joost Hansen S, Simonsen E, Pedersen N, Tendal B, Callesen HE, Faltinsen E, Gluud C. Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev 2019; 6:CD008223. [PMID: 31222721 PMCID: PMC6587063 DOI: 10.1002/14651858.cd008223.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) in children is associated with hyperactivity and impulsivity, attention problems, and difficulties with social interactions. Pharmacological treatment may alleviate the symptoms of ADHD but this rarely solves difficulties with social interactions. Children with ADHD may benefit from interventions designed to improve their social skills. We examined the benefits and harms of social skills training on social skills, emotional competencies, general behaviour, ADHD symptoms, performance in school of children with ADHD, and adverse events. OBJECTIVES To assess the beneficial and harmful effects of social skills training in children and adolescents with ADHD. SEARCH METHODS In July 2018, we searched CENTRAL, MEDLINE, Embase, PsycINFO, 4 other databases and two trials registers.We also searched online conference abstracts, and contacted experts in the field for information about unpublished or ongoing randomised clinical trials. We did not limit our searches by language, year of publication, or type or status of publication, and we sought translation of the relevant sections of non-English language articles. SELECTION CRITERIA Randomised clinical trials investigating social skills training versus either no intervention or waiting-list control, with or without pharmacological treatment of both comparison groups of children and adolescents with ADHD. DATA COLLECTION AND ANALYSIS We conducted the review in accordance with the Cochrane Handbook for Systematic Reviews of Intervention. We performed the analyses using Review Manager 5 software and Trial Sequential Analysis. We assessed bias according to domains for systematic errors. We assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 25 randomised clinical trials described in 45 reports. The trials included a total of 2690 participants aged between five and 17 years. In 17 trials, participants were also diagnosed with various comorbidities.The social skills interventions were described as: 1) social skills training, 2) cognitive behavioural therapy, 3) multimodal behavioural/psychosocial therapy, 4) child life and attention skills treatment, 5) life skills training, 6) the "challenging horizon programme", 7) verbal self-instruction, 8) meta-cognitive training, 9) behavioural therapy, 10) behavioural and social skills treatment, and 11) psychosocial treatment. The control interventions were no intervention or waiting list.The duration of the interventions ranged from five weeks to two years. We considered the content of the social skills interventions to be comparable and based on a cognitive-behavioural model. Most of the trials compared child social skills training or parent training combined with medication versus medication alone. Some of the experimental interventions also included teacher consultations.More than half of the trials were at high risk of bias for generation of the allocation sequence and allocation concealment. No trial reported on blinding of participants and personnel. Most of the trials did not report on differences between groups in medication for comorbid disorders. We used all eligible trials in the meta-analyses, but downgraded the certainty of the evidence to low or very low.We found no clinically relevant treatment effect of social skills interventions on the primary outcome measures: teacher-rated social skills at end of treatment (standardised mean difference (SMD) 0.11, 95% confidence interval (CI) 0.00 to 0.22; 11 trials, 1271 participants; I2 = 0%; P = 0.05); teacher-rated emotional competencies at end of treatment (SMD -0.02, 95% CI -0.72 to 0.68; two trials, 129 participants; I2 = 74%; P = 0.96); or on teacher-rated general behaviour (SMD -0.06 (negative value better), 95% CI -0.19 to 0.06; eight trials, 1002 participants; I2 = 0%; P = 0.33). The effect on the primary outcome, teacher-rated social skills at end of treatment, corresponds to a MD of 1.22 points on the social skills rating system (SSRS) scale (95% CI 0.09 to 2.36). The minimal clinical relevant difference (10%) on the SSRS is 10.0 points (range 0 to 102 points on SSRS).We found evidence in favour of social skills training on teacher-rated core ADHD symptoms at end of treatment for all eligible trials (SMD -0.26, 95% CI -0.47 to -0.05; 14 trials, 1379 participants; I2= 69%; P = 0.02), but the finding is questionable due to lack of support from sensitivity analyses, high risk of bias, lack of clinical significance, high heterogeneity, and low certainty.The studies did not report any serious or non-serious adverse events. AUTHORS' CONCLUSIONS The review suggests that there is little evidence to support or refute social skills training for children and adolescents with ADHD. We may need more trials that are at low risk of bias and a sufficient number of participants to determine the efficacy of social skills training versus no training for ADHD. The evidence base regarding adolescents is especially weak.
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Affiliation(s)
- Ole Jakob Storebø
- Region ZealandChild and Adolescent Psychiatric DepartmentBirkevaenget 3RoskildeDenmark4300
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of Southern DenmarkDepartment of PsychologyCampusvej 55OdenseDenmark5230
| | | | - Maria Skoog
- Clinical Studies Sweden ‐ Forum SouthClinical Study SupportLundSweden
| | - Signe Joost Hansen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of Southern DenmarkDepartment of PsychologyCampusvej 55OdenseDenmark5230
| | - Erik Simonsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
- University of CopenhagenInstitute of Clinical Medicine, Faculty of Health and Medical SciencesCopenhagenDenmark
| | - Nadia Pedersen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
| | - Britta Tendal
- RigshospitaletThe Nordic Cochrane Centre9 Blegdamsvej, 3343CopenhagenDenmark2100
- Danish Health AuthorityIslands Brygge 67CopenhagenDenmark
| | | | - Erlend Faltinsen
- Region Zealand PsychiatryPsychiatric Research UnitSlagelseDenmark4000
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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247
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Blanco-Vieira T, Santos M, Ferrão YA, Torres AR, Miguel EC, Bloch MH, Leckman JF, do Rosario MC. The impact of attention deficit hyperactivity disorder in obsessive-compulsive disorder subjects. Depress Anxiety 2019; 36:533-542. [PMID: 30990937 DOI: 10.1002/da.22898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recent findings suggest an association between attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Thus, we evaluated the clinical associated features of ADHD in a large sample of adult OCD patients. METHODS A cross-sectional study including 955 adult patients with OCD from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinical characteristics in adult OCD patients with and without comorbid ADHD were compared using Fisher's exact test, t-tests or Mann-Whitney tests. Bivariate analyses were followed by logistic regression analysis to identify clinical characteristics independently associated with ADHD comorbidity. RESULTS The lifetime prevalence of ADHD in adult OCD patients was 13.7%. The current results indicate that OCD + ADHD patients were more severe, had an earlier onset of the obsessive-compulsive symptoms, a higher history of rheumatic fever, with higher frequencies of sensory phenomena and comorbidity with Tourette syndrome. They also had an increased risk for academic impairment and suicide attempts. CONCLUSION Adult OCD patients with ADHD present some specific clinical features and may represent a special subgroup of adult OCD. Future studies should focus on the development of interventions more tailored to the phenotype of this subgroup of patients.
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Affiliation(s)
- Thiago Blanco-Vieira
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Matheus Santos
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ygor A Ferrão
- Department od Psychiatry, Porto Alegre Health Science Federal University, Porto Alegre, Brazil.,Brazilian OCD Research Consortium (CTOC), Brazil
| | - Albina R Torres
- Brazilian OCD Research Consortium (CTOC), Brazil.,Department of Psychiatry, Faculty of Medicine of Botucatu, State University of São Paulo, São Paulo, Brazil
| | - Eurípedes C Miguel
- Brazilian OCD Research Consortium (CTOC), Brazil.,Psychiatry Institute, Department of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Maria C do Rosario
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Brazilian OCD Research Consortium (CTOC), Brazil.,Child Study Center, Yale University, New Haven, Connecticut
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248
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Gardner F, Leijten P, Harris V, Mann J, Hutchings J, Beecham J, Bonin EM, Berry V, McGilloway S, Gaspar M, João Seabra-Santos M, Orobio de Castro B, Menting A, Williams M, Axberg U, Morch WT, Scott S, Landau S. Equity effects of parenting interventions for child conduct problems: a pan-European individual participant data meta-analysis. Lancet Psychiatry 2019; 6:518-527. [PMID: 31072801 DOI: 10.1016/s2215-0366(19)30162-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Childhood conduct problems are a costly public health problem and are five times more common in socially disadvantaged groups than they are in advantaged groups. Untreated, conduct problems have a poor prognosis, with increasing gaps between socioeconomic groups, and high rates of subsequent criminality. Incredible Years is a high quality parenting programme for reducing conduct problems and is widely disseminated in Europe. Many trials have shown Incredible Years to be effective but the potential effects of parenting interventions on social inequality are unknown. Some behavioural interventions (eg, smoking cessation programmes), although beneficial overall, can widen inequality gaps. Because single trials and aggregate-level meta-analyses are ill equipped for examining differential intervention (moderator) effects, we pooled individual-level trial data to assess the effects of Incredible Years on social equity. METHODS We did a systematic review and individual participant data meta-analysis by searching CINAHL, Embase, Global Health, Medline, and PsycINFO, for studies published from inception to March 15, 2019. We also searched the Incredible Years website library and consulted with experts, including the European Incredible Years mentors' network. We included data from all completed randomised trials of the Incredible Years parenting intervention in Europe that included children aged 1-12 years, including unpublished trials, without restriction on publication year or outcome measures. We included prevention (selective or universal) and treatment or indicated prevention trials (for children diagnosed or above the clinical cutoff for conduct problems). We excluded trials or conditions within trials that were not randomised, included additional non-parenting material (eg, child-focused interventions), or were abbreviated, non-standard versions of the usual Incredible Years intervention of 12-14 weekly sessions. We requested individual participant data from the study authors. The primary outcome was child conduct problems, assessed using the Eyberg Child Behavior Inventory Intensity (ECBI-I) scale. Moderators were analysed using multilevel modelling with multiple imputation. FINDINGS Of 15 European trials of Incredible Years parenting programmes (n=1696 children), individual participant data were unavailable for one trial and one trial did not assess the primary outcome. Children were aged 2-10 years (median 5·1), 492 (30%) of 1651 children were from an ethnic minority and 931 (58%) of 1614 were from low-income families. Families who received the Incredible Years intervention reported an overall reduction in child conduct problems (13·5 points on the ECBI-I scale, 95% CI 10·9-16·1). There were no differential effects by family disadvantage (indicated by poverty, lone parenthood, teenage parenthood, household joblessness, or low education), or ethnic minority status. INTERPRETATION We found no evidence for differential effects by social disadvantage, suggesting that Incredible Years is unlikely to widen socioeconomic inequalities in conduct problems. Furthermore, the programme might be an important tool for reducing social disparities and improving poor long-term outcomes in disadvantaged families because follow-up studies indicate that benefits persist. Clinicians and commissioners can be reassured that the programme is similarly effective for families from different backgrounds. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Frances Gardner
- Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Patty Leijten
- Social Policy and Intervention, University of Oxford, Oxford, UK; University of Amsterdam, Amsterdam, Netherlands
| | - Victoria Harris
- Department of Biostatistics, King's College London, London, UK
| | - Joanna Mann
- Social Policy and Intervention, University of Oxford, Oxford, UK
| | | | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics, London, UK
| | - Vashti Berry
- Institute for Health Services Research, University of Exeter, Exeter, UK
| | | | - Maria Gaspar
- Psicologia e Ciências da Educação, University of Coimbra, Coimbra, Portugal
| | | | | | - Ankie Menting
- Department of Developmental Psychology, Utrecht University, Utrecht, Netherlands
| | | | - Ulf Axberg
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | | | - Stephen Scott
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics, King's College London, London, UK
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249
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Hsu YC, Chen CT, Yang HJ, Chou P. Family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD). Soc Psychiatry Psychiatr Epidemiol 2019; 54:661-670. [PMID: 30535676 DOI: 10.1007/s00127-018-1624-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD). METHODS We conducted a matched case-control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD. RESULTS 277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings. CONCLUSIONS Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.
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Affiliation(s)
- Yuan-Chang Hsu
- Department of Child and Adolescent Psychiatry, Tao-Yuan Psychiatric Center, Ministry of Health and Welfare, Taoyüan, Taiwan.,Institute of Public Health, National Yang-Ming University, 155 Li-Nong St., Sec. 2 Beitou, Taipei, Taiwan
| | - Chih-Tsai Chen
- Department of Child and Adolescent Psychiatry, Tao-Yuan Psychiatric Center, Ministry of Health and Welfare, Taoyüan, Taiwan
| | - Hao-Jan Yang
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan
| | - Pesus Chou
- Institute of Public Health, National Yang-Ming University, 155 Li-Nong St., Sec. 2 Beitou, Taipei, Taiwan. .,Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
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250
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Kritchman M, Koubi M, Mimouni Bloch A, Bloch Y. Effect of Methylphenidate on State Anxiety in Children With ADHD-A Single Dose, Placebo Controlled, Crossover Study. Front Behav Neurosci 2019; 13:106. [PMID: 31156406 PMCID: PMC6530494 DOI: 10.3389/fnbeh.2019.00106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/29/2019] [Indexed: 12/01/2022] Open
Abstract
Introduction: Non-adherence to efficacious pharmacotherapy is a major obstacle in the treatment of children suffering from attention deficit hyperactive disorder (ADHD). Some hold the position that pharmacotherapy induces anxiety, and that this is one of the reasons for this non-adherence. Previous studies have pointed to the opposite, a moderating effect of methylphenidate (MPH) on state anxiety in patients with ADHD. This has been shown in continuous treatment in children, but not on a single dose. We hypothesized that a single dose might have a different effect. Method: Twenty children with ADHD were given single doses of MPH in a randomized, controlled, crossover, double blind study. State anxiety using The Spielberger State-Trait Anxiety Inventory (STAI) and a continuous performance test were assessed. Results: As a group, no change was detected in state anxiety with MPH or placebo. However, children who were given MPH during the first session as opposed to those who received placebo first, demonstrated deterioration in baseline state anxiety in the second session [t(2.485), p < 0.05]. Conclusion: Our findings show a possible delayed anxiety-provoking effect of a single dose of MPH. This may be relevant to the understanding of difficulties in adherence with MPH treatment in children with ADHD. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT01798459
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Affiliation(s)
- Maya Kritchman
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - May Koubi
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel.,Child and Adolescent Outpatient Clinic, Shalvata Mental Health Care Center, Hod-Hasharon, Israel
| | - Aviva Mimouni Bloch
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Pediatric Neurology and Developmental Unit, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Yuval Bloch
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Child and Adolescent Outpatient Clinic, Shalvata Mental Health Care Center, Hod-Hasharon, Israel
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