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Chen M, Chia M, Chua T, Shen Z, Kang M, Chen L, Tong T, Wang X. Associations between Parental Educational Attainment, Children's 24-h Behaviors and Children's Hyperactivity Behavior in the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:516. [PMID: 38470627 PMCID: PMC10930545 DOI: 10.3390/healthcare12050516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Parental Educational Attainment and children's 24-h behaviors significantly influenced children's hyperactivity symptoms. This study aimed to examine the mediating role of children's 24-h behavior changes due to the COVID-19 pandemic between Parental Educational Attainment and children's hyperactivity index. It also aimed to investigate the associations between Children's Physical Activity, digital media use, sleep, and hyperactivity index between two clusters of Parental Educational Attainments. The goal was to provide targeted behavioral optimization recommendations for caregivers to reduce the risk of children's hyperactivity. METHODS The study was a collaborative extension of the International iPreschooler Surveillance Study Among Asians and otheRs project and the Chinese Children and Adolescent Sports Health Promotion Action Project. The Parent-Surveillance of Digital Media in Childhood Questionnaire® and the Abbreviated Rating Scales from the Conners Parent Symptom Questionnaire were used to measure Parental Educational Attainment, children's behavior changes during the COVID-19 pandemic, and hyperactivity indexes. A total of 11,190 parents of 6-to-12-year-old children completed the online surveys in mainland China. A structural equation model was established by using Smart-PLS, and the linear regression model, and isotemporal substitution models were established by using a Compositional Data Analysis package with R program to achieve the research objectives. RESULTS Changes in children's 24-h behaviors due to the COVID-19 pandemic had a significant mediation effect on the negative associations between Parental Educational Attainment and children's hyperactivity index (β = 0.018, T = 4.521, p < 0.001) with a total effect (β = -0.046, T = 4.521, p < 0.001) and a direct effect (β = -0.064, T = 6.330, p < 0.001). Children's Digital Media use was significantly and negatively associated with hyperactivity index among all children. Reallocated time from digital media use to both sleep and physical activity decreased the hyperactivity index, and vice-versa. For parents without tertiary education (R2 = 0.09, p < 0.001), sleep was significantly and negatively associated with the hyperactivity index (βilr-CSL = -0.06, p < 0.001); for parents with tertiary education (R2 = 0.07, p < 0.001), physical activity was significantly and negatively associated with the hyperactivity index (βilr-CPA = -0.05, p < 0.001), and sleep was significantly and positively associated with the hyperactivity index (βilr-CSL = 0.03, p < 0.001). A significant increase in the hyperactivity index was detected when physical activity time was reallocated to sleep, with a significant decrease in the opposite direction. CONCLUSIONS Parental Educational Attainment and children's 24-h behaviors directly influenced children's hyperactivity index. However, a purposeful and targeted optimization of children's 24-h behaviors-namely, physical activity, digital media use, and sleep-could assist parents with different educational attainments to reduce their children's hyperactivity index and mitigate the risk of hyperactivity.
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Affiliation(s)
- Meiyuan Chen
- College of Physical Education & Health, East China Normal University, Shanghai 200241, China; (M.C.)
- Physical Education & Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore
| | - Michael Chia
- College of Physical Education & Health, East China Normal University, Shanghai 200241, China; (M.C.)
- Physical Education & Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore
| | - Terence Chua
- Physical Education & Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 637616, Singapore
| | - Zhi Shen
- Department of Astronomy, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Mengke Kang
- College of Physical Education & Health, East China Normal University, Shanghai 200241, China; (M.C.)
| | - Lu Chen
- School of Physical Education, Shandong University, Jinan 250061, China
| | - Tiantian Tong
- College of Sports, China University of Mining and Technology, Xuzhou 221000, China;
| | - Xiaozan Wang
- College of Physical Education & Health, East China Normal University, Shanghai 200241, China; (M.C.)
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Zhang DW, Johnstone SJ, Sauce B, Arns M, Sun L, Jiang H. Remote neurocognitive interventions for attention-deficit/hyperactivity disorder - Opportunities and challenges. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110802. [PMID: 37257770 DOI: 10.1016/j.pnpbp.2023.110802] [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: 11/04/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
Improving neurocognitive functions through remote interventions has been a promising approach to developing new treatments for attention-deficit/hyperactivity disorder (AD/HD). Remote neurocognitive interventions may address the shortcomings of the current prevailing pharmacological therapies for AD/HD, e.g., side effects and access barriers. Here we review the current options for remote neurocognitive interventions to reduce AD/HD symptoms, including cognitive training, EEG neurofeedback training, transcranial electrical stimulation, and external cranial nerve stimulation. We begin with an overview of the neurocognitive deficits in AD/HD to identify the targets for developing interventions. The role of neuroplasticity in each intervention is then highlighted due to its essential role in facilitating neuropsychological adaptations. Following this, each intervention type is discussed in terms of the critical details of the intervention protocols, the role of neuroplasticity, and the available evidence. Finally, we offer suggestions for future directions in terms of optimizing the existing intervention protocols and developing novel protocols.
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Affiliation(s)
- Da-Wei Zhang
- Department of Psychology/Center for Place-Based Education, Yangzhou University, Yangzhou, China; Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia.
| | - Stuart J Johnstone
- School of Psychology, University of Wollongong, Wollongong, Australia; Brain & Behaviour Research Institute, University of Wollongong, Australia
| | - Bruno Sauce
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, Netherlands; Department of Experimental Psychology, Utrecht University, Utrecht, Netherlands; NeuroCare Group, Nijmegen, Netherlands
| | - Li Sun
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Han Jiang
- College of Special Education, Zhejiang Normal University, Hangzhou, China
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Dhakal S, Gupta S, Sharma NP, Upadhyay A, Oliver A, Sumich A, Kumari V, Niraula S, Pandey R, Lau JYF. Can we challenge attention and interpretation threat biases in rescued child labourers with a history of physical abuse using a computerised cognitive training task? Data on feasibility, acceptability and target engagement. Behav Res Ther 2023; 162:104267. [PMID: 36780810 DOI: 10.1016/j.brat.2023.104267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
Child labourers are more likely to have experienced physical victimisation, which may increase risk for anxiety/depression, by shaping threat biases in information-processing. To target threat biases and vulnerability for anxiety/depression, we evaluated whether Cognitive Bias Modification (CBM) training could be feasibly and acceptably delivered to rescued youth labourers. Seventy-six physically abused rescued labourers aged 14-17 (40 from Nepal, 36 from India) in out-of-home care institutions received either multi-session computerised CBM or control training. Training targeted attention away from threat to positive cues and the endorsement of benign over threat interpretations. Feasibility and acceptability data were gathered along with pre and post intervention measures of attention and interpretation bias and emotional and behavioural symptoms. In terms of feasibility, uptake (proportion of those who completed the pre-intervention assessment from those who consented) and retention (proportion of those who completed the post-intervention assessment from those who completed the pre-intervention assessment) were above 75% in both countries. Average acceptability ratings were mostly 'moderate' on most indices for both countries, and none of the participants reported experiencing serious adverse events or reactions in response to or during the trial. Secondarily, CBM participants showed increased attention to positive and decreased attention to threatening stimuli, as well as increased endorsement of benign interpretation and decreased endorsement in negative interpretations of ambiguous social situations. Symptom changes were less clear. Delivering CBM to former child labourers in out-of-home care institutions has interventive potential. ClinicalTrials.gov Identifier: NCT03625206, Date of registration: August 10, 2018.
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Affiliation(s)
- Sandesh Dhakal
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Shulka Gupta
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | | | - Aakanksha Upadhyay
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | - Abigail Oliver
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Alex Sumich
- Division of Psychology, Nottingham Trent University, Nottingham, UK
| | - Veena Kumari
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UB8 3PH, UK
| | - Shanta Niraula
- Central Department of Psychology, Tribhuvan University, Kathmandu, Nepal
| | - Rakesh Pandey
- Department of Psychology, Banaras Hindu University, Varanasi, 221 005, UP, India
| | - Jennifer Y F Lau
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK; Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary, University of London, London, E1 4NS, UK.
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Zhang DW. Perspectives on heterogeneity-informed cognitive training for attention-deficit/hyperactivity disorder. Front Psychiatry 2023; 13:1100008. [PMID: 36713921 PMCID: PMC9878183 DOI: 10.3389/fpsyt.2022.1100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (AD/HD) is a heterogeneous neurodevelopmental condition, posing a severe threat to quality of life. Pharmacological therapies are the front-line treatment; however, their shortages encourage the development of alternative treatments for AD/HD. One promising method of developing alternative treatments is cognitive training (CT). A CT-based therapy was recently approved by the US Food and Drug Administration. However, due to heterogeneity in AD/HD, a CT protocol is unlikely to provide a one-size-fits-all solution for all patients with AD/HD. Therefore, this article highlights key aspects that need to be considered to further develop CT protocols for AD/HD, regarding training content, timing, suitability, and delivery mode. The perspectives presented here contribute to optimizing CT as an alternative option for treating AD/HD.
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Affiliation(s)
- Da-Wei Zhang
- Department of Psychology and Center for Place-Based Education, Yangzhou University, Yangzhou, China
- Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia
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Zhou P, Zhang W, Xu YJ, Liu RQ, Qian Z, McMillin SE, Bingheim E, Lin LZ, Zeng XW, Yang BY, Hu LW, Chen W, Chen G, Yu Y, Dong GH. Association between long-term ambient ozone exposure and attention-deficit/hyperactivity disorder symptoms among Chinese children. ENVIRONMENTAL RESEARCH 2023; 216:114602. [PMID: 36265606 DOI: 10.1016/j.envres.2022.114602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although ozone exposure has neurological toxicity, it remains unclear whether it was associated with an increased risk of attention-deficit/hyperactivity disorders (ADHD) among childhood. METHODS We matched the four-year average ozone concentration with questionnaire data for 35,103 children aged 3-12 years from seven cities in Liaoning, China, 2012-2013. Using mixed-effect logistic regression models, we assessed the association of ozone concentration with multiple ADHD indicators using the Conners Abbreviated Symptom Questionnaire (C-ASQ), including explicit attention-deficit/hyperactivity symptoms (ADHD; score ≥15), attention-deficit/hyperactivity disorder tendencies (ADHD-T; 11 ≤ score ≤14), and attention-deficit/hyperactivity problems (ADHP; score ≥11). Results were also stratified by sociodemongraphics. RESULTS After adjusting for covariates, we found that each interquartile range (IQR) increase in ozone concentration was associated with an increased risk of ADHD, ADHD-T, and ADHP (P < 0.001) with an odds ratio of 1.12 (95% confidence interval, 1.04-1.21), 1.08 (1.03-1.13), and 1.09 (1.05-1.14), respectively. Additionally, we found greater effect estimates in children who reported longer exercise time (vs those with limited exercise time) with odds ratio of 1.18 (1.07-1.31) vs 1.06 (0.96-1.17) for ADHD, 1.13 (1.06-1.21) vs 1.03 (0.96-1.10) for ADHD-T, and 1.15 (1.08-1.21) vs 1.04 (0.98-1.10) for ADHP. Non-breastfed children were also shown to be more vulnerable to ADHD with an odds ratio of 1.22 (1.09-1.36) compared with 1.06 (0.96-1.16) among the rest. CONCLUSIONS Long-term ozone exposure may be associated with increased ADHD among children. Additional studies are needed to validate our findings and support policies and interventions to address this growing public health concern.
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Affiliation(s)
- Peien Zhou
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Wangjian Zhang
- Department of Biostatistics, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yu-Jie Xu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Ru-Qing Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Zhengmin Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | | | - Elizabeth Bingheim
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Li-Zi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Wen Chen
- Department of Toxicology, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Gongbo Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Yunjiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, 510655, China.
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment; Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China.
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Wu JB, Yin XN, Qiu SY, Wen GM, Yang WK, Zhang JY, Zhao YF, Wang X, Hong XB, Lu D, Jing J. Association between screen time and hyperactive behaviors in children under 3 years in China. Front Psychiatry 2022; 13:977879. [PMID: 36440411 PMCID: PMC9683344 DOI: 10.3389/fpsyt.2022.977879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screen time during early life has increased dramatically among Chinese children. Excessive screen time has raised growing concerns about the neuropsychological development of children. The effects of screen exposure on early life and the boundary between screen time and hyperactive behaviors are well worth investigating. We examined associations between screen time and hyperactive behaviors in children under the age of 3 years using data from the Longhua Children Cohort Study (LCCS). METHODS A cross-sectional study was conducted among 42,841 3-year-old children from Longhua District, Shenzhen. Information on socio-demographic characteristics, children's annual screen time since birth, and hyperactive behaviors (measured by the Conners Parental Symptom Questionnaire) was collected through self-administered structured questionnaires completed by the primary caregiver. A series of logistic regression models assessed the association between screen time and hyperactive behaviors. RESULTS The average daily screen time of children under the age of 3 years was 55.83 ± 58.54 min, and screen time increased with age. Binomial logistic regression analysis found that the earlier the screen exposure, the greater the risk of hyperactive behaviors. Using binary logistic regression model, after controlling for confounding factors, the study found that more screen time was more associated with hyperactive behaviors. For children aged 0-3 years with daily screen time exceeding 90, 120, 150, and 180 min, the risk values for hyperactive behaviors were 1.98 [95% confidence interval (CI): 1.05, 3.78), 2.71 (95%CI:1.38, 5.30), 3.17 (95% CI: 1.50, 6.65), and 4.62 (95% CI: 2.45, 8.71)], respectively. CONCLUSION Early screen exposure may be associated with hyperactive behaviors in children under the age of 3 years. More than 90 min of screen time per day in children under 3 years was associated with hyperactive behaviors. The findings support the importance of screen time interventions for children under 3 years.
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Affiliation(s)
- Jian-Bo Wu
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Xiao-Na Yin
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Shuang-Yan Qiu
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Guo-Ming Wen
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Wei-Kang Yang
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Jing-Yu Zhang
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Ya-Fen Zhao
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Xin Wang
- Key Laboratory of Brain, Cognition and Education Science, Ministry of Education, Institute for Brain Research and Rehabilitation, Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Xiao-Bing Hong
- School of Management, Jinan University, Guangzhou, China
| | - DaLi Lu
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Sullivan ADW, Forehand R, Acosta J, Parent J, Comer JS, Loiselle R, Jones DJ. COVID-19 and the Acceleration of Behavioral Parent Training Telehealth: Current Status and Future Directions. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:618-629. [PMID: 34629838 PMCID: PMC8488182 DOI: 10.1016/j.cbpra.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/12/2021] [Accepted: 06/19/2021] [Indexed: 02/01/2023]
Abstract
The SARS-COV-2 (COVID-19) pandemic and associated social distancing guidelines have accelerated the telehealth transition in mental health. For those providing Behavioral Parent Training (BPT), this transition has called for moving sessions that are traditionally clinic-based, active, and directive to engaging, supporting, and treating families of children with behavior disorders remotely in their homes. Whereas many difficulties accompany this transition, the lessons learned during the current public health crisis have the potential to transform BPT service delivery on a large scale in ways that address many of its long-standing limitations. We describe both challenges and opportunities and consider the possibilities inherent in a large scale BPT service delivery model capable of increasing the reach and impact of evidence-based treatment for all families.
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Affiliation(s)
| | | | - Juliana Acosta
- Center for Children and Families, Florida International University
| | - Justin Parent
- Center for Children and Families, Florida International University
| | - Jonathan S Comer
- Center for Children and Families, Florida International University
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Miller M, Iosif AM, Bell LJ, Farquhar-Leicester A, Hatch B, Hill A, Hill MM, Solis E, Young GS, Ozonoff S. Can Familial Risk for ADHD Be Detected in the First Two Years of Life? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:619-631. [PMID: 31951755 PMCID: PMC7365744 DOI: 10.1080/15374416.2019.1709196] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: We evaluated trajectories of attention-deficit/hyperactivity (ADHD)-relevant behaviors in a sample of infants at high and low familial risk for ADHD who were prospectively evaluated at 12, 18, and 24 months of age.Method: Participants included 43 infants at risk for ADHD based on family history (i.e., diagnosed first-degree relative) and 40 low-risk infants (i.e., no family history of ADHD). Instances of inattention, out-of-seat, and grabbing behavior were coded from video; analogous constructs were rated by examiners unaware of familial risk status after completing structured standardized assessments with the infants/toddlers. At the end of each study visit, examiners solicited parents' concerns about their child's behavior. Differences in ADHD-related behaviors and parent concerns were examined between 12 and 24 months of age.Results: Infants with an older sibling or parent diagnosed with ADHD were distinguishable from infants with no family history of ADHD as early as 12 months of age based on directly observed and examiner reports of behavior, particularly with respect to hyperactive-impulsive behavior. Parents of infants at familial risk for ADHD also reported significantly more behavior/temperament concerns as early as 12 months of age compared to parents of infants at low risk for ADHD.Conclusions: These findings highlight the ability to detect genetic liability for ADHD by the end of the first year of life, suggesting that well-designed family risk studies of ADHD are feasible and may be clinically valuable. They also suggest the potential for earlier detection of risk for ADHD than has previously been possible.
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Affiliation(s)
- Meghan Miller
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis
| | - Laura J Bell
- Department of Psychology, University of California, Berkeley
| | | | - Burt Hatch
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Alesha Hill
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Monique Moore Hill
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Erika Solis
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Gregory S Young
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
| | - Sally Ozonoff
- Department of Psychiatry & Behavioral Sciences and MIND Institute, University of California, Davis
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Larsen LB, Daley D, Lange AM, Sonuga-Barke E, Thomsen PH, Rask CU. Effect of Parent Training on Health-Related Quality of Life in Preschool Children With Attention-Deficit/Hyperactivity Disorder: A Secondary Analysis of Data From a Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2021; 60:734-744.e3. [PMID: 32505701 DOI: 10.1016/j.jaac.2020.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/04/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE School-age children with attention-deficit/hyperactivity disorder (ADHD) have reduced health-related quality of life (HRQoL), but it is unclear whether this is also true for preschool children. It is unknown whether parent training (PT) improves HRQoL. This study compared HRQoL in preschool children with ADHD with age-matched children from the general population; examined whether PT improves HRQoL; and tested if treatment-related changes in HRQoL were mediated by improvements in ADHD, parent efficacy, and family stress. METHOD Parents of 164 children age 3-7 years with an ADHD diagnosis participated in a randomized controlled trial comparing the New Forest Parenting Programme and treatment as usual. Measures of HRQoL, ADHD, parent efficacy, and family stress were completed at baseline, posttreatment, and 36-week follow-up. Child baseline HRQoL was compared with 2 general population-based reference groups. PT effects were analyzed using linear models and mediation analyses. RESULTS Preschoolers with ADHD had lower HRQoL than the reference groups. The New Forest Parenting Programme, but not treatment as usual, was associated with improvement in psychosocial HRQoL at posttreatment (change 2.28, 95% CI [0.78, 3.77]) and at 36-week follow-up (change 2.05, 95% CI [0.56, 3.54]). This difference between treatment arms was not statistically significant. Parent efficacy and family stress scores at posttreatment significantly mediated improvements in HRQoL at 36-week follow-up; ADHD scores at posttreatment did not. CONCLUSION ADHD negatively impacts HRQoL in early childhood. PT for ADHD has the potential to improve HRQoL independently of its effects on ADHD symptoms. CLINICAL TRIAL REGISTRATION INFORMATION A Controlled Study of Parent Training in the Treatment of ADHD in Young Children (D'SNAPP); http://clinicaltrial.gov/; NCT01684644.
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Behavioural Measures of Infant Activity but Not Attention Associate with Later Preschool ADHD Traits. Brain Sci 2021; 11:brainsci11050524. [PMID: 33919004 PMCID: PMC8143002 DOI: 10.3390/brainsci11050524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Mapping infant neurocognitive differences that precede later ADHD-related behaviours is critical for designing early interventions. In this study, we investigated (1) group differences in a battery of measures assessing aspects of attention and activity level in infants with and without a family history of ADHD or related conditions (ASD), and (2) longitudinal associations between the infant measures and preschool ADHD traits at 3 years. Participants (N = 151) were infants with or without an elevated likelihood for ADHD (due to a family history of ADHD and/or ASD). A multi-method assessment protocol was used to assess infant attention and activity level at 10 months of age that included behavioural, cognitive, physiological and neural measures. Preschool ADHD traits were measured at 3 years of age using the Child Behaviour Checklist (CBCL) and the Child Behaviour Questionnaire (CBQ). Across a broad range of measures, we found no significant group differences in attention or activity level at 10 months between infants with and without a family history of ADHD or ASD. However, parent and observer ratings of infant activity level at 10 months were positively associated with later preschool ADHD traits at 3 years. Observable behavioural differences in activity level (but not attention) may be apparent from infancy in children who later develop elevated preschool ADHD traits.
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11
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Oerbeck B, Overgaard KR, Pripp AH, Reichborn-Kjennerud T, Aase H, Zeiner P. Early Predictors of ADHD: Evidence from a Prospective Birth Cohort. J Atten Disord 2020; 24:1685-1692. [PMID: 29254401 DOI: 10.1177/1087054717696765] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective: To identify preschool predictors of registered ADHD diagnoses and compare two ADHD rating scales, Child Behavior Checklist (CBCL) and Conners' Parent Rating Scale (CPRS-R:S). Method: The Norwegian Mother and Child Cohort study (MoBa) is a prospective population-based cohort study. The sample were singletons whose mothers responded to MoBa questionnaires at child age 3 years (n = 57,986) and 5 years (n = 32,377). ADHD diagnoses were obtained from the Norwegian Patient Register. Predictors were child gender, development and symptoms, and maternal ADHD symptoms. We used Cox proportional hazard regression analyses. Results: In all final models, ADHD symptoms at age 3 and 5 years predicted later ADHD: Age 3, CBCL: hazard ratio (HR) = 3.23 (CI [2.59, 4.02]); age 5, CBCL: HR = 10.30 (CI [7.44, 14.26]); and age 5 CPRS-R:S: HR = 5.92 (CI [4.95, 7.07]). Conclusion: The findings underline the importance of taking early parent-reported symptoms seriously. Both rating scales were useful for predicting ADHD.
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Affiliation(s)
| | | | | | | | - Heidi Aase
- Norwegian Institute of Public Health, Oslo, Norway
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12
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May F, Ford T, Janssens A, Newlove-Delgado T, Emma Russell A, Salim J, Ukoumunne OC, Hayes R. Attainment, attendance, and school difficulties in UK primary schoolchildren with probable ADHD. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2020; 91:442-462. [PMID: 32740914 DOI: 10.1111/bjep.12375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/08/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Among children aged 6-16, there is a clear association between attention-deficit/hyperactivity disorder (ADHD) symptoms and academic attainment. We wanted to know whether this association was replicated in younger children. AIMS To explore the relationship between children aged 4-8 with probable ADHD and their academic attainment and school attendance. Secondly, the study aimed to explore their behaviour within school and their reported attitudes towards school. SAMPLE A total of 1,152 children who were taking part in the Supporting Teachers and Children in Schools (STARS) cluster randomized controlled trial. METHODS ADHD status was established by using the Strengths and Difficulties Questionnaire predictive algorithm to identify children with probable ADHD. Using baseline data, random-effects regression models on ADHD status were fitted to attainment, attendance, special educational needs (SEN) provision, and attitudes towards school and classroom behaviour; models that were also fitted to attainment were evaluated again at 9, 18, and 30 months after baseline. RESULTS Children with probable ADHD (n = 47) were more likely than controls (n = 1,105) to have below-expected attainment in literacy (odds ratio (OR) 16.7, 95% CI 6.93-to-40.1), numeracy (OR 11.3, 95% CI 5.34-to-24.1) and to be identified as having SEN (OR-55.2, 95%-CI 22.1-to-137). Their attendance was poorer with more unauthorized absences (rate ratio (RR)-1.91, 95%-CI-1.57-to-2.31). They had more teacher-reported behavioural problems (mean difference (MD) 5.0, 95%-CI 4.6-to-5.4) and less positive attitudes towards school (MD -1.1, 95% CI -0.56 to -1.85). Poorer attainment in literacy and numeracy persisted at all follow-ups. CONCLUSIONS Children aged as young as 4 whose behaviour indicates probable ADHD struggle to cope at school in terms of academic attainment, attendance, classroom behaviour, and attitude towards school when compared to other children. Early identification and intervention to help these children manage in school are needed.
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Affiliation(s)
- Felix May
- Exeter Medical School, University of Exeter, UK
| | - Tamsin Ford
- Department of Psychiatry, Child and Adolescent Psychiatry, Cambridge, UK
| | - Astrid Janssens
- Department of Public Health, University of Southern Denmark, Odense C, Denmark.,University of Exeter Medical School, UK
| | - Tamsin Newlove-Delgado
- Child Mental Health Research Group, Institute of Health Research, College of Medicine and Health, Exeter, UK
| | - Abigail Emma Russell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, UK
| | - Javid Salim
- Exeter Medical School, University of Exeter, UK
| | | | - Rachel Hayes
- Child Mental Health Research Group, Institute of Health Research, College of Medicine and Health, Exeter, UK
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13
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Pagani LS, Ellemberg D, Moore RD. Clinically Historical and Prospective Associations Between Learning Disorders and Concussion in Young Adult Athletes. Am J Lifestyle Med 2020; 14:187-193. [PMID: 32231484 PMCID: PMC7092401 DOI: 10.1177/1559827618793350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/17/2018] [Accepted: 07/18/2018] [Indexed: 11/16/2022] Open
Abstract
Background. Athletes with specific learning disorder (LD) tend to score lower on neuropsychological tests and are at increased risk of personal injury than their counterparts without such disorders. Using a retrospective historical and prospective design, we examined whether adult athletes with LD, the most prevalent of neurodevelopmental disorders, experience greater chances of past and future concussions than their counterparts without LD. We expected to find that young athletes with LD would show greater risk of past (historical) and future (prospective) cerebral concussions. Methods. Participants (95 men and 53 women aged 18 to 25 years) were recruited from university sports teams and followed during an entire season. Of these, 38 participants had a history of LD and 101 had a history of at least 1 concussion (72 males, 29 females) at the preseason baseline. One-third experienced a new concussion. Data analytic procedures include inferential cross-tabulations. Results. Athletes with LD were twice more likely to have a concussion history at baseline and to have a history of multiple concussions than athletes without LD; 95% CI = [0.86, 4.92] and [0.77, 3.40], respectively. Athletes with LD were twice more likely to incur a new concussion than those without LD; 95% CI = [0.86, 4.92]. Conclusions. Adult athletes with LD experience greater chances of previous and future concussions compared with counterparts without LD. Preventive practices regarding individuals with neurodevelopmental disorders may not only prevent the biopsychosocial consequences of brain trauma for the individual, but also represent a cost-effective public health measure.
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Affiliation(s)
- Linda S. Pagani
- Linda S. Pagani, PhD, School of
Psycho-Education, Université de Montréal, CP 6128, succursale Centre-ville,
Montréal, QC H3C 3J7, Canada; e-mail:
| | - Dave Ellemberg
- École de psychoéducation, Université de Montréal,
Canada (LSP)
- Sainte-Justine’s Hospital Research Center (Brain
Diseases Division), Université de Montréal, Canada (LSP, DE)
- Laboratoire de la neuropsychologie du sport et du
développement, Université de Montréal, Canada (DE)
- Arnold School of Public Health, University of South
Carolina, Columbia, North Carolina (RDM)
| | - Robert Davis Moore
- École de psychoéducation, Université de Montréal,
Canada (LSP)
- Sainte-Justine’s Hospital Research Center (Brain
Diseases Division), Université de Montréal, Canada (LSP, DE)
- Laboratoire de la neuropsychologie du sport et du
développement, Université de Montréal, Canada (DE)
- Arnold School of Public Health, University of South
Carolina, Columbia, North Carolina (RDM)
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14
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Hubel GS, Cooley JL, Moreland AD. Incorporating evidence-based behavioral teacher training into Head Start mental health consultation: Description and initial outcomes of a large-scale program. PSYCHOLOGY IN THE SCHOOLS 2020; 57:735-756. [PMID: 33833474 DOI: 10.1002/pits.22348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Development of a multicomponent mental health consultation program for a countywide Head Start program is described. The consultation program incorporates strategies from the evidence-based practice, Teacher-Child Interaction Training (TCIT). Through large group professional development trainings before the school year, comprehensive feedback reports based on observations, and in-class coaching via modeling and performance feedback on teachers' use of TCIT skills, the consultation program served 55 Head Start classrooms with 789 children. Outcome data are presented on teachers' improvement in TCIT skill use and the relative effectiveness of two coaching methods (i.e., modeling and performance feedback) used during consultation. Results from multilevel modeling analyses indicated that teachers improved in the use of multiple observed TCIT skills between the initial and midyear assessment (i.e., increased frequency of labeled praises, reflections, behavioral descriptions, and commands that were complied with; decreased frequency of commands that children did not have an opportunity to comply with). Additionally, teachers who received coaching in the form of performance feedback, in comparison to modeling, exhibited greater gains in the frequency of labeled praises and commands that resulted in compliance. Discussion focuses on implementation of evidence-based practice in large-scale preventative early interventions, study limitations, and directions for future research.
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Affiliation(s)
- Grace S Hubel
- Department of Psychology, The College of Charleston, Charleston, South Carolina
| | - John L Cooley
- Department of Psychiatry, Developmental Psychobiology Research Group, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angela D Moreland
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, South Carolina
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15
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DuPaul GJ, Fu Q, Anastopoulos AD, Reid R, Power TJ. ADHD Parent and Teacher Symptom Ratings: Differential Item Functioning across Gender, Age, Race, and Ethnicity. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:679-691. [DOI: 10.1007/s10802-020-00618-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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McCabe KM, Yeh M, Zerr AA. Personalizing Behavioral Parent Training Interventions to Improve Treatment Engagement and Outcomes for Culturally Diverse Families. Psychol Res Behav Manag 2020; 13:41-53. [PMID: 32021508 PMCID: PMC6966146 DOI: 10.2147/prbm.s230005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral Parent Training (BPT) interventions are efficacious for young children with externalizing behavior problems. However, not all families benefit, and ethnic minority families in particular are less likely to enroll, engage, and improve in BPT. Versions of BPT interventions tailored for specific ethnic groups have been successful at improving engagement and outcomes for ethnic minorities; however, the specificity of these models presents challenges for broad dissemination. This article presents a personalization approach (PersIn) that utilizes cultural assessment results to tailor treatment protocols to the characteristics of individual families. We believe this approach has the potential to maximize cultural sensitivity while preserving generalizability to both minority and non-minority ethnic groups. We further propose that personalization on Parent Explanatory Model (PEM) parameters that have been found to vary across ethnic groups and to impact treatment engagement and/or outcomes is a promising approach to decreasing disparities in BPTs. We describe examples of evidence-supported PEMs that present good targets for personalization and provide examples from MY PCIT to illustrate how PersIn can be applied to Parent-Child Interaction Therapy (PCIT).
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Affiliation(s)
- Kristen M McCabe
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - May Yeh
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Argero A Zerr
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- Department of Psychology, California State University Channel Islands, Camarillo, CA, USA
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17
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He GH, Strodl E, Liu L, Ruan ZL, Yin XN, Wen GM, Sun DL, Xian DX, Jiang H, Jing J, Jin Y, Wu CA, Chen WQ. Teacher's Type D Personality and Chinese Children's Hyperactive Behaviors: Moderation Effect of Parental Type D Personality and Mediation Effect of Teacher-Student Relationship. Front Psychol 2019; 10:2517. [PMID: 31781007 PMCID: PMC6856868 DOI: 10.3389/fpsyg.2019.02517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/24/2019] [Indexed: 02/02/2023] Open
Abstract
This study aimed to explore the association between teacher’s type D personality (TDP) and children’s hyperactive behaviors, along with the moderation effect of parental TDP and the mediation effect of the teacher–student relationship. In this prospective study, a total of 25,852 children were surveyed from 2014 to 2016 in Longhua District of Shenzhen, China, and followed up 1 year later. At baseline, parents provided data on parental TDP and children’s hyperactive behaviors, while teachers reported on their TDP. At follow-up, parents provided data on children’s hyperactive behaviors again, and teachers described their relationship with each student. Two-level multilevel logistic models were conducted to assess the influence of a teacher’s TDP, parental TDP, and their interaction on children’s hyperactive behaviors. Mediation analysis was used to examine the mediating role of the teacher–student relationship. Results indicated that teachers’ TDP was not a significant predictor of children’s hyperactive behaviors after 1 year in kindergarten. Conversely, maternal and paternal TDP were prospectively and positively associated with children’s subsequent hyperactive behaviors. However, the children with a TDP teacher, a TDP mother, and/or a TDP father had higher risk of hyperactive behaviors than those with either a TDP teacher or a TDP mother or a TDP father. In addition, the teacher–student relationship was not a significant mediator between teacher’s TDP and children’s hyperactive behaviors. Further, researchers may consider the effect of the combination of teacher’s TDP, maternal TDP, and paternal TDP on hyperactive behaviors in children in further studies.
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Affiliation(s)
- Guan-Hao He
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Li Liu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zeng-Liang Ruan
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Na Yin
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Guo-Ming Wen
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Deng-Li Sun
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Dan-Xia Xian
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Hui Jiang
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jin Jing
- Department of Women and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yu Jin
- Department of Women and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chuan-An Wu
- Women's and Children's Hospital of Longhua District, Shenzhen, China
| | - Wei-Qing Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Department of Information Management, Xinhua College of Sun Yat-sen University, Guangzhou, China
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18
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Peskin M, Rotem A, Golubchik P, Weizman A, Manor I. Demographic and Clinical Predictors of Hospitalization in Preschoolers With ADHD. J Atten Disord 2019; 23:1284-1290. [PMID: 29749278 DOI: 10.1177/1087054718772145] [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: 11/15/2022]
Abstract
Objective: This chart review study characterized demographic and clinical indicators of the need for hospitalization in preschoolers with ADHD. Method: Medical records of preschoolers with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) ADHD during 2009-2012 were systematically reviewed. The cohort included 111 children (aged 5.13 ± 0.55 years, 77.47% boys). The demographic and clinical variables of hospitalized at a day-care unit (n = 30) and nonhospitalized (n = 81) preschoolers were compared. Results: Hospitalized preschoolers were younger (p < .0001), had higher rates of unmarried mothers (p < .001), and a higher number of comorbidities. The number of inattentive/hyperactivity-impulsivity symptoms was similar in both groups. Neurodevelopmental comorbidity (p < .0001), but not externalized (p = .82) or internalized (p = .20) psychopathology, was significantly higher in the hospitalized group. Conclusion: ADHD severity in preschoolers tends to be associated with younger age, specific parenthood constellations, and a high rate of neurodevelopmental, but not other, comorbidities. These findings emphasize the importance of the neurodevelopmental context in planning ADHD interventions at preschool age.
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Affiliation(s)
- Miriam Peskin
- 1 Geha Mental Health Center, Petah Tikva, Israel.,2 Tel Aviv University, Israel
| | - Ann Rotem
- 1 Geha Mental Health Center, Petah Tikva, Israel
| | - Pavel Golubchik
- 1 Geha Mental Health Center, Petah Tikva, Israel.,2 Tel Aviv University, Israel
| | - Abraham Weizman
- 1 Geha Mental Health Center, Petah Tikva, Israel.,2 Tel Aviv University, Israel
| | - Iris Manor
- 1 Geha Mental Health Center, Petah Tikva, Israel.,2 Tel Aviv University, Israel
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19
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Daley D, Jacobsen RH, Lange AM, Sørensen A, Walldorf J. The economic burden of adult attention deficit hyperactivity disorder: A sibling comparison cost analysis. Eur Psychiatry 2019; 61:41-48. [PMID: 31288209 DOI: 10.1016/j.eurpsy.2019.06.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
AIM Attention Deficit Hyperactivity Disorder (ADHD) is a lifespan disorder associated with considerable economic cost. While the economic burden of ADHD has been widely estimated, there is considerable variation in reported costs between studies, which typically focus on health outcomes only, lack adequate control and fail to correct for the influence of genetic and shared environmental factors. The aim of this study is to overcome these limitations to reach a fuller understanding of the economic burden of ADHD. METHOD Using the Danish National Registers 5269 adults with a diagnosis of ADHD in adulthood who had not received a diagnosis in childhood were identified. Excluding cases with missing data, comorbid diagnoses, and cases without a same sex sibling free of any diagnosed psychiatric diagnoses, a final cohort was formed consisting of 460 sibling dyads. Using a cross-sectional method focusing on the year 2010, cost differences between each adult with ADHD and their sibling were calculated from data retrieved from health, education, crime, employment and social care registers. RESULTS Adults with ADHD had considerably lower disposable income and paid less tax than their siblings. They also received more state benefits, had higher costs for health, social care, and crime than their siblings. The total average costs difference for the year 2010 was 20,134 euros more than their sibling for each adult with ADHD. CONCLUSION ADHD is associated with considerable costs which are borne by both the individual and the state and underlines the need to consider the wider economic impact of ADHD beyond income and healthcare utilisation costs.
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Affiliation(s)
- D Daley
- Division of Psychiatry and Applied Psychology, School of Medicine & Centre for ADHD and Neurodevelopmental Disorders across the Lifespan & NIHR MindTech Health Care Technology Cooperative, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.
| | - R H Jacobsen
- VIVE, The Danish Centre for Applied Social Science, Copenhagen, Denmark
| | - A-M Lange
- Aarhus University Hospital, Department of Child & Adolescent Psychiatry, Skejby, Denmark
| | - A Sørensen
- Department of Economics, Copenhagen Business School, Porcelaenshaven, Copenhagen, Denmark
| | - J Walldorf
- Department of Economics, Copenhagen Business School, Porcelaenshaven, Copenhagen, Denmark
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20
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The predictive validity of the Strengths and Difficulties Questionnaire for child attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2019; 28:625-633. [PMID: 30220077 DOI: 10.1007/s00787-018-1226-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/06/2018] [Indexed: 01/31/2023]
Abstract
We need accurate screening measures for attention-deficit/hyperactivity disorder (ADHD) to ensure that children with the disorder are referred for assessment without raising concern for children with normal behaviour. The Strengths and Difficulties Questionnaire (SDQ) provides hyperactivity-inattention (HI), conduct, emotional and peer problem subscales and impact scores that may be used for screening. The aim of the study was to investigate the predictive validity of the Danish version of the parent SDQ HI subscale at the child age of 7 years for subsequent clinically diagnosed ADHD (age 8-15 years). Participants were part of the Danish National Birth Cohort (N = 51,096), and children with ADHD were identified through the Danish National Health registries (n = 943). Receiver operating characteristic analysis showed that the screening accuracy for the HI scores was good (area under the curve = .84). With Cox multivariate regression analysis, we found that SDQ HI subscale scores ≥ 7 with impact gave a nearly 14-fold [hazard ratio (HR) = 13.59] increased risk for ADHD, while conduct and emotional problems indicated low risk (HRs of 1.62 and 1.67, respectively). For the HI subscale to be a sensitive measure for ADHD, a low cutoff (4) was needed, but gave many false screening positives (PPV = .02). Although the diagnostic accuracy of the parent version of the SDQ HI subscale for predicting ADHD was good, our results question the feasibility of screening the general child population for ADHD with only the parent SDQ HI subscale.
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21
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He GH, Liu L, Strodl E, Ruan ZL, Jiang H, Jing J, Jin Y, Chen WQ. Parental Type D Personality and Children's Hyperactive Behaviors: The Mediating Role of Parent⁻Child Interactive Activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071116. [PMID: 30925765 PMCID: PMC6480101 DOI: 10.3390/ijerph16071116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/27/2023]
Abstract
This study explored the associations between parental Type D personality (TDP), parent–child interactive activities, and children’s hyperactive behaviors. Moreover, the study examined whether parent–child interactive activities mediated the associations between parental TDP and children’s hyperactive behaviors. A cross-sectional survey was conducted among children from all kindergartens in a district of a southern city in China. Data on parental TDP, the frequency of parent–child interactive activities, children’s hyperactive behaviors, and socio-demographic characteristics were provided by 47,648 parent–child dyads. Multiple regression analysis was employed to assess the associations between parental TDP, parent–child interactive activities, and children’s hyperactive behaviors. Mediation analysis was applied to explore the mediating role of parent–child interactive activities on the associations between parental TDP and children’s hyperactive behaviors. Parental TDP was negatively associated with the frequency of parent–child interactive activities and positively associated with children’s hyperactive behaviors. The frequencies of parent–child interactive activities were negatively associated with children’s hyperactive behaviors. The frequency of parent–child interactive activities partially mediated the associations between parental TDP and children’s hyperactive behaviors. Future research may consider parental TDP and parent–child interactive activities as potential important predictors of hyperactive behaviors in children. Such research will help identify further targets for intervention to reduce hyperactive behaviors in children.
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Affiliation(s)
- Guan-Hao He
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Li Liu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane 4059, Queensland, Australia.
| | - Zeng-Liang Ruan
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Hui Jiang
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Jin Jing
- Department of Women and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Yu Jin
- Department of Women and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Wei-Qing Chen
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
- Department of Information Management, Xinhua College of Sun Yat-Sen University, Guangzhou 510080, China.
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22
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Jacobson LA, Schneider H, Mahone EM. Preschool Inhibitory Control Predicts ADHD Group Status and Inhibitory Weakness in School. Arch Clin Neuropsychol 2019; 33:1006-1014. [PMID: 29293868 DOI: 10.1093/arclin/acx124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/27/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Discriminative utility of performance measures of inhibitory control was examined in preschool children with and without ADHD to determine whether performance measures added to diagnostic prediction and to prediction of informant-rated day-to-day executive function. Method Children ages 4-5 years (N = 105, 61% boys; 54 ADHD, medication-naïve) were assessed using performance measures (Auditory Continuous Performance Test for Preschoolers-Commission errors, Conflicting Motor Response Test, NEPSY Statue) and caregiver (parent, teacher) ratings of inhibition (Behavior Rating Inventory of Executive Function-Preschool version). Results Performance measures and parent and teacher reports of inhibitory control significantly and uniquely predicted ADHD group status; however, performance measures did not add to prediction of group status beyond parent reports. Performance measures did significantly predict classroom inhibitory control (teacher ratings), over and above parent reports of inhibitory control. Conclusions Performance measures of inhibitory control may be adequate predictors of ADHD status and good predictors of young children's classroom inhibitory control, demonstrating utility as components of clinical assessments.
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Affiliation(s)
- Lisa A Jacobson
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - E Mark Mahone
- Kennedy Krieger Institute, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
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23
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Reinelt T, Samdan G, Kiel N, Petermann F. Frühkindliche Prädiktoren externalisierender Verhaltensauffälligkeiten. KINDHEIT UND ENTWICKLUNG 2019. [DOI: 10.1026/0942-5403/a000268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Externalisierende Verhaltensauffälligkeiten sind mit hohen gesellschaftlichen Kosten verbunden. Damit wirksame Präventions- und frühe Therapieprogramme entwickelt werden können, ist es notwendig, bereits in den ersten Lebensjahren Risiken für einen externalisierenden Entwicklungsverlauf zu identifizieren. In einer systematischen Literaturrecherche konnten aus 21 Publikationen zu 12 längsschnittlichen Geburtskohorten mit insgesamt 55 077 Kindern frühe Risiken bezogen auf eine elterliche Psychopathologie, einen niedrigen sozio-ökonomischen Status und ungünstige Eltern-Kind-Interaktionen identifiziert werden. Insbesondere eine mütterliche Depression, ein niedriger sozio-ökonomischer Status und ein harsches Erziehungsverhalten in den ersten Lebensjahren waren prädiktiv für externalisierende Verhaltensauffälligkeiten im Kindergarten und bei Schuleintritt. Implikationen für die klinische Praxis werden vorgestellt.
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Affiliation(s)
- Tilman Reinelt
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Gizem Samdan
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Natalie Kiel
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
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24
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Oh Y, Yoon HJ, Kim JH, Joung YS. Trait Anxiety as a Mediator of the Association between Attention Deficit Hyperactivity Disorder Symptom Severity and Functional Impairment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:407-414. [PMID: 30466213 PMCID: PMC6245288 DOI: 10.9758/cpn.2018.16.4.407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/22/2017] [Accepted: 08/26/2017] [Indexed: 11/18/2022]
Abstract
Objective Anxiety has been shown to influence functional impairment in patients with attention deficit hyperactivity disorder (ADHD). This study aimed to compare functional impairment in subjects with and without adult ADHD and to investigate the associations among trait anxiety, functional impairment, and ADHD symptom severity. Moreover, the effects of ADHD symptom subtypes on trait anxiety and functional impairment were also examined. Methods The sample included 209 adults between the ages of 20 and 31 years. Fifty-one adults received a diagnosis of ADHD, and an additional age, sex-matched group of 51 adults comprised the adult control. Participants were assessed with Conners’ Adult ADHD Rating Scales (CAARS), the Beck Depression Inventory (BDI), the Spielberg Trait Anxiety Inventory (STAI-T), and the Sheehan Disability Scale (SDS). The relationships among ADHD severity, anxiety, and functional impairment were investigated using Pearson’s correlation analysis. Subtypes of ADHD symptoms that predicted anxiety and functional impairment were investigated using regression analyses. Results Adult ADHD patients significantly differed from normal control subjects according to BDI, STAI-T, and SDS assessment. Significant positive correlations were noted between ADHD severity, anxiety, and functional impairment. Multiple linear regression analysis confirmed anxiety as a mediator between functional impairment and ADHD CAARS symptom subscales. Conclusion Patients with adult ADHD showed higher levels of anxiety, depression, and functional impairment. Additionally, ADHD symptoms and anxiety impacted subject functional impairment. Our results suggest that anxiety may be a strong mediator between ADHD severity and functional impairment.
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Affiliation(s)
- Yunhye Oh
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Psychiatry, National Center for Mental Health, Seoul, Korea
| | - Hee Joon Yoon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hae Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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25
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Moodley DT, Swanepoel C, van Lierde K, Abdoola S, van der Linde J. Vocal Characteristics of School-Aged Children With and Without Attention Deficit Hyperactivity Disorder. J Voice 2018; 33:945.e37-945.e45. [PMID: 30115579 DOI: 10.1016/j.jvoice.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/20/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of this study was to describe the laryngeal anatomy, perceptual, acoustic, and aerodynamic vocal characteristics of school-aged children with and without Attention Deficit Hyperactivity Disorder (ADHD). The predisposition that children with ADHD have for laryngeal injuries are recurrent in nature and are more often than not overlooked as laryngitis. Previous studies have reported varied results on the prevalence rates of pediatric vocal fold nodules within the school-aged ADHD population. STUDY DESIGN A static, two-group comparison was used in the study to investigate the clinical, perceptual, acoustic, and aerodynamic vocal characteristics of children between 7 and 9 years old with and without ADHD. METHODS The study replicated the protocol as executed by Barona-Lleo and Fernandez (2016) with additions. The Multidimensional Voice Program and the Voice Range Profile as additions to the assessment of vocal parameters were used with which comparable dysphonia severity index scores were calculated. Once-off clinical, perceptual, acoustic, and aerodynamic voice assessments were conducted on 20 age-gender matched participants (Control group mean age [months] = 98.80, standard deviation = 10.379; ADHD group mean age [months] = 108.00, standard deviation = 10.873). It was hypothesized that children with ADHD would have more hyperfunctional vocal characteristics; leading to laryngeal injuries, than their control group peers. RESULTS Forty-five percent (n = 9) of the total sample population (both groups combined) had laryngeal pathology. Similar parent reported etiological voice symptoms and vocal habits were seen across both groups. Both groups performed similarly across both perceptual and aerodynamic voice assessments. Acoustically, the control group achieved significantly higher producible pitches than the ADHD group (P = 0.028) and were found to have more dysphonic dysphonia severity index scores than their ADHD group peers (P = 0.034). CONCLUSION Prepubertal, school-aged children with or without ADHD may have similar vocal characteristics than previously thought. This is in support of the null hypothesis. The authors of the current study recommend that vocal screening in all school-aged children be carried out as an effective measure to monitor voice disorders in the pediatric population. Future research into larger sample sizes with this population with a special focus on the effect that central nervous system stimulants may have on the voice is recommended.
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Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE, Vorstman JA, McDaid D, Marín O, Serrano-Drozdowskyj E, Freedman R, Carpenter W. Preventive strategies for mental health. Lancet Psychiatry 2018; 5:591-604. [PMID: 29773478 DOI: 10.1016/s2215-0366(18)30057-9] [Citation(s) in RCA: 290] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
Abstract
Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions also seem to be cost-effective. In the transition to mental illness, the cumulative lifetime effect of multiple small effect size risk factors progressively increases vulnerability to mental health disorders. This process might inform different levels and stages of tailored interventions to lessen risk, or increase protective factors and resilience, especially during sensitive developmental periods. Gaps between knowledge, policy, and practice need to be bridged. Future steps should emphasise mental health promotion, and improvement of early detection and interventions in clinical settings, schools, and the community, with essential support from society and policy makers.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Patrick D McGorry
- Orygen, National Centre for Excellence in Youth Mental Health, and Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Iris E Sommer
- Department of Neuroscience, University Medical Center Groningen, Groningen, Netherlands
| | - Jacob A Vorstman
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - David McDaid
- Department of Health Policy at the London School of Economics and Social Science, London, UK
| | - Oscar Marín
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, and MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Elena Serrano-Drozdowskyj
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Robert Freedman
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - William Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, Baltimore, MD, USA
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Anomalous Brain Development Is Evident in Preschoolers With Attention-Deficit/Hyperactivity Disorder. J Int Neuropsychol Soc 2018; 24:531-539. [PMID: 29576028 PMCID: PMC6035105 DOI: 10.1017/s1355617718000103] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Attention-deficit/hyperactivity disorder (ADHD) is a common neurological disorder with symptom onset early in childhood. Growing evidence suggests anomalous brain development across multiple brain regions is evident in school-aged children; however, few studies have examined whether such differences are notable in the preschool years when symptom onset typically occurs. METHODS High resolution anatomical (MPRAGE) images and cognitive and behavioral measures were analyzed in a total of 90 medication-naïve preschoolers, ages 4-5 years (52 with ADHD, 38 controls; 64.4% boys). RESULTS Results revealed reductions in bilateral frontal, parietal, and temporal lobe gray matter volumes in children with ADHD relative to typically developing children, with largest effect sizes noted for right frontal and left temporal lobe volumes. Examining frontal lobe sub-regions, the largest between group effect sizes were evident for left orbitofrontal cortex, left primary motor cortex (M1), and left supplementary motor complex (SMC). ADHD-related reductions in specific sub-regions (left prefrontal, left premotor, left frontal eye field, left M1, and right SMC) were significantly correlated with symptom severity, such that higher ratings of hyperactive/impulsive symptoms were associated with reduced cortical volumes. CONCLUSIONS These findings represent the first comprehensive examination of cortical volume in preschool children with ADHD, providing evidence that anomalous brain structure in ADHD is evident very early in development. Furthermore, findings set the stage for developing our understanding of the way in which developmental trajectories of anomalous brain development are associated with the unfolding of symptoms in childhood ADHD. (JINS, 2018, 24, 531-539).
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Outpatient rehabilitation resources and medical expenditure in children with attention-deficit hyperactivity disorder in Taiwan. PLoS One 2018; 13:e0199877. [PMID: 29953532 PMCID: PMC6023132 DOI: 10.1371/journal.pone.0199877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 06/15/2018] [Indexed: 11/19/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in children. This study investigated the use of rehabilitation treatment in Taiwan. We selected children aged 3-12 years from the National Health Insurance Research Database from 2008 to 2012 and included them in the analysis. The children who received a diagnosis according to the International Classification of Diseases, Ninth Revision, Clinical Modification were divided into two groups: ADHD and non-ADHD. We used the chi-squared test, independent sample t test, and multiple regression analysis to conduct the analysis. The utilisation of rehabilitation resources was higher in the ADHD group than in the non-ADHD group. The number of school-aged children with ADHD was higher than the number of preschool-aged children (p < 0.001). The highest utilisation of rehabilitation resources was observed in clinics (p < 0.001). In terms of region, Taipei exhibited the highest utilisation of rehabilitation resources, and the East exhibited the lowest resource utilisation (p < 0.001). Prediction of the use of rehabilitation resources, average cost, average frequency of visits, and total annual cost was affected by factors such as the average frequency of rehabilitation use, demographic characteristics, and the hospital characteristics and location (p < 0.001). The number of children with ADHD and rehabilitation use are increasing yearly; however, limitations in payment restrict the growth of rehabilitation resource use in hospitals. Supplementation of rehabilitation resources at clinics accounts for more than 60%, however, the total annual cost is less than what is observed for hospitals (p < 0.001). Policies should be established to aid in the early detection and treatment of children with ADHD to improve treatment outcomes and reduce the family burden and treatment expenditure in the future.
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Young S, González RA, Fridman M, Hodgkins P, Kim K, Gudjonsson GH. The economic consequences of attention-deficit hyperactivity disorder in the Scottish prison system. BMC Psychiatry 2018; 18:210. [PMID: 29940897 PMCID: PMC6019793 DOI: 10.1186/s12888-018-1792-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/13/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is highly prevalent amongst prison inmates and the criminal justice system (CJS) likely bears considerable costs for offenders with ADHD. We aimed to examine the relationship between ADHD and health-related quality of life (HRQoL) and quality-adjusted life years (QALY) amongst imprisoned adults; and to estimate the annual expenditure associated with ADHD status in prison. METHODS An observational study was performed in 2011-2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 (HUI3) was used to measure health status, and to calculate attribute specific HRQoL scores and QALY. Health service utilisation was obtained through inspection of medical prison records. Inmates with ADHD were compared with inmates without ADHD. RESULTS Inmates with ADHD had significantly lower QALYs, with a clinically significant adjusted difference of 0.13. Psychiatric co-morbidity accounted for the variation of ADHD on the HUI3 emotion domain only. Medical costs for inmates with ADHD were significantly higher; and behaviour-related prison costs were similar to prisoners without ADHD, reflecting a low frequency of recorded critical incidents. CONCLUSIONS ADHD may directly contribute to adverse health and quality of life through cognitive and executive function deficits, and co-morbid disorders. The extrapolation of conservative cost estimates suggests that the financial burden of medical and behavior-related prison care for inmates with ADHD in the UK is approximately £11.7 million annually. The reported cost estimates are conservative as there is great variability in recorded critical incidents in prisons. In turn, for some prison establishments the prison care costs associated with prisoners with ADHD may be considerably greater.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, PO Box 1735, Croydon, CR97AE, UK. .,Reykjavik University, Reykjavik, Iceland.
| | - Rafael A. González
- 0000 0004 0426 7183grid.450709.fEast London NHS Foundation Trust, London, UK
| | | | - Paul Hodgkins
- 0000 0004 5913 664Xgrid.476678.cSage Therapeutics, Cambridge, MA USA
| | - Keira Kim
- Indedpendent Medical Writer, San Diego, CA USA
| | - Gisli H. Gudjonsson
- 0000 0004 0643 5232grid.9580.4Reykjavik University, Reykjavik, Iceland ,0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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30
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Sonuga-Barke EJS, Barton J, Daley D, Hutchings J, Maishman T, Raftery J, Stanton L, Laver-Bradbury C, Chorozoglou M, Coghill D, Little L, Ruddock M, Radford M, Yao GL, Lee L, Gould L, Shipway L, Markomichali P, McGuirk J, Lowe M, Perez E, Lockwood J, Thompson MJJ. A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic, group-based programme: a multi-centre, randomised controlled trial of the New Forest Parenting Programme versus Incredible Years. Eur Child Adolesc Psychiatry 2018; 27:797-809. [PMID: 29086103 PMCID: PMC5973956 DOI: 10.1007/s00787-017-1054-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/21/2017] [Indexed: 12/18/2022]
Abstract
The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33-54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)-12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)-12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome-Parent ratings of child's ADHD symptoms (Swanson, Nolan & Pelham Questionnaire-SNAP-IV). Secondary outcomes-teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference - 0.009 95% CI (- 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [- 0.189 95% CI (- 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [- 0.16 95% CI (- 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK.
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK.
| | - Joanne Barton
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - David Daley
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, School of Psychology, Bangor University, Bangor, UK
| | - Tom Maishman
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Louise Stanton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Maria Chorozoglou
- Southampton Health Technology Assessment Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - Louisa Little
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Martin Ruddock
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Mike Radford
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Louise Lee
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Lisa Gould
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Lisa Shipway
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - Pavlina Markomichali
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
| | - James McGuirk
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - Michelle Lowe
- North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, UK
| | - Elvira Perez
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Joanna Lockwood
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TR, UK
- NIHR MindTech, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TR, UK
| | - Margaret J J Thompson
- Academic Unit of Psychology, University of Southampton, Southampton, SO17 IBJ, UK
- CAMHS, Solent NHS Trust, Better Care Centre, Southampton, UK
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ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry 2018; 5:175-186. [PMID: 29033005 DOI: 10.1016/s2215-0366(17)30167-0] [Citation(s) in RCA: 546] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 12/17/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common childhood behavioural disorder. Systematic reviews indicate that the community prevalence globally is between 2% and 7%, with an average of around 5%. At least a further 5% of children have substantial difficulties with overactivity, inattention, and impulsivity that are just under the threshold to meet full diagnostic criteria for ADHD. Estimates of the administrative prevalence (clinically diagnosed or recorded) vary worldwide, and have been increasing over time. However, ADHD is still relatively under-recognised and underdiagnosed in most countries, particularly in girls and older children. ADHD often persists into adulthood and is a risk factor for other mental health disorders and negative outcomes, including educational underachievement, difficulties with employment and relationships, and criminality. The timely recognition and treatment of children with ADHD-type difficulties provides an opportunity to improve long-term outcomes. This Review includes a systematic review of the community and administrative prevalence of ADHD in children and adolescents, an overview of barriers to accessing care, a description of associated costs, and a discussion of evidence-based pathways for the delivery of clinical care, including a focus on key issues for two specific age groups-younger children (aged ≤6 years) and adolescents requiring transition of care from child to adult services.
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O'Neill S, Rajendran K, Mahbubani SM, Halperin JM. Preschool Predictors of ADHD Symptoms and Impairment During Childhood and Adolescence. Curr Psychiatry Rep 2017; 19:95. [PMID: 29082443 PMCID: PMC6349372 DOI: 10.1007/s11920-017-0853-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW This paper summarizes key, recently published research examining longitudinal outcomes for preschoolers with high levels of inattention and/or hyperactivity/impulsivity. RECENT FINDINGS Symptom trajectories show that hyperactivity/impulsivity declines across childhood. At the group level, the course of inattention appears more variable. However, identification of subgroups of children showing stable, rising, and falling inattention over time is promising. Early ADHD-like symptoms portend risk for academic and social difficulties, as well as comorbid emotional and behavioral problems in childhood and adolescence. Several early risk factors appear to moderate these relations, including comorbid symptoms, parental psychopathology, socioeconomic disadvantage, and perhaps neuropsychological dysfunction. Furthermore, high levels of inattention and/or hyperactivity/impulsivity during the preschool period appear to compromise development of regulatory and neuropsychological functions, which in turn increases risk for negative outcomes later in childhood. Identified risk factors are targets for novel interventions, which ideally would be delivered early to at-risk children.
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Affiliation(s)
- Sarah O'Neill
- The City College and The Graduate Center, City University of New York, New York, NY, USA.
- Department of Psychology, The City College and The Graduate Center, The City College of New York, 160 Convent Avenue, New York, NY, 10031, USA.
| | - Khushmand Rajendran
- Department of Social Sciences, Human Services and Criminal Justice, Borough of Manhattan Community College, City University of New York, New York, NY, USA
| | | | - Jeffrey M Halperin
- Department of Psychology, Queens College and The Graduate Center, City University of New York, Flushing, NY, USA
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Morsink S, Sonuga-Barke E, Mies G, Glorie N, Lemiere J, Van der Oord S, Danckaerts M. What motivates individuals with ADHD? A qualitative analysis from the adolescent's point of view. Eur Child Adolesc Psychiatry 2017; 26:923-932. [PMID: 28233072 DOI: 10.1007/s00787-017-0961-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/09/2017] [Indexed: 12/26/2022]
Abstract
Individuals with ADHD appear to respond differently to incentives than their peers. This could be due to a general altered sensitivity to reinforcers. However, apart from differences in the degree of motivation, individuals with ADHD might also be motivated by qualitatively different factors. This study aimed to harvest a range of motivational factors and identify ADHD-related qualitative differences in motivation, from the adolescent's point of view. Semi-structured interviews allowing participants to describe what motivates them in daily life were conducted with young adolescents (9-16 years) with and without ADHD. Thematic analysis was undertaken using NVivo software. Major themes relating to motivation were identified from the interview data. These were: (1) achieving a sense of togetherness; (2) feeling competent; (3) fulfilling a need for variation; (4) gaining pleasure from applying effort to achieve a goal; (5) valuing social reinforcement; (6) desiring to be absorbed/forget problems; (7) feeling free and independent, (8) attaining material reinforcement; and (9) an enjoyment of bodily stimulation. The theme structure was very similar for both groups. However, individuals with ADHD differed in some specifics: their focus on the passing of time, the absence of preference for predictable and familiar tasks, and their less elaborate description of the togetherness theme. A broad range of motivational themes was identified, stretching beyond the current focus of ADHD research and motivational theories. Similarities and differences in motivational values of individuals with and without ADHD should be taken into account in reward sensitivity research, and in psychological treatment.
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Affiliation(s)
- Sarah Morsink
- Department of Neuroscience, Psychiatry Research, KU Leuven, Louvain, Belgium
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK. .,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| | - Gabry Mies
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Jurgen Lemiere
- Department of Child and Adolescent Psychiatry, UPC KU Leuven, Louvain, Belgium
| | - Saskia Van der Oord
- Clinical Psychology, KU Leuven, Louvain, Belgium.,Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marina Danckaerts
- Department of Neuroscience, Psychiatry Research, KU Leuven, Louvain, Belgium.,Department of Child and Adolescent Psychiatry, UPC KU Leuven, Louvain, Belgium
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DuPaul GJ, Kern L, Belk G, Custer B, Daffner M, Hatfield A, Peek D. Face-to-Face Versus Online Behavioral Parent Training for Young Children at Risk for ADHD: Treatment Engagement and Outcomes. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2017; 47:S369-S383. [PMID: 28715272 DOI: 10.1080/15374416.2017.1342544] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is associated with significant challenges in child functioning. Although behavioral parent training (BPT) can reduce ADHD symptoms, factors associated with traditional face-to-face (F2F) delivery results in only about half of families receiving BPT. The purpose of this pilot randomized controlled trial was to examine parent engagement and program acceptability of F2F and online BPT, as well as the efficacy of both formats relative to a waitlist control (WLC) group. Participants were 47 families with preschool children (30 boys, 17 girls) who were between the ages of 3 years 0 months (3;0) and 5 years 11 months (5;11) old who were identified at risk for ADHD. Children were randomly assigned to F2F or online BPT or to WLC; parents in the two treatment conditions received 10 sessions of BPT. Assessment data for all groups were collected at pre-, mid-, and posttreatment. Both intervention formats resulted in high attendance (M = 80%) and significantly improved parent knowledge of interventions, treatment implementation fidelity, and child behavior (reduced restlessness and impulsivity, improved self-control, affect, and mood) compared with WLC. However, parents in the F2F group reported significantly higher acceptability ratings than parents in the online group. Findings indicate a streamlined BPT delivered online or F2F results in high levels of engagement, acceptability, as well as parent treatment knowledge and fidelity. Online BPT is associated with similar efficacious outcomes with F2F BPT, suggesting the need for further research to determine variables that predict greater acceptability for and adoption of this format.
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Affiliation(s)
- George J DuPaul
- a Department of Education and Human Services , Lehigh University
| | - Lee Kern
- a Department of Education and Human Services , Lehigh University
| | - Georgia Belk
- a Department of Education and Human Services , Lehigh University
| | - Beth Custer
- a Department of Education and Human Services , Lehigh University
| | - Molly Daffner
- a Department of Education and Human Services , Lehigh University
| | - Andrea Hatfield
- a Department of Education and Human Services , Lehigh University
| | - Daniel Peek
- a Department of Education and Human Services , Lehigh University
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35
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Gupta VK, Grover G. Multiple imputation for gamma outcome variable using generalized linear model. J STAT COMPUT SIM 2017. [DOI: 10.1080/00949655.2017.1300904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Vinay K. Gupta
- Department of Statistics, University of Delhi, Delhi, India
| | - Gurprit Grover
- Department of Statistics, University of Delhi, Delhi, India
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36
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Thompson MJJ, Au A, Laver-Bradbury C, Lange AM, Tripp G, Shimabukuro S, Zhang JS, Shuai L, Thompson CE, Daley D, Sonuga-Barke EJ. Adapting an attention-deficit hyperactivity disorder parent training intervention to different cultural contexts: The experience of implementing the New Forest Parenting Programme in China, Denmark, Hong Kong, Japan, and the United Kingdom. Psych J 2017; 6:83-97. [PMID: 28371554 DOI: 10.1002/pchj.159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/02/2017] [Accepted: 01/05/2017] [Indexed: 11/07/2022]
Abstract
The New Forest Parenting Programme (NFPP) is a parenting program developed for parents who have a child with attention-deficit hyperactivity disorder (ADHD). It is a manualized program that is delivered in a parent's home over 8 weeks, or in a group format, or through a self-help manual. Three randomized controlled trials have been carried out in the United Kingdom. The NFPP group has adapted the program according to feedback from parents and therapists, and for use with different populations, both within the United Kingdom and internationally. The first international trial took place in New York, United States. Trials in Denmark, Hong Kong, and Japan followed. More recently, a trial of the self-help manual has been carried out in mainland China. This paper will outline the adaptions that were needed in order to be able to deliver the program in different countries with their own expectations of parenting, culture, and language. Training had to be differently focused; manuals and handouts had to be revised, translated and back-translated; and supervision had to be delivered at a distance to maintain the fidelity of the program. The international group will outline their experience of running trials in their own countries with the NFPP in a face-to-face format (Denmark), a group format (Hong Kong and Japan), and a self-help format (mainland China).
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Affiliation(s)
- Margaret J J Thompson
- Academic Unit of Psychology, University of Southampton, Southampton, UK.,CAMHS, Solent NHS Trust, Better Care Centre, Southampton, UK
| | - Alma Au
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | | | - Anne-Mette Lange
- Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Risskov, Denmark
| | - Gail Tripp
- Human Developmental Neurobiology Research Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Shizuka Shimabukuro
- Human Developmental Neurobiology Research Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan
| | - Jin S Zhang
- Department of Medical Psychology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Shuai
- Department of Medical Psychology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - David Daley
- Division of Psychiatry and Applied Psychology, School of Medicine & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan & NIHR MindTech Health Care Technology Cooperative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Edmund J Sonuga-Barke
- Academic Unit of Psychology, University of Southampton, Southampton, UK.,Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Risskov, Denmark.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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37
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Chen Q, Kuja-Halkola R, Sjölander A, Serlachius E, Cortese S, Faraone SV, Almqvist C, Larsson H. Shared familial risk factors between attention-deficit/hyperactivity disorder and overweight/obesity - a population-based familial coaggregation study in Sweden. J Child Psychol Psychiatry 2017; 58:711-718. [PMID: 28121008 DOI: 10.1111/jcpp.12686] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite meta-analytic evidence for the association between attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity, the mechanisms underlying the association are yet to be fully understood. METHODS By linking multiple Swedish national and regional registers, we identified 472,735 index males born during 1973-1992, with information on body weight and height directly measured before they were conscripted for military service. We further identified 523,237 full siblings born during 1973-2002 for the index males. All individuals were followed up from their third birthday to December 31, 2009 for ADHD diagnosis. Logistic regression models were used to estimate the association between overweight/obesity in index males and ADHD in their full siblings. RESULTS Siblings of index males with overweight/obesity had increased risk for ADHD (overweight: OR = 1.14, 95% CI = 1.05-1.24; obesity: OR = 1.42, 95% CI = 1.24-1.63), compared with siblings of index males with normal weight. The results were adjusted for birth year of the index male and sex of the sibling. After further adjustment for ADHD status of the index male, the familial coaggregation remained significant (overweight: OR = 1.13, 95% CI = 1.04-1.22; obesity: OR = 1.38, 95% CI = 1.21-1.57). The results were similar across sex of the siblings. CONCLUSIONS Attention-deficit/hyperactivity disorder and overweight/obesity share familial risk factors, which are not limited to those causing overweight/obesity through the mediation of ADHD. Future research aiming at identifying family-wide environmental risk factors as well as common pleiotropic genetic variants contributing to both traits is warranted.
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Affiliation(s)
- Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Samuele Cortese
- Department of Psychology, Developmental Brain-Behavior Laboratory, University of Southampton, Southampton, UK.,Solent NHS Trust, Southampton, UK.,Langone Medical Center, New York University Child Study Center, New York, NY, USA
| | - Stephen V Faraone
- Departments of Psychiatry and Neuroscience and Physiology, SUNY Upstate Medical University, New York, NY, USA.,The K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
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38
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Forehand R, Parent J, Sonuga-Barke E, Peisch VD, Long N, Abikoff HB. Which Type of Parent Training Works Best for Preschoolers with Comorbid ADHD and ODD? A Secondary Analysis of a Randomized Controlled Trial Comparing Generic and Specialized Programs. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 44:1503-1513. [PMID: 26909683 DOI: 10.1007/s10802-016-0138-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present study examined whether the presence of comorbid ODD differentially moderated the outcome of two Behavioral Parent Training (BPT) programs in a sample of preschoolers with ADHD: One designed specifically for ADHD (NFPP: New Forest Parenting Programme) and one designed primarily for ODD (HNC: Helping the Noncompliant Child). In a secondary analysis, 130 parents and their 3-4 year-old children diagnosed with ADHD were assigned to one of the two programs. 44.6 % of the children also met criteria for ODD. Significant interactions between treatment conditions (NFPP vs. HNC) and child ODD diagnosis (presence vs. absence) indicated that based on some parent and teacher reports, HNC was more effective with disruptive behaviors than NFPP but only when children had a comorbid diagnosis. Further, based on teacher report, NFPP was more effective with these behaviors when children had a diagnosis of only ADHD whereas HNC was equally effective across ADHD only and comorbid ODD diagnoses. Comorbidity profile did not interact with treatment program when parent or teacher reported ADHD symptoms served as the outcome. Implications for clinical interventions are discussed and directions for future work are provided.
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Affiliation(s)
- Rex Forehand
- University of Vermont, 2 Colchester Ave., Burlington, VT, 05405, USA.
| | - Justin Parent
- University of Vermont, 2 Colchester Ave., Burlington, VT, 05405, USA
| | - Edmund Sonuga-Barke
- University of Southampton, Southampton, UK.,Ghent University, Ghent, Belgium.,Aarhus University, Aarhus, Denmark
| | - Virginia D Peisch
- University of Vermont, 2 Colchester Ave., Burlington, VT, 05405, USA
| | - Nicholas Long
- University of Arkansas Medical School, Little Rock, AR, USA
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39
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The Effects of Attention Problems on Psychosocial Functioning in Childhood Brain Tumor Survivors: A 2-Year Postcraniospinal Irradiation Follow-up. J Pediatr Hematol Oncol 2017; 39:e46-e53. [PMID: 28099397 DOI: 10.1097/mph.0000000000000766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the psychosocial outcomes and impact of attention problems in survivors of pediatric brain tumor. STUDY DESIGN The survivors' cognitive functioning was measured using the Wechsler Intelligence Scale for Children. The Child Behavior Checklist-Attention Problems scale was used to screen for attention problems, and participants were classified as having attention problems (n=15) or normal attention (n=36). Psychosocial functioning was examined with the Korean Personality Rating scale for Children (K-PRC) at precraniospinal radiation and at 2-year follow-up. RESULTS The attention problem group showed significantly higher depression and externalizing symptoms (delinquency, hyperactivity) and more significant impairment in family relationships than did the normal attention group at baseline. At follow-up, the attention problem group demonstrated significantly more delinquency and impaired family and social relationships. With the K-PRC scores, except for the somatization, social relationship subscale, there were significant differences between groups, but not in terms of treatment by time interaction or within time. At follow-up, multiple linear regressions showed that age at diagnosis significantly predicted K-PRC somatization (B=-1.7, P=0.004) and social relationships (B=-1.7, P=0.004), baseline full-scale intelligence quotient predicted K-PRC depression (B=-0.4, P=0.032) and somatization (B=-0.3, P=0.015), and attention problems at baseline predicted K-PRC depression (B=-15.2, P=0.036) and social relationships (B=-11.6, P=0.016). CONCLUSION Pediatric brain tumor survivors, in particular, patients with attention problems, had worse psychosocial functioning at baseline and follow-up. Attention problems at baseline need to be carefully evaluated in assessing psychosocial functioning of pediatric brain tumor survivors.
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40
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Smith E, Meyer BJ, Koerting J, Laver-Bradbury C, Lee L, Jefferson H, Sayal K, Treglown L, Thompson M, Sonuga-Barke EJS. Preschool hyperactivity specifically elevates long-term mental health risks more strongly in males than females: a prospective longitudinal study through to young adulthood. Eur Child Adolesc Psychiatry 2017; 26:123-136. [PMID: 27295115 PMCID: PMC5233734 DOI: 10.1007/s00787-016-0876-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/31/2016] [Indexed: 12/15/2022]
Abstract
Evidence of continuities between preschool hyperactivity and adult mental health problems highlights the potential value of targeting early identification and intervention strategies. However, specific risk factors are currently unclear. This large-scale prospective longitudinal study aimed to identify which hyperactive preschoolers are at the greatest long-term risk of poor mental health. One hundred and seventy children (89 females) rated as hyperactive by their parents, and 88 non-hyperactive controls (48 females) were identified from a community sample of 4215 3-year-olds. Baseline data relating to behavioral/emotional problems and background characteristics were collected. Follow-up mental health and functional impairment outcomes were collected between 14 and 25 years of age. At age 3 years, males and females in the hyperactive group had similarly raised levels of hyperactivity and other behavior problems. In adolescence/young adulthood, these individuals showed elevated symptoms of ADHD, conduct disorder, mood disorder, anxiety and autism, as well as functional impairment. Preschool hyperactivity was strongly predictive of poor adolescent/adult outcomes for males across domains with effects being specifically driven by hyperactivity. For females, the effects of preschool hyperactivity were smaller and dropped to non-significant levels when other preschool problems were taken into account. Environmental risk factors also differed between the sexes, although these may also have been mediated by genetic risk. In conclusion, these results demonstrate marked sex differences in preschool predictors of later adolescent/adult mental health problems. Future research should include a measure of preschool inattention as well as hyperactivity. The findings highlight the potential value of tailored approaches to early identification strategies.
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Affiliation(s)
| | - Brenda J. Meyer
- Developmental Brain and Behaviour Laboratory, Psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - Johanna Koerting
- Developmental Brain and Behaviour Laboratory, Psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - Cathy Laver-Bradbury
- Developmental Brain and Behaviour Laboratory, Psychology, University of Southampton, Southampton, SO17 1BJ UK ,CAMHS, Better Care Centre, Solent NHS Trust, Southampton, UK
| | - Louise Lee
- Developmental Brain and Behaviour Laboratory, Psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - Harriet Jefferson
- Developmental Brain and Behaviour Laboratory, Psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK ,Centre for ADHD and NeuroDevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Luke Treglown
- Department of Psychology, University College London, London, UK
| | - Margaret Thompson
- Developmental Brain and Behaviour Laboratory, Psychology, University of Southampton, Southampton, SO17 1BJ UK ,CAMHS, Better Care Centre, Solent NHS Trust, Southampton, UK
| | - Edmund J. S. Sonuga-Barke
- Developmental Brain and Behaviour Laboratory, Psychology, University of Southampton, Southampton, SO17 1BJ UK
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Goodwin A, Salomone S, Bolton P, Charman T, Jones EJH, Mason L, Pickles A, Robinson E, Smith T, Sonuga-Barke EJS, Wass S, Johnson MH. Attention training for infants at familial risk of ADHD (INTERSTAARS): study protocol for a randomised controlled trial. Trials 2016; 17:608. [PMID: 28031039 PMCID: PMC5192597 DOI: 10.1186/s13063-016-1727-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/31/2016] [Indexed: 12/29/2022] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that can negatively impact on an individual’s quality of life. It is pathophysiologically complex and heterogeneous with different neuropsychological processes being impaired in different individuals. Executive function deficits, including those affecting attention, working memory and inhibitory control, are common. Cognitive training has been promoted as a treatment option, based on the notion that by strengthening the neurocognitive networks underlying these executive processes, ADHD symptoms will also be reduced. However, if implemented in childhood or later, when the full disorder has become well-established, cognitive training has only limited value. INTERSTAARS is a trial designed to test a novel approach to intervention, in which cognitive training is implemented early in development, before the emergence of the disorder. The aim of INTERSTAARS is to train early executive skills, thereby increasing resilience and reducing later ADHD symptoms and associated impairment. Methods/design Fifty 10–14-month-old infants at familial risk of ADHD will participate in INTERSTAARS. Infants will be randomised to an intervention or a control group. The intervention aims to train early attention skills by using novel eye-tracking technology and gaze-contingent training paradigms. Infants view animated games on a screen and different events take place contingent on where on the screen the infant is looking. Infants allocated to the intervention will receive nine weekly home-based attention training sessions. Control group infants will also receive nine weekly home visits, but instead of viewing the training games during these visits they will view non-gaze-contingent age-appropriate videos. At baseline and post treatment, infant attention control will be assessed using a range of eye-tracking, observational, parent-report and neurophysiological measures. The primary outcome will be a composite of eye-tracking tasks used to assess infant attention skills. Follow-up data will be collected on emerging ADHD symptoms when the infants are 2 and 3 years old. Discussion This is the first randomised controlled trial to assess the potential efficacy of cognitive training as a prevention measure for infants at familial risk of ADHD. If successful, INTERSTAARS could offer a promising new approach for developing early interventions for ADHD. Trial registration International Standard Randomised Controlled Trial registry: ISRCTN37683928. Registered on 22 June 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1727-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy Goodwin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Simona Salomone
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Patrick Bolton
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,MRC Social, Genetic and Developmental Psychiatry Centre, IoPPN, King's College London, London, UK.,NIHR Biomedical Research Centre at South London and Maudsley NHS Trust, London, UK
| | - Tony Charman
- Department of Psychology, IoPPN, King's College London, London, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | | | - Andrew Pickles
- Department of Biostatistics, IoPPN, King's College London, London, UK
| | - Emily Robinson
- Department of Biostatistics, IoPPN, King's College London, London, UK
| | - Tim Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Edmund J S Sonuga-Barke
- Department of Psychology, University of Southampton, Southampton, UK.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Sam Wass
- School of Psychology, University of East London, London, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
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42
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Kennedy M, Kreppner J, Knights N, Kumsta R, Maughan B, Golm D, Rutter M, Schlotz W, Sonuga‐Barke EJ. Early severe institutional deprivation is associated with a persistent variant of adult attention-deficit/hyperactivity disorder: clinical presentation, developmental continuities and life circumstances in the English and Romanian Adoptees study. J Child Psychol Psychiatry 2016; 57:1113-25. [PMID: 27264475 PMCID: PMC5042050 DOI: 10.1111/jcpp.12576] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Early-life institutional deprivation is associated with attention-deficit/hyperactivity disorder (ADHD) later in childhood and adolescence. In this article, we examine, for the first time, the persistence of deprivation-related ADHD into young adulthood in a sample of individuals adopted as young children by UK families after periods in extremely depriving Romanian orphanages. METHODS We estimated rates of ADHD at age 15 years and in young adulthood (ages 22-25 years) in individuals at low (LoDep; nondeprived UK adoptees and Romanian adoptees with less than 6-month institutional exposure) and high deprivation-related risk (HiDep; Romanian adoptees with more than 6-month exposure). Estimates were based on parent report using DSM-5 childhood symptom and impairment criteria. At age 15, data were available for 108 LoDep and 86 HiDep cases, while in young adulthood, the numbers were 83 and 60, respectively. Data on education and employment status, IQ, co-occurring symptoms of young adult disinhibited social engagement (DSE), autism spectrum disorder (ASD), cognitive impairment, conduct disorder (CD), callous-unemotional (CU) traits, anxiety, depression and quality of life (QoL) were also collected. RESULTS ADHD rates in the LoDep group were similar to the general population in adolescence (5.6%) and adulthood (3.8%). HiDep individuals were, respectively, nearly four (19%) and over seven (29.3%) times more likely to meet criteria, than LoDep. Nine 'onset' young adult cases emerged, but these had a prior childhood history of elevated ADHD behaviours at ages 6, 11 and 15 years. Young adult ADHD was equally common in males and females, was predominantly inattentive in presentation and co-occurred with high levels of ASD, DSE and CU features. ADHD was associated with high unemployment and low educational attainment. CONCLUSION We provide the first evidence of a strong persistence into adulthood of a distinctively complex and impairing deprivation-related variant of ADHD. Our results confirm the powerful association of early experience with later development in a way that suggests a role for deep-seated alterations to brain structure and function.
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Affiliation(s)
- Mark Kennedy
- Department of PsychologyDevelopmental Brain‐Behaviour LaboratoryUniversity of SouthamptonSouthamptonUK
| | - Jana Kreppner
- Department of PsychologyDevelopmental Brain‐Behaviour LaboratoryUniversity of SouthamptonSouthamptonUK
| | | | - Robert Kumsta
- Department of Genetic PsychologyFaculty of PsychologyRuhr‐University BochumBochumGermany
| | - Barbara Maughan
- MRC Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Dennis Golm
- Department of PsychologyDevelopmental Brain‐Behaviour LaboratoryUniversity of SouthamptonSouthamptonUK
| | - Michael Rutter
- MRC Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Wolff Schlotz
- Max‐Planck‐Institute for Empirical AestheticsFrankfurt am MainGermany
| | - Edmund J.S. Sonuga‐Barke
- Department of PsychologyDevelopmental Brain‐Behaviour LaboratoryUniversity of SouthamptonSouthamptonUK
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Usami M. Functional consequences of attention-deficit hyperactivity disorder on children and their families. Psychiatry Clin Neurosci 2016; 70:303-17. [PMID: 27061213 DOI: 10.1111/pcn.12393] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 12/12/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with core symptoms that include hyperactivity, impulsiveness, and inattention, and it is the most common psychiatric disorder among children and adolescents. These core symptoms are continuously recognized throughout the day from childhood to adulthood. Furthermore, children with ADHD from childhood to adulthood might also have various comorbid psychiatric disorders. Recently, bipolar disorder and disruptive mood dysregulation disorder, a new clinical issue, have been discussed as comorbid disorders or differential disorders associated with ADHD. Furthermore, comorbid disorders of ADHD are related to quality of life and family burden. Children with ADHD have poorer long-term outcomes than controls with respect to: academic achievement and attainment, occupational rank and job performance, risky sexual practices and early unwanted pregnancies, substance use, relationship difficulties, marital problems, traffic violations, and car accidents. Irritability of children with ADHD has been a key symptom that clinicians and researchers have used to evaluate the developmental condition of children with ADHD. ADHD is sometimes a chronic disorder that occurs over a long period, increasing the family burden of these children (including health-care costs), which will increase with aging for unremitted children with ADHD. Therefore, clinicians should evaluate not only the mental condition of the child but also the family burden. Children with ADHD should be treated during childhood to reduce their clinical symptoms and family burden.
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Affiliation(s)
- Masahide Usami
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
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44
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Lange AM, Daley D, Frydenberg M, Rask CU, Sonuga-Barke E, Thomsen PH. The Effectiveness of Parent Training as a Treatment for Preschool Attention-Deficit/Hyperactivity Disorder: Study Protocol for a Randomized Controlled, Multicenter Trial of the New Forest Parenting Program in Everyday Clinical Practice. JMIR Res Protoc 2016; 5:e51. [PMID: 27076496 PMCID: PMC4848388 DOI: 10.2196/resprot.5319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 12/11/2022] Open
Abstract
Background Parent training is recommended as the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) in preschool children. The New Forest Parenting Programme (NFPP) is an evidence-based parenting program developed specifically to target preschool ADHD. Objective The objective of this trial is to investigate whether the NFPP can be effectively delivered for children referred through official community pathways in everyday clinical practice. Methods A multicenter randomized controlled parallel arm trial design is employed. There are two treatment arms, NFPP and treatment as usual. NFPP consists of eight individually delivered parenting sessions, where the child attends during three of the sessions. Outcomes are examined at three time points (T1, T2, T3): T1 (baseline), T2 (week 12, post intervention), and T3 (6 month follow/up). 140 children between the ages of 3-7, with a clinical diagnosis of ADHD, informed by the Development and Well Being Assessment, and recruited from three child and adolescent psychiatry departments in Denmark will take part. Randomization is on a 1:1 basis, stratified for age and gender. Results The primary endpoint is change in ADHD symptoms as measured by the Preschool ADHD-Rating Scale (ADHD-RS) by T2. Secondary outcome measures include: effects on this measure at T3 and T2 and T3 measures of teacher reported Preschool ADHD-RS scores, parent and teacher rated scores on the Strength & Difficulties Questionnaire, direct observation of ADHD behaviors during Child’s Solo Play, observation of parent-child interaction, parent sense of competence, and family stress. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials Statement for Randomized Controlled Trials of nonpharmacological treatments. Conclusions The trial will provide evidence as to whether NFPP is a more effective treatment for preschool ADHD than the treatment usually offered in everyday clinical practice. Trial Registration ClinicalTrials.gov NCT01684644; https://clinicaltrials.gov/ct2/show/NCT01684644?term= NCT01684644&rank=1 (Archived by WebCite at http://www.webcitation/6eOOAe8Qe)
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Affiliation(s)
- Anne-Mette Lange
- Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Risskov, Denmark.
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