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Bradford A, Meyer AND, Khan S, Giardina TD, Singh H. Diagnostic error in mental health: a review. BMJ Qual Saf 2024; 33:663-672. [PMID: 38575311 DOI: 10.1136/bmjqs-2023-016996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
Diagnostic errors are associated with patient harm and suboptimal outcomes. Despite national scientific efforts to advance definition, measurement and interventions for diagnostic error, diagnosis in mental health is not well represented in this ongoing work. We aimed to summarise the current state of research on diagnostic errors in mental health and identify opportunities to align future research with the emerging science of diagnostic safety. We review conceptual considerations for defining and measuring diagnostic error, the application of these concepts to mental health settings, and the methods and subject matter focus of recent studies of diagnostic error in mental health. We found that diagnostic error is well understood to be a problem in mental healthcare. Although few studies used clear definitions or frameworks for understanding diagnostic error in mental health, several studies of missed, wrong, delayed and disparate diagnosis of common mental disorders have identified various avenues for future research and development. Nevertheless, a lack of clear consensus on how to conceptualise, define and measure errors in diagnosis will pose a barrier to advancement. Further research should focus on identifying preventable missed opportunities in the diagnosis of mental disorders, which may uncover generalisable opportunities for improvement.
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Affiliation(s)
- Andrea Bradford
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Ashley N D Meyer
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Sundas Khan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Traber D Giardina
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Hardeep Singh
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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2
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Diehl E, O'Neill M, Gray L, Schwaede A, Kuntz N, Rao VK. Prevalence of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Individuals With Dystrophinopathy at a Tertiary Care Center in Chicago. Pediatr Neurol 2024; 158:94-99. [PMID: 39024712 DOI: 10.1016/j.pediatrneurol.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE To study the prevalence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in individuals with dystrophinopathy compared with the general population. METHODS Retrospective chart review to examine the prevalence of ADHD and ASD, diagnosed both formally and informally, in individuals with dystrophinopathy receiving care in the multidisciplinary neuromuscular clinic at the Ann and Robert H. Lurie Children's Hospital of Chicago. RESULTS Our results demonstrate an ADHD prevalence of 18.40% and ASD prevalence of 12.73%, both significantly higher than those reported for the general population. Our results revealed a significant association between ADHD diagnosis and a positive family history but did not show a statistically significant association between prevalence of ADHD and the use of steroids. CONCLUSION Based on our current study results, we plan to further evaluate the prevalence, in a prospective cross-sectional manner, using validated screens for both ADHD and ASD.
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Affiliation(s)
- Emily Diehl
- Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Meghan O'Neill
- Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Developmental and Behavioral Pediatrics, Ann and Robert Lurie Children's Hospital, Chicago, Illinois
| | - Larry Gray
- Division of Developmental and Behavioral Pediatrics, Ann and Robert Lurie Children's Hospital, Chicago, Illinois
| | - Abigail Schwaede
- Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nancy Kuntz
- Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vamshi K Rao
- Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sweere DJJ, Hendriksen JGM, Jeroen Vermeulen R, Klinkenberg S. Efficacy of methylphenidate treatment in childhood myotonic dystrophy type 1 and comorbid attention deficit hyperactivity disorder: A case report using eye tracking assessment. Brain Dev 2024; 46:118-121. [PMID: 38007339 DOI: 10.1016/j.braindev.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Despite the increased prevalence of comorbid attention deficit hyperactivity disorder (ADHD) in children with myotonic dystrophy type 1, the effects of methylphenidate treatment on associated cognitive deficits in this population is not yet investigated. CASE We describe a case study of an eleven-year-old male patient with myotonic dystrophy type 1 and comorbid ADHD that was treated with methylphenidate in a twice daily regime (0.60 mg/kg/day). Positive effects on learning and cognition were reported by the parents and teachers. No negative side effects were reported. Sequential neuropsychological assessments before and 45 minutes after methylphenidate intake were conducted to quantify the cognitive effects of methylphenidate treatment. Significant improvements in regulation of attention were behaviorally observed and were quantified using eye tracking technology. CONCLUSION We conclude that methylphenidate may be an effective treatment for ADHD-related cognitive deficits and learning difficulties in children with myotonic dystrophy type 1 which merits further research.
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Affiliation(s)
- Dirk J J Sweere
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.
| | - Jos G M Hendriksen
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands
| | - R Jeroen Vermeulen
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Maastricht University Medical Centre, Department of Neurology, Maastricht, the Netherlands
| | - Sylvia Klinkenberg
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands; Maastricht University Medical Centre, Department of Neurology, Maastricht, the Netherlands
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4
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Barone H, Elgen IB, Bliksrud YT, Vangsøy Hansen E, Skavhellen RR, Furevik MI, Haavik J. Case report: ADHD and prognosis in tyrosinemia type 1. Front Psychiatry 2023; 14:1213590. [PMID: 37533886 PMCID: PMC10392124 DOI: 10.3389/fpsyt.2023.1213590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/26/2023] [Indexed: 08/04/2023] Open
Abstract
Neurometabolic disorders such as tyrosinemia type 1 (TYRSN1) may interfere with brain metabolism and show symptoms of attention-deficit hyperactivity disorder (ADHD) in patients treated with the enzyme inhibitor nitisinone [2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione, NTBC]. It has been reported that ADHD treatment improves treatment compliance, which is imperative for the long-term prognosis of patients with TYRSN1. In this study, we report the case of a male patient who was diagnosed with TYRSN1 at 3 months of age and was subsequently treated with NTBC, restricted protein intake, and amino acids supplementation. At 7 years of age, he was referred for neuropsychiatric assessment, diagnosed with ADHD, and treated with methylphenidate. The effects of the treatment were monitored via parental interviews, questionnaires covering ADHD symptoms, and a continuous performance test. A reduction in ADHD symptoms, particularly inattentiveness, was observed across all measures. The early identification of ADHD and the treatment of neurometabolic disorders, such as TYRSN1, may be important from a lifetime perspective as this may improve the prognosis of the medical condition as well.
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Affiliation(s)
- Helene Barone
- Regional Resource Center for Autism, ADHD and Tourette Syndrome, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | | | - Rita Rigmor Skavhellen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Magne Ivar Furevik
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jan Haavik
- Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
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Boulton KA, Guastella AJ, Hodge MA, Demetriou EA, Ong N, Silove N. Mental health concerns in children with neurodevelopmental conditions attending a developmental assessment service. J Affect Disord 2023; 335:264-272. [PMID: 37119867 DOI: 10.1016/j.jad.2023.04.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/20/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Children with neurodevelopmental conditions (NDCs) experience co-occurring mental health concerns. Little research has examined mental health symptoms in children attending developmental assessment services. This study profiled mental health symptoms in children with NDCs attending a hospital-based diagnostic service for their first diagnostic assessment. Participants were 232 children aged 1.96-17.51 years. Mental health concerns were assessed using the Child Behavior Checklist (CBCL), a caregiver-rated, questionnaire-based assessment of behavioural and emotional difficulties. Subclinical or clinically elevated internalising, externalising and total scores on the CBCL were reported in over one third of children. These increased prevalence rates remained after excluding items specifically relating to neurodevelopmental concerns. More school-aged females reported elevated internalising problems, relative to males (67 % vs 48 %). The number of diagnoses impacted symptoms, with children who received two or more DSM-5 diagnoses showing a greater rate of subclinical or clinically elevated scores, relative to children who received one DSM-5 diagnosis. Our findings demonstrate that children attending developmental assessment services have considerable mental health needs. It is critical that mental health concerns are identified and addressed in children when they first present to developmental assessment services, and that service providers are equipped to provide appropriate resources and pathways to ongoing care.
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Affiliation(s)
- Kelsie A Boulton
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia.
| | - Adam J Guastella
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia
| | - Marie-Antoinette Hodge
- Child Development Unit, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia
| | - Eleni A Demetriou
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia
| | - Natalie Ong
- Child Development Unit, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Natalie Silove
- Child Development Unit, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia
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Becker-Haimes EM, Wislocki K, DiDonato S, Beidas RS, Jensen-Doss A. Youth Trauma Histories are Associated with Under-diagnosis and Under-treatment of Co-occurring Youth Psychiatric Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:184-195. [PMID: 34038229 PMCID: PMC8617069 DOI: 10.1080/15374416.2021.1923020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We examined whether in the presence of trauma exposure, non-traumatic stress-related symptoms are interpreted by mental health clinicians as less salient than the trauma exposure and are de-emphasized as a treatment target, consistent with a diagnostic overshadowing bias. METHODS Using an adapted version of a diagnostic overshadowing bias experimental paradigm, mental health clinicians (N = 266, M age = 34.4 years, 82% female) were randomly assigned to receive two of six clinical vignette variations. Vignette 1 described an adolescent with obsessive-compulsive disorder (OCD). Vignette 2 described a pre-adolescent with oppositional defiant disorder (ODD). Vignettes were identical except for whether the youth reported exposure to a potentially traumatic event (PTE; no PTE, sexual PTE, or physical PTE). Clinicians received one vignette with a PTE and one without, counterbalancing order. Clinicians rated the likelihood the youth met criteria for various diagnoses and the appropriateness of various treatments on 7-point scales. RESULTS Across both vignettes, clinicians rated the target diagnosis (OCD in Vignette 1, ODD in Vignette 2) as less likely for vignettes with a PTE than for the same vignettes without a PTE. Clinicians also rated evidence-based treatment modalities for target diagnoses as less appropriate in the presence of a PTE than when a PTE was present. CONCLUSIONS Consistent with possible bias, clinicians may under-recognize and under-treat non-traumatic stress-related mental health symptoms in youth with a co-occurring trauma history. Future work to validate this bias in real-world practice is indicated.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA
- Hall Mercer Community Mental Health, University of
Pennsylvania Health System
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA
| | - Stephen DiDonato
- College of Nursing, Thomas Jefferson University,
Philadelphia, PA
| | - Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA
- Department of Medical Ethics and Health Policy, University
of Perelman School of Medicine, Philadelphia, PA
- Penn Implementation Science Center at the Leonard Davis
Institute of Health Economics (PISCE@LDI), University of Pennsylvania
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7
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Closing the nursing leadership gap: Leveraging partnerships with people with intellectual disabilities and developmental disabilities. Nurs Outlook 2022; 70:783-785. [PMID: 36085060 DOI: 10.1016/j.outlook.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022]
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8
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Clinical Utility of Eye Tracking in Assessing Distractibility in Children with Neurological Disorders or ADHD: A Cross-Sectional Study. Brain Sci 2022; 12:brainsci12101369. [PMID: 36291303 PMCID: PMC9599566 DOI: 10.3390/brainsci12101369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to investigate distractibility quantified by recording and analyzing eye movements during task-irrelevant distraction in children with and without ADHD and in children with and without neurological disorders. Gaze behavior data and press latencies of 141 participants aged 6−17 that were collected during a computerized distraction paradigm with task-irrelevant stimuli (IDistrack) were analyzed. Children using attention-regulating medication were excluded from participation. Data were analyzed for subgroups that were formed based on the presence of neurological disorders and the presence of ADHD separately. Participants with ADHD and participants with neurological disorders spent less time fixating on the target stimuli compared to their peers without ADHD (p = 0.025) or their peers without neurological disorders (p < 0.001). Participants with and without ADHD had equal press latencies (p = 0.79). Participants with neurological disorders had a greater press latency compared to their typically developing peers (p < 0.001). Target fixation duration shows a significant association with parent-reported attention problems (r = −0.39, p < 0.001). We conclude that eye tracking during a distraction task reveals potentially valid clinical information that may contribute to the assessment of dysfunctional attentional processes. Further research on the validity and reliability of this paradigm is recommended.
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9
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Taylor LE, Kaplan-Kahn EA, Lighthall RA, Antshel KM. Adult-Onset ADHD: A Critical Analysis and Alternative Explanations. Child Psychiatry Hum Dev 2022; 53:635-653. [PMID: 33738692 DOI: 10.1007/s10578-021-01159-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is characterized as a neurodevelopmental disorder. However, data from several recent studies suggest that there may be adults who meet current criteria for ADHD, yet did not experience symptoms until adulthood (i.e., "adult-onset ADHD"). This systematic review evaluated and synthesized the empirical evidence on adult-onset ADHD to answer the question: Is the extant literature strong enough to evaluate adult-onset ADHD? Nine studies met strict inclusion/exclusion criteria. Results suggest that the methodologies of the extant studies were not strong enough to evaluate adult-onset ADHD. Insufficient methodologies provide presently unclear information about the nature of late-onset symptoms. These symptoms seem to exist but their source could be (1) adult-emergent symptoms that were previously surpassed due to lower environmental demands/supportive facilitators, (2) mimics that were not properly assessed, or (3) childhood-onset symptoms that were not detected earlier due to failure to come to clinical attention. Future directions, clinical recommendations, and limitations of the literature and the current review are discussed.
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Affiliation(s)
- Lea E Taylor
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA.
| | | | | | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, 13244, USA
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10
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Bjorgaas HM, Elgen IB, Hysing M. Mental Health in Pre-Adolescents with Cerebral Palsy: Exploring the Strengths and Difficulties Questionnaire as a Screening Tool in a Follow-Up Study including Multi-Informants. CHILDREN 2022; 9:children9071009. [PMID: 35883993 PMCID: PMC9318898 DOI: 10.3390/children9071009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
There is a high prevalence of mental health problems in children with Cerebral Palsy (CP). Still, knowledge regarding the trajectory of mental health problems throughout childhood and differences according to informants is lacking. There is also a need for more knowledge regarding the validity of mental health screening tools. In the present study, we assessed changes in parent-rated mental health problems in a cohort of 36 children with CP from school-starting age to pre-adolescence and differences in mental health problems according to informants. Further, we assessed the validity of the Strengths and Difficulties Questionnaire (SDQ) for psychiatric disorders. The study cohort was assessed using the SDQ and a child psychiatric diagnostic instrument at school-starting age and at pre-adolescence. Mean parental SDQ scores increased significantly for emotional, hyperactivity and total problems. Self-reported impact of mental health problems was significantly lower than parent-reported impact, and parents and pre-adolescents reported significantly higher mean scores than teachers for emotional problems, conduct problems and total problem scores. Validated against psychiatric disorders, the SDQ was satisfactory for screening children with CP for risk of psychiatric disorders at pre-adolescence. We recommend that mental health screening be integrated into the regular follow-up for children with CP.
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Affiliation(s)
- Hanne Marit Bjorgaas
- Department of Pediatric Neurology, Habu Stavanger, Stavanger University Hospital, Stavanger HF, 4068 Stavanger, Norway
- Correspondence: ; Tel.: +47-98895956
| | - Irene Bircow Elgen
- Department of Clinical Medicine, Bergen University Hospital, 5020 Bergen, Norway;
| | - Mari Hysing
- Department of Psychosocial Science, University of Bergen, 5020 Bergen, Norway;
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11
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Esbensen AJ, Vincent LB, Epstein JN, Kamimura-Nishimura K, Wiley S, Angkustsiri K, Abbeduto L, Fidler D, Anixt JS, Froehlich TE. Co-occurring medical and behavioural conditions in children with Down syndrome with or without ADHD symptom presentation. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:282-296. [PMID: 34939724 PMCID: PMC8816818 DOI: 10.1111/jir.12911] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Co-occurring attention deficit hyperactivity disorder (ADHD) is a challenge to characterise in the presence of other medical conditions commonly present in children with Down syndrome (DS). The current study examined differences among children with DS with or without ADHD symptomatology in terms of demographics, developmental level, co-occurring medical conditions, and parent and teacher ratings of behaviour and executive functioning. METHODS Parents and teachers of 108 school-age children with DS provided ratings of ADHD symptoms, behaviour problems and executive functioning skills. Children with DS and ADHD symptom presentation, as identified by a scoring algorithm, were compared with those without ADHD symptom presentation on demographic characteristics, developmental level, co-occurring medical conditions and parent-report and teacher-report measures of behaviours and executive functioning. RESULTS Sleep disorders, disruptive behaviour disorder, allergies and seizures were more common in children with DS and ADHD symptom presentation than in children without ADHD symptom presentation. After controlling for ADHD medication use, children with DS and ADHD symptom presentation had poorer performance than those without ADHD symptom presentation on parent behaviour ratings, teacher behaviour ratings and parent but not teacher ratings of executive functioning. No significant group differences in demographic characteristics or developmental level were identified. CONCLUSIONS Higher rates of co-occurring medical conditions present in children with DS and ADHD symptom presentation support the need for thorough differential diagnoses. The different pattern of group differences between parent-report and teacher-report has implications for diagnostic practices across settings as well as for treatment.
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Affiliation(s)
- Anna J. Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | | | - Jeffery N. Epstein
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center
| | - Kelly Kamimura-Nishimura
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Susan Wiley
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Kathleen Angkustsiri
- MIND Institute, University of California, Davis
- Department of Pediatrics, University of California, Davis
| | - Leonard Abbeduto
- MIND Institute, University of California, Davis
- Department of Psychiatry and Behavioral Sciences, University of California, Davis
| | - Deborah Fidler
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO
| | - Julia S. Anixt
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Tanya E. Froehlich
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
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12
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Boulton KA, Coghill D, Silove N, Pellicano E, Whitehouse AJO, Bellgrove MA, Rinehart NJ, Lah S, Redoblado‐Hodge M, Badawi N, Heussler H, Rogerson N, Burns J, Farrar MA, Nanan R, Novak I, Goldwater MB, Munro N, Togher L, Nassar N, Quinn P, Middeldorp CM, Guastella AJ. A national harmonised data collection network for neurodevelopmental disorders: A transdiagnostic assessment protocol for neurodevelopment, mental health, functioning and well-being. JCPP ADVANCES 2021; 1:e12048. [PMID: 37431407 PMCID: PMC10242941 DOI: 10.1002/jcv2.12048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/11/2021] [Indexed: 01/03/2023] Open
Abstract
Background Children with neurodevelopmental disorders share common phenotypes, support needs and comorbidities. Such overlap suggests the value of transdiagnostic assessment pathways that contribute to knowledge about research and clinical needs of these children and their families. Despite this, large transdiagnostic data collection networks for neurodevelopmental disorders are not well developed. This paper describes the development of a nationally supported transdiagnostic clinical and research assessment protocol across Australia. The vision is to establish a harmonised network for data collection and collaboration that promotes transdiagnostic clinical practice and research. Methods Clinicians, researchers and community groups across Australia were consulted using surveys and national summits to identify assessment instruments and unmet needs. A national research committee was formed and, using a consensus approach, selected assessment instruments according to pre-determined criteria to form a harmonised transdiagnostic assessment protocol. Results Identified assessment instruments were clustered into domains of transdiagnostic assessment needs, which included child functioning/quality of life, child mental health, caregiver mental health, and family background information. From this, the research committee identified a core set of nine measures and an extended set of 14 measures that capture these domains with potential for further modifications as recommended by clinicians, researchers and community members. Conclusion The protocol proposed here was established through a strong partnership between clinicians, researchers and the community. It will enable (i) consensus driven transdiagnostic clinical assessments for children with neurodevelopmental disorders, and (ii) research studies that will inform large transdiagnostic datasets across neurodevelopmental disorders and that can be used to inform research and policy beyond narrow diagnostic groups. The long-term vision is to use this framework to facilitate collaboration across clinics to enable large-scale data collection and research. Ultimately, the transdiagnostic assessment data can be used to inform practice and improve the lives of children with neurodevelopmental disorders and their families.
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13
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Cannon Homaei S, Barone H, Kleppe R, Betari N, Reif A, Haavik J. ADHD symptoms in neurometabolic diseases: Underlying mechanisms and clinical implications. Neurosci Biobehav Rev 2021; 132:838-856. [PMID: 34774900 DOI: 10.1016/j.neubiorev.2021.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022]
Abstract
Neurometabolic diseases (NMDs) are typically caused by genetic abnormalities affecting enzyme functions, which in turn interfere with normal development and activity of the nervous system. Although the individual disorders are rare, NMDs are collectively relatively common and often lead to lifelong difficulties and high societal costs. Neuropsychiatric manifestations, including ADHD symptoms, are prominent in many NMDs, also when the primary biochemical defect originates in cells and tissues outside the nervous system. ADHD symptoms have been described in phenylketonuria, tyrosinemias, alkaptonuria, succinic semialdehyde dehydrogenase deficiency, X-linked ichthyosis, maple syrup urine disease, and several mitochondrial disorders, but are probably present in many other NMDs and may pose diagnostic and therapeutic challenges. Here we review current literature linking NMDs with ADHD symptoms. We cite emerging evidence that many NMDs converge on common neurochemical mechanisms that interfere with monoamine neurotransmitter synthesis, transport, metabolism, or receptor functions, mechanisms that are also considered central in ADHD pathophysiology and treatment. Finally, we discuss the therapeutic implications of these findings and propose a path forward to increase our understanding of these relationships.
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Affiliation(s)
- Selina Cannon Homaei
- Division of Psychiatry, Haukeland University Hospital, Norway; Department of Biomedicine, University of Bergen, Norway.
| | - Helene Barone
- Regional Resource Center for Autism, ADHD, Tourette Syndrome and Narcolepsy, Western Norway, Division of Psychiatry, Haukeland University Hospital, Norway.
| | - Rune Kleppe
- Division of Psychiatry, Haukeland University Hospital, Norway; Norwegian Centre for Maritime and Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Norway.
| | - Nibal Betari
- Department of Biomedicine, University of Bergen, Norway.
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Norway; Department of Biomedicine, University of Bergen, Norway.
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14
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Kittel-Schneider S, Arteaga-Henriquez G, Vasquez AA, Asherson P, Banaschewski T, Brikell I, Buitelaar J, Cormand B, Faraone SV, Freitag CM, Ginsberg Y, Haavik J, Hartman CA, Kuntsi J, Larsson H, Matura S, McNeill RV, Ramos-Quiroga JA, Ribases M, Romanos M, Vainieri I, Franke B, Reif A. Non-mental diseases associated with ADHD across the lifespan: Fidgety Philipp and Pippi Longstocking at risk of multimorbidity? Neurosci Biobehav Rev 2021; 132:1157-1180. [PMID: 34757108 DOI: 10.1016/j.neubiorev.2021.10.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
Several non-mental diseases seem to be associated with an increased risk of ADHD and ADHD seems to be associated with increased risk for non-mental diseases. The underlying trajectories leading to such brain-body co-occurrences are often unclear - are there direct causal relationships from one disorder to the other, or does the sharing of genetic and/or environmental risk factors lead to their occurring together more frequently or both? Our goal with this narrative review was to provide a conceptual synthesis of the associations between ADHD and non-mental disease across the lifespan. We discuss potential shared pathologic mechanisms, genetic background and treatments in co-occurring diseases. For those co-occurrences for which published studies with sufficient sample sizes exist, meta-analyses have been published by others and we discuss those in detail. We conclude that non-mental diseases are common in ADHD and vice versa and add to the disease burden of the patient across the lifespan. Insufficient attention to such co-occurring conditions may result in missed diagnoses and suboptimal treatment in the affected individuals.
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Affiliation(s)
- Sarah Kittel-Schneider
- Center of Mental Health, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany.
| | - Gara Arteaga-Henriquez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Alejandro Arias Vasquez
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Psychiatry and Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Phil Asherson
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Isabell Brikell
- National Centre for Register-based Research, Department of Economics and Business Economics Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Aarhus, Denmark; iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77, Stockholm, Sweden
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Catalonia, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, D-60528 Frankfurt am Main, Germany
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Jan Haavik
- Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Jonna Kuntsi
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77, Stockholm, Sweden; Örebro University, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany
| | - Rhiannon V McNeill
- Center of Mental Health, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Marta Ribases
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Catalonia, Spain
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany
| | - Isabella Vainieri
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Barbara Franke
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Psychiatry and Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany
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15
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George C, Felix SA, McLellan A, Shetty J, Middleton J, Chin RF, Poveda B, Brand C, Small M, Verity K. Pilot project of psychological services integrated into a pediatric epilepsy clinic: Psychology Adding Value - Epilepsy Screening (PAVES). Epilepsy Behav 2021; 120:107968. [PMID: 33971391 DOI: 10.1016/j.yebeh.2021.107968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
RATIONALE Children and young people with epilepsy (CYPwE) are particularly vulnerable to developing social, emotional, behavioral, and learning difficulties, which, if not identified or addressed at an early stage, can impact adversely on quality of life and long-term psychosocial outcomes. This paper describes the development of a screening protocol and a pathway of early, 'stepped' intervention, which aims to address this issue, together with initial outcomes. METHODS The Strengths and Difficulties Questionnaire (SDQ) was completed by CYPwE and their parents prior to routine epilepsy clinic appointments. A traffic light system was devised to indicate the reported level of concern and a potential route through the early intervention pathway. RESULTS Of those CYPwE screened, 53% were found to be experiencing elevated levels of mental health difficulties, which had not previously been identified, and had the opportunity to access an appropriate early intervention. Initial feedback on the PAVES pathway has been positive, with high levels of feasibility and acceptability indicated by young people, parents, and clinicians. CONCLUSIONS The PAVES approach enables mental health difficulties to be identified and appropriate intervention accessed at an early stage, potentially improving long-term psychosocial outcomes for CYPwE. In addition, if found to be effective in larger trials, PAVES has potential to be adapted and generalized to other populations.
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Affiliation(s)
- Catriona George
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Suzanne A Felix
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Ailsa McLellan
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Jay Shetty
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Jack Middleton
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Richard F Chin
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Blanca Poveda
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Celia Brand
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Michelle Small
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, Child Life and Health, The University of Edinburgh, Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Kirsten Verity
- Royal Hospital for Children and Young People, 50 Little France Crescent, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
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16
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Catanzano M, Bennett SD, Tibber MS, Coughtrey AE, Liang H, Heyman I, Shafran R. A Mental Health Drop-In Centre Offering Brief Transdiagnostic Psychological Assessment and Treatment in a Paediatric Hospital Setting: A One-Year Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105369. [PMID: 34069973 PMCID: PMC8157880 DOI: 10.3390/ijerph18105369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
AIM This study was part of a broader project to examine the acceptability, feasibility and impact of a transdiagnostic mental health drop-in centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long-term physical health conditions (LTCs). The aims of this investigation were to characterise: (i) the use of such a centre, (ii) the demographics and symptoms of those presenting to the centre, and (iii) the types of support that are requested and/or indicated. METHODS A mental health "booth" was located in reception of a national paediatric hospital over one year. Characteristics of young people with LTCs and their siblings/parents attending the booth were defined. Emotional/behavioural symptoms were measured using standardised questionnaires including the Strengths and Difficulties Questionnaire (SDQ). Participants subsequently received one of four categories of intervention: brief transdiagnostic cognitive behaviour therapy (CBT), referral to other services, neurodevelopmental assessment or signposting to resources. RESULTS One hundred and twenty-eight participants were recruited. The mean age of young people was 9.14 years (standard deviation: 4.28); 61% identified as white and 45% were male. Over half of young people recruited scored in the clinical range with respect to the SDQ. Presenting problems included: anxiety (49%), challenging behaviour (35%), low mood (22%) and other (15%). CONCLUSIONS A considerable proportion of young people with LTC in a paediatric hospital scored in the clinical range for common mental health problems, indicating a potential for psychological interventions.
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Affiliation(s)
- Matteo Catanzano
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- Correspondence: ; Tel.: +44-(0)20-7405-9200
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Marc S Tibber
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK;
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - The Lucy Project Team
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
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17
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Catanzano M, Bennett SD, Kerry E, Liang H, Heyman I, Coughtrey AE, Fifield K, Taylor C, Dalgleish T, Xu L, Shafran R. Evaluation of a mental health drop-in centre offering brief transdiagnostic psychological assessment and treatment for children and adolescents with long-term physical conditions and their families: a single-arm, open, non-randomised trial. EVIDENCE-BASED MENTAL HEALTH 2021; 24:25-32. [PMID: 33243761 PMCID: PMC7958088 DOI: 10.1136/ebmental-2020-300197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Children and young people with long-term physical conditions have significantly elevated mental health needs. Transdiagnostic, brief psychological interventions have the potential to increase access to evidence-based psychological treatments for patients who attend health services primarily for physical health needs. OBJECTIVE A non-randomised study was conducted to assess the impact of brief, transdiagnostic psychological interventions in children and young people presenting at a drop-in mental health centre in the reception area of a paediatric hospital. METHODS 186 participants attending a transdiagnostic mental health drop-in centre were allocated to assessment and psychological intervention based on a clinical decision-making algorithm. Interventions included signposting, guided self-help based on a modular psychological treatment and referral to the hospital's paediatric psychology service. The primary transdiagnostic mental health outcome measure was the parent-reported Strengths and Difficulties Questionnaire (SDQ), which was given at baseline and 6 months post-baseline. FINDINGS There was a significant positive impact of attending the drop-in mental health centre on the SDQ (Cohen's d=0.22) and on the secondary outcome measure of Paediatric Quality of life (Cohen's d=0.55). CONCLUSIONS A mental health drop-in centre offering brief, transdiagnostic assessment and treatment may reduce emotional and behavioural symptoms and improve quality of life in children and young people with mental health needs in the context of long-term physical conditions. A randomised controlled trial to investigate the specificity of any effects is warranted. CLINICAL IMPLICATIONS Drop-in centres for mental health needs may increase access and have beneficial effects for children and young people with physical conditions.
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Affiliation(s)
- Matteo Catanzano
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ellie Kerry
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kate Fifield
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chloe Taylor
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, Cambridge, Cambridgeshire, UK
| | - Laila Xu
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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18
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Stübner C, Flynn T, Gillberg C, Fernell E, Miniscalco C. Schoolchildren with unilateral or mild to moderate bilateral sensorineural hearing loss should be screened for neurodevelopmental problems. Acta Paediatr 2020; 109:1430-1438. [PMID: 31769539 DOI: 10.1111/apa.15088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/07/2019] [Accepted: 11/08/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim was to assess the rate and overlap of language and other neurodevelopmental problems in children aged 9-12 years with unilateral or mild to moderate bilateral sensorineural hearing loss. METHODS Caregivers of 24 of the 58 eligible children, born 2004-2007, registered at the regional audiology department in Gothenburg, Sweden, with these types of hearing loss completed the Five-to-Fifteen questionnaire, a comprehensive screening instrument for neurodevelopmental problems. Of these 24 children, 21 were assessed with the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4). Children with scores indicating definite problem on the Five-to-Fifteen questionnaire and their parents were invited to a clinical neuropaediatric assessment. RESULTS Of the 24 children, 13 (54%) screened positive for definite neurodevelopmental problems. Clinical assessments confirmed the presence of at least one neurodevelopmental disorder in eight of these 24, corresponding to 33%. Seven (33%) of the 21 children participating in the CELF-4 had scores indicating a language disorder, of whom four children had a neurodevelopmental disorder according to the neuropaediatric assessment. CONCLUSION The results support that schoolchildren with unilateral or mild to moderate bilateral sensorineural hearing loss should undergo neurodevelopmental screening to identify possible coexisting neurodevelopmental problems or disorders.
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Affiliation(s)
- Charlotte Stübner
- Department of Paediatric Speech and Language Pathology Queen Silvia Children’s Hospital Gothenburg Sweden
| | - Traci Flynn
- Speech Pathology Faculty of Education and Arts School of Humanities and Social Sciences University of Newcastle Newcastle NSW Australia
- Previously at Division of Speech and Language Pathology Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Department of Child Neuropsychiatry Queen Silvia Children´s Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Department of Child Neuropsychiatry Queen Silvia Children´s Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Carmela Miniscalco
- Department of Paediatric Speech and Language Pathology Queen Silvia Children’s Hospital Gothenburg Sweden
- Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden
- Department of Child Neuropsychiatry Queen Silvia Children´s Hospital Sahlgrenska University Hospital Gothenburg Sweden
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19
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Barone H, Bliksrud YT, Elgen IB, Szigetvari PD, Kleppe R, Ghorbani S, Hansen EV, Haavik J. Tyrosinemia Type 1 and symptoms of ADHD: Biochemical mechanisms and implications for treatment and prognosis. Am J Med Genet B Neuropsychiatr Genet 2020; 183:95-105. [PMID: 31633311 DOI: 10.1002/ajmg.b.32764] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/25/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022]
Abstract
Hereditary tyrosinemia Type 1 (HT-1) is a rare metabolic disease where the enzyme catalyzing the final step of tyrosine breakdown is defect, leading to accumulation of toxic metabolites. Nitisinone inhibits the degradation of tyrosine and thereby the production of harmful metabolites, however, the concentration of tyrosine also increases. We investigated the relationship between plasma tyrosine concentrations and cognitive functions and how tyrosine levels affected enzyme activities of human tyrosine hydroxylase (TH) and tryptophan hydroxylase 2 (TPH2). Eight Norwegian children between 6 and 18 years with HT-1 were assessed using questionnaires measuring Attention Deficit Hyperactivity Disorder (ADHD)-symptoms and executive functioning. Recent and past levels of tyrosine were measured and the enzyme activities of TH and TPH2 were studied at conditions replicating normal and pathological tyrosine concentrations. We observed a significant positive correlation between mean tyrosine levels and inattention symptoms. While TH exhibited prominent substrate inhibition kinetics, TPH2 activity also decreased at elevated tyrosine levels. Inhibition of both enzymes may impair syntheses of dopamine, noradrenaline, and serotonin in brain tissue. Inattention in treated HT-1 patients may be related to decreased production of these monoamines. Our results support recommendations of strict guidelines on plasma tyrosine levels in HT-1. ADHD-related deficits, particularly inattention, should be monitored in HT-1 patients to determine whether intervention is necessary.
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Affiliation(s)
- Helene Barone
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Yngve T Bliksrud
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Irene B Elgen
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Rune Kleppe
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Sadaf Ghorbani
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Eirik V Hansen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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20
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Lionarons JM, Hellebrekers DMJ, Klinkenberg S, Faber CG, Vles JSH, Hendriksen JGM. Methylphenidate use in males with Duchenne muscular dystrophy and a comorbid attention-deficit hyperactivity disorder. Eur J Paediatr Neurol 2019; 23:152-157. [PMID: 30287260 DOI: 10.1016/j.ejpn.2018.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/04/2018] [Accepted: 09/14/2018] [Indexed: 11/20/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common comorbidity in Duchenne muscular dystrophy (DMD). Until now, treatment with methylphenidate (MPH) has never been systematically assessed and described in this population. Our aim was to evaluate the effectiveness and safety of short acting MPH for learning problems in males with DMD and ADHD. Neuropsychological (cognition and behavior) and medical data of a sample of ten males (mean age = 8.1 years, range 6.3-9.8) with DMD and an ADHD diagnosis was retrospectively analyzed at baseline (T0; without MPH), short-term follow-up (T1; with MPH; mean interval T0-T1 = 8.3 months, range 4.3-15.6), and long-term follow-up (T2; mean interval T1-T2 = 23.1 months, range 2.6-77.7). An initial MPH dose of 5 mg/day was given on school mornings, with an increase of 2.5-5 mg/week depending on individual tolerance and treatment response, until a sufficiently effective dose was reached (range 0.2-0.6 mg/kg/day). At T1, results demonstrated an improvement in attention (i.e. concentration, impulsivity, and distractibility) in four patients. Suboptimal effects were reported in four patients, and no effects in two patients. At T2, seven patients showed considerable improvement in attention. No major side effects were reported. Overall, our data show that short acting MPH can be clinically effective for learning problems in males with DMD and ADHD, with regular cardiac follow-up, and close monitoring of side effects and neuropsychological effects. Furthermore, this underscores the importance of the use of validated cognitive and behavioral measurement tools with adequate sensitivity to objectively evaluate the effect of MPH.
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Affiliation(s)
- Judith M Lionarons
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University Medical Centre, Department of Neurology, School for Mental Health and Neuroscience, Maastricht, the Netherlands.
| | - Danique M J Hellebrekers
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University Medical Centre, Department of Neurology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Sylvia Klinkenberg
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University Medical Centre, Department of Neurology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Catharina G Faber
- Maastricht University Medical Centre, Department of Neurology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Johan S H Vles
- Maastricht University Medical Centre, Department of Neurology, School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Jos G M Hendriksen
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, the Netherlands; Maastricht University Medical Centre, Department of Neurology, School for Mental Health and Neuroscience, Maastricht, the Netherlands; Duchenne Centre Netherlands, the Netherlands
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21
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Gittins S, Steel D, Brunklaus A, Newsom-Davis I, Hawkins C, Aylett SE. Autism spectrum disorder, social communication difficulties, and developmental comorbidities in Sturge-Weber syndrome. Epilepsy Behav 2018; 88:1-4. [PMID: 30195931 DOI: 10.1016/j.yebeh.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 11/18/2022]
Abstract
Sturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by the combination of a facial naevus flammeus and pial angioma, often associated with learning difficulties and/or epilepsy. Here, we report on the neuropsychological characteristics of a cohort of 92 children with SWS seen at a national referral center between 2002 and 2015. Almost a quarter (24%) had a diagnosis of autism spectrum disorder (ASD), with 45% overall having evidence of social communication difficulties (SCD). Autism spectrum disorder was more commonly seen in those individuals with bilateral angioma (p = 0.021). Significant behavioral difficulties were reported in 50% while 26% had difficulties with sleep. Difficulties with social communication, behavior, and sleep were closely associated with one another. They were not, however, significantly associated with markers of epilepsy severity and were noted to occur even in children without epilepsy. The prevalence of ASD/SCD, sleep difficulties, and behavioral disorders seen in SWS is high and reflects the complex needs of this group.
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Affiliation(s)
- Samuel Gittins
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; University College London Medical School, London, UK
| | - Dora Steel
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Andreas Brunklaus
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Imogen Newsom-Davis
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Developmental Neurosciences Programme of the UCL Institute of Child Health, London, UK
| | - Christina Hawkins
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sarah E Aylett
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Developmental Neurosciences Programme of the UCL Institute of Child Health, London, UK.
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22
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Hyperkinetic disorder in a community service for people with intellectual disability. Ir J Psychol Med 2018; 38:177-181. [PMID: 30280680 DOI: 10.1017/ipm.2018.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There appears to be a higher rate of prevalence of hyperkinetic disorder in the intellectual disability (ID) population, although there is a large variability in rates in previous studies. Hyperkinetic disorder can be a challenge to diagnose in a population with ID and can present a barrier to the development of the activities of daily living in an already vulnerable population. OBJECTIVES Our objective was to examine the point prevalence of hyperkinetic disorder in the ID population in a community ID service and also to determine the prevalence of hyperkinetic disorder based on the level of ID. METHODS A cross-sectional review of the Online Information Service 'OLIS' database was undertaken to establish the total number of patients with ID and those with comorbid hyperkinetic disorder. The overall point prevalence and prevalence based on the level of ID was calculated from the collected data. RESULTS The point prevalence of hyperkinetic disorder in the population with ID was similar to that found in studies in the general population at 3.1% in adults and 32.6% in children. When divided by the level of disability, the calculated point prevalence in both adults and children was highest in the population with mild ID and decreased as the level of disability increased. CONCLUSION This report contributes to previous research establishing the rates of hyperkinetic disorder in an ID population and establishes the point prevalence of hyperkinetic disorder in individuals diagnosed with ID in a clinical sample.
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Affiliation(s)
- Lauren Harris
- Academic Foundation Doctor, Haringey Learning Disabilities Partnership, London
| | - Rory Sheehan
- Academic Clinical Fellow in Psychiatry of Intellectual Disability, Division of Psychiatry, University College London, London W1T 7NF
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Magnin E, Maurs C. Attention-deficit/hyperactivity disorder during adulthood. Rev Neurol (Paris) 2017; 173:506-515. [DOI: 10.1016/j.neurol.2017.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/14/2022]
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Hendriksen RGF, Aalbers MW, Hendriksen JGM, de Die-Smulders CEM, Hoogland G, Vles JSH. An Unusual Triad in Pediatric Neurology: A Case Report on Cerebral Palsy, Epilepsy, and Duchenne Muscular Dystrophy. Child Neurol Open 2017; 3:2329048X16642948. [PMID: 28503609 PMCID: PMC5417281 DOI: 10.1177/2329048x16642948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/20/2022] Open
Abstract
We present a case of an unusual triad in pediatric neurology: a currently 12-year-old boy with cerebral palsy and epilepsy who was later also diagnosed with Duchenne muscular dystrophy. We describe the clinical path that resulted in this exceptional diagnosis. This case report illustrates how different neurological disorders may overshadow each other. In addition, it demonstrates that every child with cerebral palsy and either an atypical clinical course or with inexplicable laboratory values—as well as every infant boy born to a theoretical Duchenne muscular dystrophy carrier—should be subjected to additional investigations.
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Affiliation(s)
- Ruben G. F. Hendriksen
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Ruben G. F. Hendriksen, BSc, Department of Neurology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Marlien W. Aalbers
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Neurosurgery, Groningen University Medical Centre, Groningen, the Netherlands
| | - Jos G. M. Hendriksen
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Kempenhaeghe, Centre of Neurological Learning Disabilities, Heeze, the Netherlands
| | - Christine E. M. de Die-Smulders
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Govert Hoogland
- School for Mental Health & Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Johan S. H. Vles
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Kempenhaeghe, Centre of Neurological Learning Disabilities, Heeze, the Netherlands
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Theory of mind, emotional and social functioning, and motor severity in children and adolescents with dystonic cerebral palsy. Eur J Paediatr Neurol 2017; 21:549-556. [PMID: 28237421 DOI: 10.1016/j.ejpn.2017.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 11/19/2016] [Accepted: 01/12/2017] [Indexed: 11/24/2022]
Abstract
AIMS This cross-sectional study aimed to investigate whether children and adolescents with dystonic cerebral palsy (CP) present with emotional and social difficulties along side motor limitations. PARTICIPANTS/MEASURES Twenty-two verbal and nonverbal children and adolescents with dystonic CP were compared with a normative sample of twenty children and adolescents on measures of theory of mind (ToM), emotion regulation (ER), and social difficulties (SD). RESULTS Higher social and emotional difficulties were found in the dystonic CP group compared to the control group. Nonverbal participants with dystonic CP were found to present with greater social impairment and lower ToM ability than their verbal counterparts. Emotional regulation and hyperactivity and attentional difficulties (HAD) significantly predicted ToM ability and social difficulties. Lower Gross Motor Function Classification System (GMFCS) level and IQ also contributed to differences in ToM ability. INTERPRETATION Findings support the need for greater attention to the emotional health and social development of children/adolescents with dystonic CP, along with assessments of motor difficulties in the planning and implementation of interventions and individual care plans. Further research is needed to explore links between motor disorder and mental state understanding in this clinical group.
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Can IQ predict parent-reported behavioral and emotional problems in children with neurological deficiencies? Eur J Paediatr Neurol 2017; 21:336-343. [PMID: 27707654 DOI: 10.1016/j.ejpn.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/11/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate whether total intelligence scores (FSIQ) and/or a discrepancy in intelligence can predict behavioral or emotional problems in children with neurological deficiencies. METHOD The population consists of children with neurological deficiencies (N = 610, ranging from 6 to 17 years), referred due to concerns on the (educational) development of the child to a tertiary outpatient clinic. All children were tested with the Dutch Wechsler Intelligence Scale for Children - third edition (WISC-III-NL). A VIQ-PIQ discrepancy score was calculated by subtracting the performance capacities of the verbal capacities. The effects of demographic variables, FSIQ, and the VIQ-PIQ discrepancy on two parent-rated questionnaires measuring behavior and emotions in children were analyzed with linear and logistic regression models. RESULTS AND CONCLUSION The VIQ-PIQ discrepancy was not predictive of behavioral or emotional problems recorded on the above-mentioned parent-rated questionnaires. The FSIQ score, age, and sex were predictive to some extent: increases in age and FSIQ led to a decrease of reported problems, and boys showed more problems than girls. Children with neurological deficiencies had on average significantly higher verbal capacities than performance capacities, in line with the neuropsychological principle that language survives brain damage whereas performance capacities are more affected.
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Jun-O’Connell AH, Butala A, Morales IB, Henninger N, Deligiannidis KM, Byatt N, Ionete C. The Prevalence of Bipolar Disorders and Association With Quality of Life in a Cohort of Patients With Multiple Sclerosis. J Neuropsychiatry Clin Neurosci 2017; 29:45-51. [PMID: 27539374 PMCID: PMC5288280 DOI: 10.1176/appi.neuropsych.15120403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clinical observations of mood instability in multiple sclerosis (MS) have led to the hypothesis that bipolar disorder (BD) may be more prevalent in persons with MS than in the general population. This cross-sectional study assesses the prevalence of BD among patients with MS using standardized psychiatric diagnostic interviews and evaluates quality of life. This study demonstrates a higher prevalence of BD in patients with MS compared with the general population. It also reveals the negative impact of BD on quality of life, raises the concern that BD can occur before the onset of neurological symptoms in MS, and suggests that, in some cases, BD may delay diagnosis of MS.
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Handwriting-based model for identification of developmental disorders among North Indian children. SCHOOL PSYCHOLOGY INTERNATIONAL 2015. [DOI: 10.1177/0143034315615936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Handwriting execution is based on the cognitive, kinesthetic, motor skills, and manual co-ordination skills of an individual. The deterioration in handwriting quality is a common implication of neurological disorders. Difficulty and degradation in handwriting has been attributed to the sensory motor deficits prevalent in developmental disorders. In spite of the association between developmental disorders and handwriting ability, the diagnostic potential of handwriting characteristics remains untapped. The present case control study was conducted among 300 subjects aged 6- to 11-years-old of North Indian origin to measure the potentials of handwriting characteristics to identify the selected developmental disorders namely ADHD, AD/HD, CD and DCD. A significant difference was obtained in the kinematics, relative size, number of handwriting defects, spatial orientation, line quality, and the mirror image presence between children with developmental disorders and typically developing (TD) children. A logistic model based on selected handwriting characteristics showed a cross validated 94.9% accuracy rate for diagnosis of developmental disorders. Receiver operator characteristic curve (ROC) analysis was conducted to assess the diagnostic potential of the model as presented by the area under curve was found to be 98.5%. The method is non-invasive, operationally easy and useful for an early identification of developmental disorders by parents and educators.
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30
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Hamed AM, Kauer AJ, Stevens HE. Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters. Front Psychiatry 2015; 6:168. [PMID: 26635643 PMCID: PMC4659921 DOI: 10.3389/fpsyt.2015.00168] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/12/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity disorder (ADHD) is one of the most common and challenging childhood neurobehavioral disorders. ADHD is known to negatively impact children, their families, and their community. About one-third to one-half of patients with ADHD will have persistent symptoms into adulthood. The prevalence in the United States is estimated at 5-11%, representing 6.4 million children nationwide. The variability in the prevalence of ADHD worldwide and within the US may be due to the wide range of factors that affect accurate assessment of children and youth. Because of these obstacles to assessment, ADHD is under-diagnosed, misdiagnosed, and undertreated. OBJECTIVES We examined factors associated with making and receiving the diagnosis of ADHD. We sought to review the consequences of a lack of diagnosis and treatment for ADHD on children's and adolescent's lives and how their families and the community may be involved in these consequences. METHODS We reviewed scientific articles looking for factors that impact the identification and diagnosis of ADHD and articles that demonstrate naturalistic outcomes of diagnosis and treatment. The data bases PubMed and Google scholar were searched from the year 1995 to 2015 using the search terms "ADHD, diagnosis, outcomes." We then reviewed abstracts and reference lists within those articles to rule out or rule in these or other articles. RESULTS Multiple factors have significant impact in the identification and diagnosis of ADHD including parents, healthcare providers, teachers, and aspects of the environment. Only a few studies detailed the impact of not diagnosing ADHD, with unclear consequences independent of treatment. A more significant number of studies have examined the impact of untreated ADHD. The experience around receiving a diagnosis described by individuals with ADHD provides some additional insights. CONCLUSION ADHD diagnosis is influenced by perceptions of many different members of a child's community. A lack of clear understanding of ADHD and the importance of its diagnosis and treatment still exists among many members of the community including parents, teachers, and healthcare providers. More basic and clinical research will improve methods of diagnosis and information dissemination. Even before further advancements in science, strong partnerships between clinicians and patients with ADHD may be the best way to reduce the negative impacts of this disorder.
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Affiliation(s)
- Alaa M Hamed
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Aaron J Kauer
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Hanna E Stevens
- Child and Adolescent Psychiatry Division, Department of Psychiatry, University of Iowa Carver College of Medicine , Iowa City, IA , USA ; Neuroscience Program, Pappajohn Biomedical Institute, University of Iowa , Iowa City, IA , USA
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