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De Rossi P, D'Aiello B, Pretelli I, Menghini D, Di Vara S, Vicari S. Age-related clinical characteristics of children and adolescents with ADHD. Front Psychiatry 2023; 14:1069934. [PMID: 36778635 PMCID: PMC9911799 DOI: 10.3389/fpsyt.2023.1069934] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) has been associated with difficulties in regulating aversion states, high functional impairment, and a high risk of psychopathology across the lifespan. ADHD is clinically heterogeneous, with a wide spectrum of severity and associated symptoms. Clinical characteristics need to be carefully defined in different periods of life as ADHD course, symptoms, and comorbidities may fluctuate and change over time. Adolescence usually represents the transition from primary to secondary education, with a qualitative and quantitative change in environmental and functional demands, thus driving symptoms' change. METHODS In order to characterize age-related clinical features of children (<11 years) and adolescents (≥11 years) with ADHD, we conducted a naturalistic study on 750 children and adolescents assessed for ADHD at our Neuropsychiatry Unit over the course of 3 years (2018-2020). RESULTS We found that ADHD symptoms were significantly higher in children than adolescents. More importantly, we found worse global functioning, lower adaptive skills, higher levels of anxiety and depressive symptoms, somatic complaints, emotional dysregulation, social problems, and aggression in adolescents, despite a lower severity of ADHD-specific symptoms. CONCLUSION These results should be confirmed in longitudinal observational studies of adequate sample size in order to reliably describe a potential course characterized by worsening of functioning, reduction in ADHD-specific symptoms and increase in general psychopathology during the transition from childhood to adolescence.
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Affiliation(s)
- Pietro De Rossi
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Barbara D'Aiello
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Department of Human Sciences, Libera Università Maria Santissima Assunta University, Rome, Italy
| | - Italo Pretelli
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Silvia Di Vara
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.,Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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De Rossi P, Pretelli I, Menghini D, D'Aiello B, Di Vara S, Vicari S. Clinical characteristics of children and adolescents with ADHD with or without methylphenidate prescription at their first diagnostic assessment. Eur Arch Psychiatry Clin Neurosci 2022; 272:1437-1442. [PMID: 35211779 DOI: 10.1007/s00406-022-01386-9] [Citation(s) in RCA: 2] [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: 06/14/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is the most prevalent neurodevelopmental disorder diagnosed in the scholar age. It is associated with significant impairment in global functioning, and in moderate/severe presentations the outcome is critically dependent on pharmacological optimization of the multi-modal treatment. Methylphenidate (MPH) is the first-choice pharmacological treatment in children and adolescents with ADHD, with substantial evidence of significant efficacy and effectiveness on global functioning and symptoms' severity. There is some evidence supporting a few clinical and socio-demographic variables as predictors of pharmacological treatment prescription in children with ADHD independently of ADHD symptoms severity. However, it is warranted to investigate clinical and general psychopathological characteristics potentially associated with negative outcomes and the need for pharmacological treatment to inform appropriate prescription strategies. In this context, we compared 268 children and adolescents who were prescribed MPH (ADHD/MPH) for the first time after their first diagnostic assessment at our center, and 444 children and adolescents with ADHD (ADHD/noMPH) who were recommended non-pharmacological evidence-based interventions alone. ADHD/MPH group had higher severity of non-ADHD psychopathological symptoms compared to the ADHD/noMPH group, as documented by higher scores on the Child Behavior Checklist (CBCL) subscales, higher severity of ADHD symptoms, lower average IQ and lower adaptive levels independently of IQ. More specifically, beside externalizing symptoms, also internalizing symptoms were significantly higher in the ADHD/MPH group. The presence of significant non-ADHD psychopathology should be considered as a clinical factor associated with the need for MPH prescription in children and adolescents with ADHD.
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Affiliation(s)
- Pietro De Rossi
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
| | - Italo Pretelli
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
| | - Deny Menghini
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
| | - Barbara D'Aiello
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
- Department of Human Science, LUMSA University, Rome, Italy
| | - Silvia Di Vara
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Department of Neuroscience, Child and Adolescence Neuropsychiatry Unit, I. R. C. C. S. Bambino Gesù Children's Hospital, Rome, Italy.
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy.
- Centro di Riabilitazione, Casa San Giuseppe, Opera Don Guanella, Rome, Italy.
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The other face of medical globalization? Pharmaceutical data, prescribing trends, and the social localization of psychostimulants. BIOSOCIETIES 2022. [DOI: 10.1057/s41292-022-00271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bachmann CJ, Gerste B, Hoffmann F. Diagnoses of autism spectrum disorders in Germany: Time trends in administrative prevalence and diagnostic stability. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 22:283-290. [PMID: 29671642 DOI: 10.1177/1362361316673977] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For Germany, no data on trends in autism spectrum disorder diagnoses are available. The primary aim of this study was to establish the time trends in the administrative prevalence of autism spectrum disorder diagnoses. The second aim was to assess the stability of autism spectrum disorder diagnoses over time. We analysed administrative outpatient data (2006-2012) from a nationwide health insurance fund and calculated the prevalence of autism spectrum disorder diagnoses for each year, stratified by age and sex. Additionally, we studied a cohort with a first-time diagnosis of autism spectrum disorder in 2007 through 2012, investigating the percentage of retained autism spectrum disorder diagnoses. From 2006 to 2012, the prevalence of autism spectrum disorder diagnoses in 0- to 24-year-olds increased from 0.22% to 0.38%. In insurees with a first-time autism spectrum disorder diagnosis in 2007, this diagnosis was carried on in all years through 2012 in 33.0% (The International Classification of Diseases, Tenth Revision diagnoses: F84.0/F84.1/F84.5) and 11.2% (F84.8/F84.9), respectively. In Germany, like in other countries, there has been an increase in the administrative prevalence of autism spectrum disorder diagnoses. Yet, prevalences are still lower than in some other Western countries. The marked percentage of autism spectrum disorder diagnoses which were not retained could indicate a significant portion of autism spectrum disorder misdiagnoses, which might contribute to rising autism spectrum disorder prevalences.
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Affiliation(s)
| | | | - Falk Hoffmann
- 3 Carl von Ossietzky University of Oldenburg, Germany
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Frigerio A, Montali L. An Ethnographic-Discursive Approach to Parental Self-Help Groups: The Case of ADHD. QUALITATIVE HEALTH RESEARCH 2016; 26:935-950. [PMID: 25987584 DOI: 10.1177/1049732315586553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mutual aid groups have become a common form of help in the mental health field. Although self-help groups are associated with a range of health and social benefits, they remain poorly understood in terms of the dynamics of their interactions. Adopting an ethnographic-discursive approach, we conducted a 6-month observation of the meetings of a self-help group of parents with children diagnosed with attention deficit/hyperactivity disorder (ADHD) to analyze the discursive dynamics of the interactions that characterized the group. Using a set of discursive strategies and practices, the parents promoted a homogeneity of viewpoints and experiences within the group and constructed a shared and consensual narrative to endorse a specific understanding of ADHD. The production of both homogeneity within the group and a shared narrative served to absolve parents of guilt, helped parents to signify their experience within a blaming social context, and preserved their identities as "good parents."
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Filipe AM. Making ADHD Evident: Data, Practices, and Diagnostic Protocols in Portugal. Med Anthropol 2015; 35:390-403. [DOI: 10.1080/01459740.2015.1101102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Conrad P, Bergey MR. The impending globalization of ADHD: notes on the expansion and growth of a medicalized disorder. Soc Sci Med 2014; 122:31-43. [PMID: 25441315 DOI: 10.1016/j.socscimed.2014.10.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) has been medicalized in the United States since the 1960s. Primarily used in North America until the 1990s, ADHD diagnosis and treatment have increasingly been applied internationally. After documenting the expansion of ADHD in a global context, this paper presents five brief international examples examining ADHD usage and expansion: the United Kingdom, Germany, France, Italy and Brazil. We then identify and describe several vehicles that facilitate the migration of the ADHD diagnosis: the transnational pharmaceutical industry; the influence of western psychiatry; moving from ICD to DSM diagnostic criteria; the role of the Internet including the related advent of easily accessible online screening checklists; and advocacy groups. Finally, we discuss what this globalization of a diagnosis reflects about the potential global medicalization of other conditions.
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Affiliation(s)
- Peter Conrad
- Department of Sociology, MS-71, Brandeis University, Waltham, MA 02454-9110, USA.
| | - Meredith R Bergey
- Department of Sociology, MS-71, Brandeis University, Waltham, MA 02454-9110, USA.
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Zucchetti G, Ortega E, Scholte RHJ, Rabaglietti E. The Mediating Role of Aggressive Behaviour, Emotional and Behavioural Instability on the Association between ADHD Symptoms and Best Friend Conflicts. CURRENT PSYCHOLOGY 2014. [DOI: 10.1007/s12144-014-9243-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Edwards C. Spatialising the contentious politics of ADHD: networks and scalar strategies in health social movement activism. Health Place 2014; 29:52-9. [PMID: 24956032 DOI: 10.1016/j.healthplace.2014.05.005] [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: 05/23/2013] [Revised: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 11/27/2022]
Abstract
This paper explores the spatial dynamics of health social movement activism in the context of a specific condition, Attention Deficit Hyperactivity Disorder (ADHD). Deploying qualitative research conducted with Irish ADHD organisations, it examines how place and space affect activist networks and the dilemmas that emerge when local 'mobilisations' converge at national and transnational levels. ADHD activism in Ireland has been predominantly localist in orientation, but certain organisations have shifted their activism to the European scale as a means of gaining further political and epistemic recognition for the condition. The paper suggests that health social movement studies would benefit from an engagement with the geographies of inter-scalar relations in analysing organisations׳ action repertoires.
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Affiliation(s)
- Claire Edwards
- School of Applied Social Studies, University College Cork, Cork, Ireland.
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Attention deficit hyperactivity disorder in France and Ireland: Parents’ groups’ scientific and political framing of an unsettled condition. BIOSOCIETIES 2014. [DOI: 10.1057/biosoc.2014.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Singh I, Filipe AM, Bard I, Bergey M, Baker L. Globalization and cognitive enhancement: emerging social and ethical challenges for ADHD clinicians. Curr Psychiatry Rep 2013; 15:385. [PMID: 23933975 DOI: 10.1007/s11920-013-0385-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Globalization of ADHD and the rise of cognitive enhancement have raised fresh concerns about the validity of ADHD diagnosis and the ethics of stimulant drug treatment. We review the literature on these two emerging phenomena, with a focus on the corresponding social, scientific and ethical debates over the universality of ADHD and the use of stimulant drug treatments in a global population of children and adolescents. Drawing on this literature, we reflect on the importance of ethically informed, ecologically sensitive clinical practices in relation to ADHD diagnosis and treatment.
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Affiliation(s)
- Ilina Singh
- Department of Social Science, Health & Medicine, King's College London, London, UK.
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Risky and at-risk subjects: The discursive positioning of the ADHD child in the Italian context. BIOSOCIETIES 2013. [DOI: 10.1057/biosoc.2013.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Frigerio A, Montali L, Fine M. Attention deficit/hyperactivity disorder blame game: a study on the positioning of professionals, teachers and parents. Health (London) 2013; 17:584-604. [PMID: 23413098 DOI: 10.1177/1363459312472083] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Attention deficit/hyperactivity disorder is currently the most debated childhood psychiatric diagnosis. Given the circulation of competing perspectives about the 'real' causes of children's behaviour and the 'best' way to treat them, we aim to analyse the interactions of the central social actors' discourses about attention deficit/hyperactivity disorder children within the Italian context. Adopting a multi-method approach, we focus on the polyphonic chorus of voices surrounding the child, studying the discourses of mental health professionals, teachers and parents. These actors are representative of three contexts that are deeply engaged with attention deficit/hyperactivity disorder: medical institutions, schools and families. Our theoretical and methodological approach integrates positioning theory, the Bakhtinian notion of dialogical thinking and discourse analysis to study stakeholders' reflexive and interactive positioning in terms of the attribution of rights, duties, responsibilities and power issues. The results show that mutual blame is a constitutive element of relational dynamics among the key adults surrounding attention deficit/hyperactivity disorder children. We argue that these conflicting relationships are not merely related to the debate regarding the validity of the attention deficit/hyperactivity disorder diagnosis. Rather, the mutual blame centres on questions of compliance, recognition of authority and morality. Through the blame game, adults negotiate their own and others' subjectivity in ways that simultaneously (re)produce power relationships and resistance efforts.
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Abstract
PURPOSE OF REVIEW The field of neuroethics is experiencing a great deal of activity at present, as researchers come to realize the potentially dramatic implications of new work in neuroscience and its applications. This review aims to describe some of the work of direct relevance to psychiatric ethics. RECENT FINDINGS The review focuses on ethical issues surrounding the use of propranolol to treat or prevent posttraumatic stress disorder, issues concerning the capacity of the mentally ill to give informed consent to medical treatment and the potential social implications of cognitive enhancers and other interventions into the mind. SUMMARY It is argued that psychiatric ethics would benefit from a consideration of cognate questions arising in neuroethics; in particular, neuroethics has the potential to remind psychiatrists that individual treatment decisions can have broad social implications.
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