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Jelinkova K, Charabin E, Miller C, Climie EA. Self-Stigma of Canadian Youth With ADHD and Their Parents. J Atten Disord 2024; 28:1598-1611. [PMID: 39219408 PMCID: PMC11403931 DOI: 10.1177/10870547241273161] [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] [Indexed: 09/04/2024]
Abstract
OBJECTIVE ADHD is subject to stigma from the general population. Exposure to stigma poses the risk of developing self-stigma of youth and parents, but few studies have focused on self-stigma of ADHD. Furthermore, parental factors have been implicated in self-stigma of youth, but no previous research has assessed the association between self-stigma of parents and youth. Therefore, the objective of this study was to better understand the experience of self-stigma of youth and their parents in the context of ADHD. METHOD Fifty-five youth with ADHD (aged 8-17) and one parent reporter per youth completed surveys to report their experiences. RESULTS The results of this study found that both youth and parents reported significantly lower self-stigma scores compared to most previously published research. Parents of boys reported higher self-stigma scores compared to parents of girls. Youth who reported higher self-stigma also reported lower self-esteem. Self-stigma scores in youth were predicted by inattentive symptoms but not hyperactive/impulsive symptoms or parental self-stigma. CONCLUSION Results emphasize the importance of understanding self-stigma of ADHD, symptom severity, and the need for interventions for families with ADHD.
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Butt DA, Jaakkimainen L, Tu K. Prevalence and Incidence Trends of Attention Deficit/Hyperactivity Disorder in Children and Youth Aged 1-24 Years in Ontario, Canada: A Validation Study of Health Administrative Data Algorithms: Tendances de la prévalence et de l'incidence du trouble de déficit de l'attention/hyperactivité chez les enfants et les jeunes âgés de 1 à 24 ans, en Ontario, Canada: une étude de validation des algorithmes de données administratives de santé. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:326-336. [PMID: 37960872 PMCID: PMC11032092 DOI: 10.1177/07067437231213553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To estimate prevalence and incidence rates over time in children and youth with attention deficit/hyperactivity disorder from the validation of population-based administrative data algorithms using family physicians' electronic medical records as a reference standard. METHODS A retrospective cohort study was conducted in Ontario, Canada to identify attention deficit/hyperactivity disorder among children and youth aged 1-24 years in health administrative data derived from case-finding algorithms using family physicians' electronic medical records. Multiple administrative data algorithms identifying attention deficit/hyperactivity disorder cases were developed and tested from physician-diagnosis of attention deficit/hyperactivity disorder in the electronic medical record to determine their diagnostic accuracy. We calculated algorithm performance using sensitivity, specificity, and predictive values. The most optimal algorithm was used to estimate prevalence and incidence rates of attention deficit/hyperactivity disorder from 2014 to 2021 in Ontario. RESULTS The optimal performing algorithm was "2 physician visits for attention deficit/hyperactivity disorder in 1 year or 1 attention deficit/hyperactivity disorder-specific prescription" with sensitivity: 83.2% (95% confidence interval [CI], 81.8% to 84.5%), specificity: 98.6% (95% CI, 98.5% to 98.7%), positive predictive value: 78.6% (95% CI, 77.1% to 80.0%) and negative predictive value: 98.9% (95% CI, 98.8% to 99.0%). From 2014, prevalence rates for attention deficit/hyperactivity disorder increased from 5.29 to 7.48 per 100 population in 2021 (N = 281,785). Males had higher prevalence rates (7.49 to 9.59 per 100 population, 1.3-fold increase) than females (2.96-5.26 per 100 population, 1.8-fold increase) from 2014 to 2021. Incidence rates increased from 2014 (0.53 per 100 population) until 2018, decreased in 2020 then rose steeply in 2021 (0.89 per 100 population, N = 34,013). Males also had higher incidence rates than females from 2014 to 2020 with females surpassing males in 2021 (0.70-0.81 per 100 male population,1.2-fold increase versus 0.36-0.97 per 100 female population, 2.7-fold increase). CONCLUSIONS Attention deficit/hyperactivity disorder is increasing in prevalence. We developed an administrative data algorithm that can reliably identify children and youth with attention deficit/hyperactivity disorder with good diagnostic accuracy.
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Affiliation(s)
- Debra A. Butt
- Department of Family and Community Medicine, Scarborough General Hospital, Scarborough Health Network, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Liisa Jaakkimainen
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Academic Family Health Team, Toronto, ON, Canada
| | - Karen Tu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, ON, Canada
- Research and Innovation and Department of Family and Community Medicine, North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
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de Oliveira C, Tanner B. Estimating Cumulative Health Care Costs of Childhood and Adolescence Autism Spectrum Disorder in Ontario, Canada: A Population-Based Incident Cohort Study. PHARMACOECONOMICS - OPEN 2023; 7:987-995. [PMID: 37755688 PMCID: PMC10721567 DOI: 10.1007/s41669-023-00441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Few studies have estimated cumulative health care costs post-diagnosis for individuals with autism spectrum disorder (ASD). OBJECTIVES Using an incidence-based approach, the objective of this analysis was to estimate cumulative costs of ASD to the Ontario health care system of children and adolescents. METHODS Using administrative health records from Ontario, Canada's most populous province, a retrospective, population-based, incident cohort study of children and adolescents aged 0-19 years old diagnosed with ASD was undertaken to estimate cumulative health care costs of ASD to the health care system from 2010 to 2019. Cumulative health care costs in 2021 Canadian dollars (CAD) from diagnosis to death or end of observation period were estimated using a consistent estimator based on the inverse probability weighting technique. Cumulative health care costs (and respective 95% confidence intervals [CI]) were estimated for 1, 5 and 10 years post-diagnosis by sex, age group and health service. RESULTS In 2010, there were 2867 diagnosed cases of ASD; in 2019, the number of incident cases had risen to 6072. The first year (i.e., 1-year) post-diagnosis cost of ASD was $4710.18 CAD (95% CI 4560.28-4860.08); just under a third of costs were for physician services. Total cumulative 5- and 10-year discounted costs were $16,025.95 CAD (15,371.64-16,680.26) and $32,635.76 CAD (28,906.94-36,364.58), respectively. Mean costs were higher for females and older age groups. CONCLUSIONS These results suggest that costs of ASD are high in the year of diagnosis and then increase at a steady rate thereafter. This information will help with future resource planning within the health care sector to ensure individuals with ASD are supported once their diagnosis is established.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- ICES, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Bryan Tanner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Canada
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de Oliveira C, Iwajomo T, Kurdyak P. Mental Health Care Use Among Children and Adolescents With High Health Care Costs in Ontario, Canada. JAMA Netw Open 2023; 6:e2313172. [PMID: 37171817 PMCID: PMC10182426 DOI: 10.1001/jamanetworkopen.2023.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Research on patients with high health care costs has examined mainly adults, with little focus on mental health care use. Objective To examine the characteristics and costs of children and adolescents with high health care costs who use mostly mental health care and whether and why they persist in the high-cost state. Design, Setting, and Participants This population-based, retrospective cohort study used health care records from Ontario, Canada, on all children and adolescents (age 0-17 years) covered under a universal health care system from January 1, 2012, to December 31, 2019. All children and adolescents in and above the 90th percentile of the cost distribution in 2012 for whom costs related to mental health care accounted for 50% or more of their costs were defined as patients with high mental health care costs. Data were analyzed from August 2019 to December 2022. Exposures High health care costs. Main Outcomes and Measures Patients with high mental health care costs were characterized in terms of their sociodemographic characteristics; chronic physical health, mental health, and behavioral conditions; and health care costs (in 2021 Canadian dollars) by health service and type of care (mental health care vs non-mental health care). Patients were followed up until 2019 to assess whether they persisted in the high-cost state and to examine factors associated with persisting in that state. Results In 2012, there were 273 490 children and adolescents with high health care costs (mean [SD] age, 6.43 [5.99] years; 55.8% male; mean cost, $7936.40; 95% CI, $7850.30-$8022.40). Of these, 20 463 (7.5%) were classified as having high mental health care costs (mean cost, $10 040.20; 95% CI, $9822.80-$10 257.50). Asthma (30.3%), attention-deficit/hyperactivity disorder (35.8%), and mood and/or anxiety disorders (94.9%) were the most common chronic physical, behavioral, or mental health conditions. Few patients with high mental health care costs persisted in the high-cost state beyond 3 years (19.0%). Mood and/or anxiety disorders (relative risk ratio [RRR], 6.17; 95% CI, 3.19-11.96) and schizophrenia spectrum disorders (RRR, 2.98; 95% CI, 2.14-4.14) were identified as the main factors associated with persistence in the high-cost state. Conclusions and Relevance In this cohort study of children and adolescents with high health care costs, some patients had high levels of mental health care use and high costs of care, but few of these persisted in the high-cost state for 3 or more years. These findings may help inform the development of care coordination interventions and service delivery models, such as youth integrated services, to reduce costs and improve outcomes for children and adolescents.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mental Health and Addictions Centre of Excellence, Ontario Health, Toronto, Ontario, Canada
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Butt DA, Stephenson E, Kalia S, Moineddin R, Tu K. Patient visits and prescriptions for attention-deficit/hyperactivity disorder from 2017-2021: Impacts of COVID-19 pandemic in primary care. PLoS One 2023; 18:e0281307. [PMID: 36913355 PMCID: PMC10010552 DOI: 10.1371/journal.pone.0281307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/20/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE To determine whether more patients presented with Attention-deficit/hyperactivity disorder (ADHD)-related visits and/or sought care from family physicians more frequently during the COVID-19 pandemic. METHODS Electronic medical records from the University of Toronto Practice-Based Research Network were used to characterize changes in family physician visits and prescriptions for ADHD medications. Annual patient prevalence and visit rates pre-pandemic (2017-2019) were used to calculate the expected rates in 2020 and 2021. The expected and observed rates were compared to identify any pandemic-related changes. RESULTS The number of patients presenting for ADHD-related visits during the pandemic was consistent with pre-pandemic trends. However, observed ADHD-related visits in 2021 were 1.32 times higher than expected (95% CI: 1.05-1.75), suggesting that patients visited family physicians more frequently than before the pandemic. CONCLUSION Demand for primary care services related to ADHD has continued to increase during the pandemic, with increased health service use among those accessing care.
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Affiliation(s)
- Debra A. Butt
- Department of Family and Community Medicine, Scarborough General Hospital, Scarborough Health Network, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Ellen Stephenson
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sumeet Kalia
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Research and Innovation, Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
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Bilsky S, Blumenthal H, Ramadan B, Lewis S, Leen-Feldner EW. Pediatric Psychotropic Polypharmacy: An Evaluation of the Correlates and Prevalence Across Assessment Cycles in the National Health and Nutrition Examination Survey. J Child Adolesc Psychopharmacol 2022; 32:416-425. [PMID: 36074100 PMCID: PMC9639228 DOI: 10.1089/cap.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Pediatric psychotropic polypharmacy (PPP) is the prescription of more than one medication targeting psychiatric disorders among people younger than 18 years. Recent data suggested that PPP rates may be plateauing. Few studies have evaluated this question in large, nationally recruited samples. Objective: The National Health and Nutrition Examination Survey was used to examine the correlates and prevalence of PPP across assessment cycles. Independent assessments were obtained biannually between 2013 and 2018. Methods: Eleven thousand four hundred thirty-nine participants (4-17 years; Mage = 8.69 years; standard deviation = 5.16) were included in analyses. The Anatomic Therapeutic Chemical coding scheme was employed to classify medications, and participants were characterized as taking psychotropic medication if the medication was associated with a psychiatric diagnosis code. Participants self-reported past month medication use. Logistic regressions were used to examine correlates of pediatric psychotropic monotherapy compared with psychotropic polypharmacy. Results: Across assessments, 1.2% of respondents reported using two or more psychotropic medications. This estimate is lower than has been observed in specialized samples, but higher than other work using national samples. There was a small, significant difference in PPP across assessment cycles, such that rates of PPP were higher at the latter assessments. Correlates of PPP accorded with prior work, including male gender, increasing age, and markers of low socioeconomic status. The most robust predictor was having seen a mental health professional in the past year. Conclusions: This study documents that ∼1% of U.S. participants from a nationally recruited sample endorsed PPP. Findings are situated in the broader literature and the need for additional, prospective data to better characterize those trends in the United States and around the world. Key Takeaway Points It is known that many children and adolescents in the United States take more than one psychotropic medication, although few studies have examined trends in large, nationally recruited datasets. This study adds to this literature by documenting the prevalence of pediatric psychotropic polypharmacy in a large, unselected sample (i.e., 1.2%) and shows that rates were slightly higher at subsequent assessment intervals. Plain Language Summary Many kids take more than one medication for psychological problems. We analyzed data from ∼11,000 children and adolescents from across the United States, evaluated between 2013 and 2018. The number of kids taking multiple medications for psychological problems was different (higher) when measured later in time. Being a boy, being older, living in poverty, and having seen a mental health professional in the past year were associated with taking multiple medications for psychological problems. Implications for Managed Care Pharmacy These findings suggest rates of pediatric psychotropic polypharmacy (PPP) remain high in the United States, and correlate with male gender, poverty, and having recently seen a mental health professional. Relative to White children and adolescents, Black participants were less likely and Hispanic participants more likely to endorse PPP. Policy considerations include fully educating families and practitioners about the benefits as well as potential downsides of PPP and additional intervention options for mental health problems.
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Affiliation(s)
- Sarah Bilsky
- Department of Psychology, University of Mississippi, University Park, Mississippi, USA
| | | | - Banan Ramadan
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Sarah Lewis
- Center for Research, Assessment, and Treatment Efficacy (CReATE), Asheville, North Carolina, USA
| | - Ellen W. Leen-Feldner
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
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A Review of Canadian Diagnosed ADHD Prevalence and Incidence Estimates Published in the Past Decade. Brain Sci 2022; 12:brainsci12081051. [PMID: 36009114 PMCID: PMC9406225 DOI: 10.3390/brainsci12081051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: ADHD is recognized as one of the most common neurodevelopmental disorders. The worldwide prevalence of ADHD is estimated at 5.3%; however, estimates vary as a function of a number of factors, including diagnostic methods, age, sex and geographical location. A review of studies is needed to clarify the epidemiology of ADHD in Canada. (2) Methods: A search strategy was created in PubMed and adapted for MEDLINE and PsycINFO. Papers were included if they examined diagnosed ADHD prevalence and/or incidence rates in any region of Canada, age group and gender. A snowball technique was used to identify additional papers from reference lists, and experts in the field were consulted. (3) Results: Ten papers included in this review reported on prevalence, and one reported on incidence. One study provided an overall prevalence estimate across provinces for adults of 2.9%, and one study provided an overall estimate across five provinces for children and youth of 8.6%. Across age groups (1 to 24 years), incidence estimates ranged from 0.4% to 1.2%, depending on province. Estimates varied by age, gender, province, region and time. (4) Conclusions: The overall Canadian ADHD prevalence estimate is similar to worldwide estimates for adults. Most studies reported on prevalence rather than incidence. Differences in estimates across provinces may reflect the varying number of practitioners available to diagnose and prescribe medication for ADHD across provinces. To achieve a more comprehensive understanding of the epidemiology of ADHD in Canada, a study is needed that includes all provinces and territories, and that considers estimates in relation to age, gender, ethnicity, geographical region, socioeconomic status and access to mental healthcare coverage. Incidence rates need further examination to be determined.
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Lunghi C, Dugas M, Leclerc J, Poluzzi E, Martineau C, Carnovale V, Stéfan T, Blouin P, Lépine J, Jalbert L, Espinoza Suarez NR, Svyntozelska O, Dery MP, Ekanmian G, Nogueira DM, Akinola PS, Turcotte S, Skidmore B, LeBlanc A. Global prevalence of antidepressant drug utilization in the community: protocol for a systematic review. BMJ Open 2022; 12:e062197. [PMID: 35641008 PMCID: PMC9157341 DOI: 10.1136/bmjopen-2022-062197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Antidepressant drugs are the most frequently prescribed medication for mental disorders. They are also used off-label and for non-psychiatric indications. Prescriptions of antidepressants have increased in the last decades, but no systematic review exists on the extent of their use in the community. METHODS AND ANALYSIS We will conduct a systematic review to estimate the prevalence of antidepressant use in the community. We will search for studies published from 1 January 2010 in the Embase and MEDLINE databases using a combination of controlled vocabulary and keywords adjusted for each database without any language restriction. The main inclusion criterion is the presence of prevalence data of antidepressant utilization. Thus, we will include all studies with a descriptive observational design reporting the prevalence of antidepressant use in the community. Study selection (by title/abstract and full-text screening) and data extraction for included studies will be independently conducted by pairs of reviewers. We will then synthesize the data on the prevalence of antidepressant use in individuals living in the community. If possible, we will perform a meta-analysis to generate prevalence-pooled estimates. If the data allows it, we will conduct subgroup analyses by antidepressant class, age, sex, country and other sociodemographic categories. We will evaluate the risk of bias for each included study through a quality assessment using the Joanna Briggs Institute Critical Appraisal tool: Checklist for Studies Reporting Prevalence Data. DistillerSR software will be used for the management of this review. ETHICS AND DISSEMINATION Ethical approval is not required for this review as it will not directly involve human or animal subjects. The findings of our systematic review will be disseminated through publications in peer-reviewed journals, the Qualaxia Network (https://qualaxia.org), presentations at international conferences on mental health and pharmacoepidemiology, as well as general public events. PROSPERO REGISTRATION NUMBER CRD42021247423.
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Affiliation(s)
- Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada
- Population Heath and Optimal Health Practices Axis, CHU de Québec-Université Laval Research Center, Quebec, Quebec City, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, Quebec, Canada
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Jacinthe Leclerc
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
- Quebec Heart and Lung Institute Research Centre - Université Laval, Quebec City, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Cathy Martineau
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada
| | - Valérie Carnovale
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Théo Stéfan
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Patrick Blouin
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Johanie Lépine
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Nataly R Espinoza Suarez
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Marie-Pier Dery
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Giraud Ekanmian
- Population Heath and Optimal Health Practices Axis, CHU de Québec-Université Laval Research Center, Quebec, Quebec City, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
| | | | - Pelumi Samuel Akinola
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
- Department of Nursing, University of Pecs, Pecs, Hungary
| | - Stéphane Turcotte
- CISSS de Chaudière-Appalaches Research Center, Lévis, Quebec, Canada
| | | | - Annie LeBlanc
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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Diallo FB, Pelletier É, Vasiliadis HM, Rochette L, Vincent A, Palardy S, Lunghi C, Gignac M, Lesage A. Morbidities and mortality of diagnosed attention deficit hyperactivity disorder (ADHD) over the youth lifespan: A population-based retrospective cohort study. Int J Methods Psychiatr Res 2022; 31:e1903. [PMID: 34952999 PMCID: PMC8886284 DOI: 10.1002/mpr.1903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/07/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of ADHD, and related comorbidities, mortality, and type of health service use among children and young adults, using different case definitions. METHODS We conducted a population-based retrospective cohort study between 2000 and 2018, using the Quebec Integrated Chronic Disease Surveillance System (QICDSS) database. All residents aged less than 25 years eligible for health insurance coverage were included. We compared outcomes of three indicators (morbidity, services use and mortality) according two different algorithms of ADHD definitions, to the general population. RESULTS The cumulative prevalence of ADHD has risen steadily over the past decade, reaching 12.6% in 2017-2018. People with ADHD have a higher prevalence of psychiatric comorbidities, make greater use of medical, mental health services, and are hospitalized more often. The comparison of prevalence between the two algorithms and the general population for the three indicators showed that the cohort having one claim was very close to that with two or more, and statistically significant higher to that of people without ADHD. CONCLUSION This finding support that a single claim algorithm for ADHD can be used for case definition. More research is needed on the impact of potentially effective treatments in improving consequences of ADHD.
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Affiliation(s)
- Fatoumata Binta Diallo
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Éric Pelletier
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Science, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Louis Rochette
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada
| | - Annick Vincent
- Clinique FOCUS, Saint-Augustin-de-Desmaures, Quebec, Canada
| | - Sylvain Palardy
- Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Carlotta Lunghi
- Department of Health sciences, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Martin Gignac
- Montreal Children's Hospital, McGill University Montreal, Montreal, Quebec, Canada
| | - Alain Lesage
- Institut national de santé publique du Québec (Quebec public health institute), Quebec, Quebec, Canada.,Department of Psychiatry, University of Montreal, Research Centre of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec, Canada
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van Stralen J, Gill SK, Reaume CJ, Handelman K. A retrospective medical chart review of clinical outcomes in children and adolescents with attention-deficit/hyperactivity disorder treated with guanfacine extended-release in routine Canadian clinical practice. Child Adolesc Psychiatry Ment Health 2021; 15:55. [PMID: 34607580 PMCID: PMC8491395 DOI: 10.1186/s13034-021-00402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/03/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study evaluated clinical outcomes in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) treated with the α2-adrenoceptor agonist guanfacine extended-release (GXR) in routine Canadian clinical practice. METHODS This retrospective chart review focused on patients with ADHD aged 6-17 years initiating treatment with GXR as monotherapy or adjunctive therapy. Patients were followed for up to 12 months after GXR initiation and, if they had received prior ADHD pharmacotherapy, for 12 months before GXR initiation. The primary outcome was change in ADHD symptoms and functionality based on physician assessments, classified as improvement, no change, or worsening relative to the time of GXR initiation. Treatment-emergent adverse events (TEAEs) were evaluated. Clinical outcomes were also analyzed post hoc according to whether GXR treatment was received as monotherapy or adjunctive therapy, and by select psychiatric comorbidities. Exploratory analyses were conducted in patients who had received prior ADHD pharmacotherapy to evaluate clinical outcomes after initiating GXR. RESULTS Improvements in ADHD symptoms were reported for 232/330 (70.3%) patients. Functional improvements in school performance and home life were reported for 213/330 (64.5%) and 209/330 (63.3%) patients, respectively. The most frequent TEAEs (≥ 5%) were somnolence, headache, insomnia, presyncope, and decreased appetite. Improvements in ADHD symptoms were observed when GXR was received as either monotherapy (35/60 [58.3%]) or adjunctive therapy (197/270 [73.0%]). Improvements in ADHD symptoms and functionality were observed in the majority of patients with select psychiatric comorbidities. Among patients who had experienced worsening of symptoms with prior ADHD pharmacotherapy, 44/54 (81.5%) experienced symptom improvement, 33/44 (75.0%) who had previously experienced worsening of school performance improved, and 34/48 (70.8%) who had previously experienced worsening of home life improved. CONCLUSION In Canadian routine clinical practice, most children and adolescents with ADHD treated with GXR experienced improvements in ADHD symptoms and in functionality both at school and at home.
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Affiliation(s)
- Judy van Stralen
- Center for Pediatric Excellence, 206-1637 Woodroffe Avenue, Ottawa, ON, K2G 1W2, Canada.
| | - Simerpal K. Gill
- grid.507459.a0000 0004 0436 0978Takeda Canada Inc., Toronto, ON Canada
| | - Christopher J. Reaume
- grid.507459.a0000 0004 0436 0978Shire Pharma Canada ULC, A Takeda Company (Now Takeda Canada Inc.), Toronto, ON Canada
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11
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Swansburg R, Hai T, MacMaster FP, Lemay JF. Impact of COVID-19 on lifestyle habits and mental health symptoms in children with attention-deficit/hyperactivity disorder in Canada. Paediatr Child Health 2021; 26:e199-e207. [PMID: 34326910 PMCID: PMC8194688 DOI: 10.1093/pch/pxab030] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/17/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives The COVID-19 pandemic created an environment of restricted access to health and recreation services. Lifestyle habits including sleep, eating, exercise, and screen use were modified, potentially exacerbating adverse mental health outcomes. This study investigates the impact of COVID-19 on lifestyle habits and mental health symptoms in paediatric attention-deficit/hyperactivity disorder (ADHD) in Canada. Methods An online survey was distributed across Canada to caregivers of children with ADHD (children aged 5 to 18 years) assessing depression (PHQ-9), anxiety (GAD-7), ADHD (SNAP-IV), and lifestyle behaviours. Data were analyzed by gender (male/female) and age category (5 to 8, 9 to 12, and 13 to 18 years). Spearman’s correlations between lifestyle habits and mental health outcomes were conducted. Results A total of 587 surveys were completed. Mean child age was 10.14 years (SD 3.06), including 166 females (28.3%). The PHQ-9 and GAD-7 indicated that 17.4% and 14.1% of children met criteria for moderately severe to severe depression and anxiety symptoms respectively. Children met SNAP-IV cut-off scores for inattention (73.7%), hyperactivity/impulsivity (66.8%), and oppositional defiant disorder (38.6%) behaviours. Caregivers reported changes in sleep (77.5%), eating (58.9%), exercise (83.7%), and screen use (92.9%) in their ADHD child, greatly impacting youth. Sleeping fewer hours/night, eating more processed foods, and watching TV/playing videogames >3.5 hours/day correlated with greater depression, anxiety and ADHD symptoms, and exercising <1 hour/day further correlated with depression symptoms (P<0.01). Conclusions The COVID-19 pandemic has resulted in less healthy lifestyle habits and increased mental health symptoms in Canadian children with ADHD. Longitudinal studies to better understand the relationship between these factors are recommended.
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Affiliation(s)
- Rose Swansburg
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tasmia Hai
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Frank P MacMaster
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jean-François Lemay
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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12
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Brooks JD, Arneja J, Fu L, Saxena FE, Tu K, Pinzaru VB, Anagnostou E, Nylen K, Saunders NR, Lu H, McLaughlin J, Bronskill SE. Assessing the validity of administrative health data for the identification of children and youth with autism spectrum disorder in Ontario. Autism Res 2021; 14:1037-1045. [PMID: 33694293 PMCID: PMC8252648 DOI: 10.1002/aur.2491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
Population‐level identification of children and youth with ASD is essential for surveillance and planning for required services. The objective of this study was to develop and validate an algorithm for the identification of children and youth with ASD using administrative health data. In this retrospective validation study, we linked an electronic medical record (EMR)‐based reference standard, consisting 10,000 individuals aged 1–24 years, including 112 confirmed ASD cases to Ontario administrative health data, for the testing of multiple case‐finding algorithms. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and corresponding 95% confidence intervals (CI) were calculated for each algorithm. The optimal algorithm was validated in three external cohorts representing family practice, education, and specialized clinical settings. The optimal algorithm included an ASD diagnostic code for a single hospital discharge or emergency department visit or outpatient surgery, or three ASD physician billing codes in 3 years. This algorithm's sensitivity was 50.0% (95%CI 40.7–88.7%), specificity 99.6% (99.4–99.7), PPV 56.6% (46.8–66.3), and NPV 99.4% (99.3–99.6). The results of this study illustrate limitations and need for cautious interpretation when using administrative health data alone for the identification of children and youth with ASD. Lay Summary We tested algorithms (set of rules) to identify young people with ASD using routinely collected administrative health data. Even the best algorithm misses more than half of those in Ontario with ASD. To understand this better, we tested how well the algorithm worked in different settings (family practice, education, and specialized clinics). The identification of individuals with ASD at a population level is essential for planning for support services and the allocation of resources. Autism Res 2021, 14: 1037–1045. © 2021 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals LLC.
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Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jasleen Arneja
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Longdi Fu
- ICES, G1 06, Toronto, Ontario, Canada
| | | | - Karen Tu
- North York General Hospital, Toronto Western Hospital Family Health Team-University Health Network, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kirk Nylen
- Ontario Brain Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Natasha R Saunders
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, G1 06, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hong Lu
- ICES, G1 06, Toronto, Ontario, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, G1 06, Toronto, Ontario, Canada
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13
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Strauß M, Petroff D, Huang J, Ulke C, Paucke M, Bogatsch H, Böhme P, Hoffmann K, Reif A, Kittel-Schneider S, Heuser I, Ahlers E, Gallinat J, Schöttle D, Fallgatter A, Ethofer T, Unterecker S, Hegerl U. The "VIP-ADHD trial": Does brain arousal have prognostic value for predicting response to psychostimulants in adult ADHD patients? Eur Neuropsychopharmacol 2021; 43:116-128. [PMID: 33388218 DOI: 10.1016/j.euroneuro.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
EEG studies have shown that adult ADHD patients have less stable brain arousal regulation than age and gender matched controls. Psychostimulants have brain arousal stabilising properties evident in EEG patterns. The aim of this study was to investigate whether the stability of brain arousal regulation has prognostic value in predicting response to methylphenidate therapy in adult ADHD patients. In an open-label, single-arm, multi-centre, confirmatory trial, 121 adult ADHD patients were recruited and 112 qualified for the full analysis set. All participants received an initial dose of 20 mg extended release methylphenidate at baseline. After a titration phase of up to 4 weeks, patients remained on a weight-based target dose of extended release methylphenidate for 4 weeks. Using the Vigilance Algorithm Leipzig (VIGALL 2.1), we assessed brain arousal regulation before the treatment with methylphenidate, based on a 15-min EEG at quiet rest recorded at baseline. Using automatic stage-classification of 1 s segments, we computed the mean EEG-vigilance (indexing arousal level) and an arousal stability score (indexing arousal regulation). The primary endpoint was the association between successful therapy, defined by a 30% reduction in CAARS, and stable/unstable brain arousal. 52 patients (46%) showed an unstable brain arousal regulation of which 23% had therapy success. In the stable group, 35% had therapy success, implying an absolute difference of 12 percentage points (95% CI -5 to 29, p = 0.17) in the direction opposite to the hypothesized one. There were no new findings regarding the tolerability and safety of extended release methylphenidate therapy.
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Affiliation(s)
- Maria Strauß
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany.
| | - David Petroff
- Clinical Trial Centre Leipzig, Faculty of Medicine, University of Leipzig, Germany
| | - Jue Huang
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Madlen Paucke
- Department of Psychiatry and Psychotherapy, University Hospital of Leipzig, Semmelweisstrasse 10, 04103 Leipzig, Germany
| | - Holger Bogatsch
- Clinical Trial Centre Leipzig, Faculty of Medicine, University of Leipzig, Germany
| | - Pierre Böhme
- Department of Psychiatry and Psychotherapy, University Hospital of Bochum, Germany
| | - Knut Hoffmann
- Department of Psychiatry and Psychotherapy, University Hospital of Bochum, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Hospital of Frankfurt
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Hospital of Frankfurt; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Germany
| | - Isabella Heuser
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany
| | - Eike Ahlers
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany
| | - Juergen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Germany
| | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, LEAD Graduate School and Research Network, University Hospital of Tübingen, Tübingen, Germany
| | - Thomas Ethofer
- Department of Psychiatry and Psychotherapy, LEAD Graduate School and Research Network, University Hospital of Tübingen, Tübingen, Germany; Department of Biomedical Magnetic Resonance, University Hospital of Tübingen, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Germany
| | - Ulrich Hegerl
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Hospital of Frankfurt
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14
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Gold A, Bondi BC, Ashkanase J, Dipchand AI. Early school-age cognitive performance post-pediatric heart transplantation. Pediatr Transplant 2020; 24:e13832. [PMID: 33105067 DOI: 10.1111/petr.13832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND As survival in pediatric heart transplantation (HTx) has improved due to medical advances, the analysis of long-term outcomes impacting quality of life such as cognition and development becomes increasingly important. Neuropsychological assessments provide a comprehensive understanding of individual needs, allowing for the development of tailored recommendations and interventions. METHODS Routine neuropsychological assessment was completed between 5 and 7 years of age in this cohort of pediatric HTx recipients at our center (Jan 2014-Oct 2018), including tests of general intellect (WPPSI-IV, WISC-V), academics (WIAT-II/III), perceptual-motor abilities (Beery VMI), and memory (CMS). Relevant medical variables were collected. RESULTS Among 25 children, the median age at testing was 6.7 (IQR:5.8-7.4) years, with a median time since HTx of 5.2 (IQR:4.8-6.8) years. Medical diagnoses included congenital heart disease (CHD; 56%) and cardiomyopathy (44%). Cognitive functioning across the intellectual, academic, and perceptual-motor domains fell within the low-average range, while memory abilities fell within the average range. DSM-5 clinical diagnoses were provided for 14 (56%) children: Intellectual Disability-Mild (20%), Learning Disability (20%), Language Disorder (8%), and Attention-Deficit/Hyperactivity Disorder (12%). The presence of neurological issues and/or CHD predicted poorer performance on various neuropsychological domains. CONCLUSIONS Over 50% of this cohort of pediatric heart transplant recipients seen for routine post-HTx neuropsychological assessment received a clinical psychological diagnosis, notably higher than rates in the general population. This population requires monitoring to ensure that high risk children are identified and successfully supported in school and their community.
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Affiliation(s)
- Anna Gold
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.,Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bianca C Bondi
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jenna Ashkanase
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Anne I Dipchand
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Labatt Family Heart Centre, Hospital for Sick Children, Toronto, ON, Canada
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15
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Brooks JD, Bronskill SE, Fu L, Saxena FE, Arneja J, Pinzaru VB, Anagnostou E, Nylen K, McLaughlin J, Tu K. Identifying Children and Youth With Autism Spectrum Disorder in Electronic Medical Records: Examining Health System Utilization and Comorbidities. Autism Res 2020; 14:400-410. [PMID: 33098262 PMCID: PMC7894325 DOI: 10.1002/aur.2419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/23/2020] [Accepted: 10/08/2020] [Indexed: 12/02/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder requiring significant health and educational resources for affected individuals. A reference standard for ASD was generated from an existing population‐based cohort of 10,000 children and youth aged 1–24 years who were randomly selected for chart abstraction from 29,256 patients from 119 family physicians. We developed and validated an algorithm to identify children and youth with ASD within an electronic medical record system (N = 80,237, aged 1–24 years) in order to examine the prevalence of comorbidities and quantify health system utilization within the cohort. We identified 1,062 children and youth with ASD representing a prevalence of 1.32%. Compared to individuals without ASD, those with ASD had a higher prevalence of asthma, were more likely to visit a specialist, undergo surgery, and be hospitalized for psychiatric reasons. Children and youth with ASD in Ontario have complex health system needs, illustrated through a significant burden of comorbidities and increased health system utilization. Lay Summary Our paper generates population‐based estimates of health system use by children and youth with ASD, who have a higher burden of comorbidities than the general population. We developed a case‐finding algorithm and applied it in electronic medical records to create a cohort of children and youth with ASD, thereby generating an important resource to further study the health care needs of individuals with ASD.
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Affiliation(s)
- Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | | | - Jasleen Arneja
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kirk Nylen
- Ontario Brain Institute, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada.,Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Gold A, Young JM, Solomon M, Grasemann H. Neuropsychological outcomes following pediatric lung transplantation. Pediatr Pulmonol 2020; 55:2427-2436. [PMID: 32567252 DOI: 10.1002/ppul.24915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/18/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Lung transplantation (LTx) is a treatment option for eligible children with end-stage pulmonary diseases. Improving our understanding of longer-term developmental outcomes in pediatric LTx recipients is important for strategized interventions targeting cognitive difficulties. METHODS Neuropsychological assessments were completed for children who received LTx at our center (2009-2017). Assessments comprised tasks of general intellect, memory, visual-perception, academics, and executive functioning as well as caregiver questionnaires of adaptive, executive, emotional, and behavioral functioning. Results were compared to age-matched population norms. Between-group nonparametric tests were performed pre-LTx vs post-LTx and for children with a primary diagnosis of cystic fibrosis (CF) vs other diagnoses (non-CF). RESULTS Neuropsychological outcomes were assessed for 21 children post-LTx, with a median age (interquartile range) at the time of transplant of 11.52 (6.89, 14.12) years. Eleven children completed pre- and post-transplant assessments and within this group, improvements for verbal learning (P = .02), aspects of mood, behavior, and adaptive functioning were observed over time (all P < .05). Post-transplant whole group analysis suggested age-appropriate abilities across most cognitive domains, with a relative weakness for executive functioning. Emotional or behavioral difficulties were not endorsed by caregivers. Across pulmonary diagnoses, higher levels of emotional, behavioral, and executive functioning difficulty were reported in the non-CF group (all P < .05). CONCLUSIONS Overall, LTx has a positive impact on cognitive functioning, particularly learning, adaptive functioning, mood, and behavior. Children transplanted for non-CF related diseases demonstrated greater challenges, highlighting the need for targeted assessments and interventions across the transplant process to support the complex needs of this population.
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Affiliation(s)
- Anna Gold
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Transplant and Regenerative Medicine Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Mary Young
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melinda Solomon
- Transplant and Regenerative Medicine Center, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hartmut Grasemann
- Transplant and Regenerative Medicine Center, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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17
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Maternal cannabis use in pregnancy and child neurodevelopmental outcomes. Nat Med 2020; 26:1536-1540. [PMID: 32778828 DOI: 10.1038/s41591-020-1002-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 06/29/2020] [Indexed: 12/31/2022]
Abstract
Cannabis use in pregnancy has increased1,2, and many women continue to use it throughout pregnancy3. With the legalization of recreational cannabis in many jurisdictions, there is concern about potentially adverse childhood outcomes related to prenatal exposure4. Using the provincial birth registry containing information on cannabis use during pregnancy, we perform a retrospective analysis of all live births in Ontario, Canada, between 1 April 2007 and 31 March 2012. We link pregnancy and birth data to provincial health administrative databases to ascertain child neurodevelopmental outcomes. We use matching techniques to control for confounding and Cox proportional hazards regression models to examine associations between prenatal cannabis use and child neurodevelopment. We find an association between maternal cannabis use in pregnancy and the incidence of autism spectrum disorder in the offspring. The incidence of autism spectrum disorder diagnosis was 4.00 per 1,000 person-years among children with exposure compared to 2.42 among unexposed children, and the fully adjusted hazard ratio was 1.51 (95% confidence interval: 1.17-1.96) in the matched cohort. The incidence of intellectual disability and learning disorders was higher among offspring of mothers who use cannabis in pregnancy, although less statistically robust. We emphasize a cautious interpretation of these findings given the likelihood of residual confounding.
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18
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Morkem R, Handelman K, Queenan JA, Birtwhistle R, Barber D. Validation of an EMR algorithm to measure the prevalence of ADHD in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). BMC Med Inform Decis Mak 2020; 20:166. [PMID: 32690025 PMCID: PMC7370518 DOI: 10.1186/s12911-020-01182-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Building and validating electronic algorithms to identify patients with specific disease profiles using health data is becoming increasingly important to disease surveillance and population health management. The aim of this study was to develop and validate an algorithm to find patients with ADHD diagnoses within primary care electronic medical records (EMR); and then use the algorithm to describe the epidemiology of ADHD from 2008 to 2015 in a Canadian Primary care sample. METHODS This was a cross sectional time series that used data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a repository of primary care EMR data. A sample of electronic patient charts from one local clinic were manually reviewed to determine the positive predictive value (PPV) and negative predictive value (NPV) of an ADHD case-finding algorithm. In each study year a practice population was determined, and the algorithm was used to measure an observed prevalence of ADHD. The observed prevalence was adjusted for misclassification, as measured by the validity indices, to obtain an estimate of the true prevalence. Estimates were calculated by age group (4-17 year olds, 18 to 34 year olds, and 35 to 64 year olds) and gender, and compared over time. RESULTS The EMR algorithm had a PPV of 98.0% (95% CI [92.5, 99.5]) and an NPV of 95.0% (95% CI [92.9, 98.6]). After adjusting for misclassification, it was determined that the prevalence of patients with a clinical diagnosis of ADHD has risen in all age groups between 2008 and 2015, most notably in children and young adults (6.92, 95% CI [5.62, 8.39] to 8.57, 95% CI [7.32, 10.00]; 5.73, 95% CI [4.40, 7.23] to 7.33, 95% CI [6.04, 8.78], respectively). The well-established gender gap persisted in all age groups across time but was considerably smaller in older adults compared to children and young adults. CONCLUSION Overall, the ADHD case-finding algorithm was found to be a valid tool to assess the epidemiology of ADHD in Canadian primary care practice. The increased prevalence of ADHD between 2008 and 2015 may reflect an improvement in the recognition and treatment of this disorder within primary care.
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Affiliation(s)
- Rachael Morkem
- Research Associate, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada.
| | - Kenneth Handelman
- Psychiatrist, Centre for Integrative Mental Health, Oakville, Ontario, Canada
| | - John A Queenan
- Senior Epidemiologist, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
| | - Richard Birtwhistle
- Professor of Family Medicine and Public Health Sciences, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
| | - David Barber
- Network Director and Assistant Professor, Centre for Studies in Primary Care, Queen's University, Kingston, Ontario, Canada
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19
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Mayes SD, Waxmonsky JG, Baweja R, Mattison RE, Memon H, Klein M, Hameed U, Waschbusch D. Symptom scores and medication treatment patterns in children with ADHD versus autism. Psychiatry Res 2020; 288:112937. [PMID: 32315876 DOI: 10.1016/j.psychres.2020.112937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/22/2020] [Indexed: 01/27/2023]
Abstract
Most children with autism have ADHD, and children with ADHD-Combined and children with autism have high rates of irritable, oppositional, and aggressive behavior. Despite similar symptoms, prescribing practices may differ between autism and ADHD, which has not been examined in a single study. 1407 children with autism and 1036 with ADHD without autism, 2-17 years, were compared with 186 typical peers. Symptom scores were maternal Pediatric Behavior Scale ratings in eight areas (ADHD, oppositional/aggressive, irritable/angry, anxious, depressed, and social, writing, and learning problems). Psychotropics were prescribed to 38.0% with ADHD-Combined, 33.3% with autism, and 20.2% with ADHD-Inattentive, most often an ADHD medication (22.1% stimulant, 2.3% atomoxetine), antipsychotic (7.8%), SSRI (5.5%), and alpha agonist (4.9%). ADHD medications were more often prescribed than other medications in all diagnostic groups. Compared to autism, children with ADHD-Combined were more likely to be prescribed an ADHD medication, whereas antipsychotics and SSRIs were more likely to be prescribed in autism than in ADHD-Combined. Children with ADHD-Inattentive were least impaired and least likely to be medicated. More severely impaired children were more often medicated regardless of diagnosis. Symptom scores were far worse for treated and untreated children with ADHD and with autism than for typical peers.
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Affiliation(s)
- Susan D Mayes
- Department of Psychiatry, Penn State College of Medicine, Hershey Medical Center, 500 University Dr., Hershey, PA, United States.
| | - James G Waxmonsky
- Department of Psychiatry, Penn State College of Medicine, Hershey Medical Center, 500 University Dr., Hershey, PA, United States
| | - Raman Baweja
- Department of Psychiatry, Penn State College of Medicine, Hershey Medical Center, 500 University Dr., Hershey, PA, United States
| | - Richard E Mattison
- Department of Psychiatry, Penn State College of Medicine, Hershey Medical Center, 500 University Dr., Hershey, PA, United States
| | - Hasan Memon
- Department of Psychiatry, Penn State College of Medicine, Hershey Medical Center, 500 University Dr., Hershey, PA, United States
| | - Melanie Klein
- Department of Psychiatry, Penn State College of Medicine, Hershey Medical Center, 500 University Dr., Hershey, PA, United States
| | - Usman Hameed
- Department of Psychiatry, Penn State College of Medicine, Hershey Medical Center, 500 University Dr., Hershey, PA, United States
| | - Daniel Waschbusch
- Department of Psychiatry, Penn State College of Medicine, Hershey Medical Center, 500 University Dr., Hershey, PA, United States
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Gabriely R, Tarrasch R, Velicki M, Ovadia-Blechman Z. The influence of mindfulness meditation on inattention and physiological markers of stress on students with learning disabilities and/or attention deficit hyperactivity disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103630. [PMID: 32163834 DOI: 10.1016/j.ridd.2020.103630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/16/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Over recent decades, the number of students diagnosed with learning disabilities and/or attention deficit hyperactivity disorders has substantially increased. These students face various challenges and experience stress when receiving higher education. AIMS The purpose of this study was to compare two non-pharmacological interventions: mindfulness and device-guided slow breathing, with a control group. METHODS Seventy-three students (age = 25.76, std. dev = 3.10) with attention problems and/or learning disabilities were randomly assigned to three groups: mindfulness meditation, device guided breathing practice and waiting-list control. Before and after the intervention physiological and psychological measures were collected. RESULTS Our results show that only mindfulness practice improved awareness of the present moment and decreased hyperactivity and inattention. Furthermore, both mindfulness and practice with device-guided breathing were associated with stress reduction, as shown by an increase in the galvanic skin response only in the control group. CONCLUSIONS Implementation of the study results may lead to an advance in treating attention deficit disorders and learning disabilities, especially among higher education students.
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Affiliation(s)
| | - Ricardo Tarrasch
- School of Education, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel.
| | - Maria Velicki
- School of Medical Engineering, Afeka - Tel Aviv Academic College of Engineering, Israel
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Abstract
OBJECTIVES Little is known about school-age functioning in children with intestinal failure (IF). This study examines neurocognitive outcomes of children with IF at ages 4 to 8 years treated at a single centre, along with relevant medical and demographic variables. METHODS Between 2012 and 2016, neurocognitive assessments were administered to 28 children receiving treatment in our IF rehabilitation program, and included measures of intelligence, academics, learning/memory, language, visual-motor integration, and fine-motor dexterity. DSM-IV/V criteria were used to diagnose Learning Disability, Intellectual Disability, and/or Attention Deficit/Hyperactivity Disorder. RESULTS Intellectual functioning ranged from extremely low to superior (Full Scale IQ range 53-123, mean = 89). Forty-six percentage received a cognitive/learning DSM diagnosis. Total number of first-year septic episodes correlated with poorer outcomes on the most cognitive measures. Adjusting for gestational age (61% were born <37 weeks), number of first-year septic episodes negatively predicted working memory, visual-motor integration, and visual memory scores. Additional factors correlating with poorer outcomes on ≥2 cognitive measures included length of first-year admissions, necrotizing enterocolitis diagnosis, and first-year sustained conjugated hyperbilirubinemia. Having ≥2 first-year septic episodes increased the likelihood of poorer outcome. Having a sibling was a significant positive predictor of working memory, processing speed, reading, and verbal learning skills. CONCLUSIONS Our data provides preliminary evidence that children with IF are at risk of neurocognitive problems at early school age. Managing septic events during the first year is one strategy that may help reduce long-term neurocognitive risks in this population.
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Morkem R, Patten S, Queenan J, Barber D. Recent Trends in the Prescribing of ADHD Medications in Canadian Primary Care. J Atten Disord 2020; 24:301-308. [PMID: 28748725 DOI: 10.1177/1087054717720719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study was to describe the prevalence and incidence of ADHD medication prescribing, by age and gender, from 2005 to 2015 in Canadian primary care. Method: A population-based retrospective cohort study was conducted to evaluate the prescribing of ADHD medications between 2005 and 2015 using electronic medical record data. Yearly prevalence and incidence of ADHD medication prescribing were calculated for preschoolers (up to 5 years old), school-aged children (6-17 years old), and adults (18-65 years old) along with a description of the types of ADHD medications prescribed between 2005 and 2015. Results: Between 2005 and 2015, there was a 2.6-fold increase in the prevalence of ADHD medication prescribing to preschoolers, a 2.5-fold increase in school-aged children, and a fourfold increase in adults. There was a corresponding rise in incidence of prescribing although this rise was moderate and estimates were much lower compared with prevalence. The most commonly prescribed medication was Methylphenidate (65.0% of all ADHD medications prescribed). Conclusion: Although the prevalence of ADHD has remained stable over time, this study found an increase in the prescribing of ADHD medications in all age groups between 2005 and 2015. Incidence of new prescriptions was small relative to prevalence, suggesting that longer term treatments are being adopted.
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Russell AE, Ford T, Russell G. Barriers and predictors of medication use for childhood ADHD: findings from a UK population-representative cohort. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1555-1564. [PMID: 31073627 PMCID: PMC6858474 DOI: 10.1007/s00127-019-01720-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/25/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Little is known about sociodemographic and clinical factors that predict and act as barriers to ADHD medication independently of symptom severity. We examined the proportion of children using medication for ADHD, age of initiation of medication, and predictors of medication use in a population-representative cohort. METHODS Data from the Millennium Cohort Study on child ADHD, medication use for ADHD at age 14 (in 2014-2015) and child, parent and sociodemographic variables were collated. Logistic regression models were used to identify factors that predict medication use for ADHD (the main outcome measure), adjusting for symptom severity at age seven. RESULTS The weighted prevalence of ADHD was 3.97% (N = 11,708). 45.57% of children with ADHD (N = 305) were taking medication. The median age at initiation was 9 years (range 3-14). Male gender (AOR 3.66, 95% CI 1.75, 7.66) and conduct problems at age seven (AOR 1.24 95% CI 1.04, 1.47) and 14 predicted medication use at age 14 after adjusting for symptom severity. CONCLUSIONS Our study is the first to assess predictors of medication whist adjusting for ADHD symptom severity. Girls with ADHD were less likely to be prescribed medication, even when they displayed similar ADHD symptom levels to boys. Conduct problems also predicted medication independently of ADHD symptoms. ADHD may be more often medicated in boys because clinicians may think a prototypical ADHD child is male, and perhaps conduct problems make boys more disruptive in the classroom, leading to boys being more often treated.
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Affiliation(s)
- A E Russell
- Centre for Academic Mental Health, University of Bristol Medical School, Oakfield House, Bristol, BS8 2BN, UK.
| | - T Ford
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - G Russell
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
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Riddell JK, Malin AJ, Flora D, McCague H, Till C. Association of water fluoride and urinary fluoride concentrations with attention deficit hyperactivity disorder in Canadian youth. ENVIRONMENT INTERNATIONAL 2019; 133:105190. [PMID: 31654913 PMCID: PMC8118663 DOI: 10.1016/j.envint.2019.105190] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Exposure to fluoride has been linked with increased prevalence of attention deficit hyperactivity disorder (ADHD) in the United States and symptoms of inattention in Mexican children. We examined the association between fluoride exposure and attention outcomes among youth living in Canada. METHOD We used cross-sectional data collected from youth 6 to 17 years of age from the Canadian Health Measures Survey (Cycles 2 and 3). Urinary fluoride concentration adjusted for specific gravity (UFSG) was available for 1877 participants. Water fluoride concentration measured in tap water samples was available for 980 participants. Community water fluoridation (CWF) status was determined by viewing reports on each city's website or contacting the water treatment plant. We used logistic regression to test the association between the three measures of fluoride exposure and ADHD diagnosis. Linear regression was used to examine the relationship between the three measures of fluoride exposure and the hyperactivity/inattention score on the Strengths and Difficulties Questionnaire (SDQ). RESULTS UFSG did not significantly predict ADHD diagnosis or hyperactive/inattentive symptoms. A 1 mg/L increase in tap water fluoride level was associated with a 6.1 times higher odds of an ADHD diagnosis (95% CI = 1.60, 22.8). A significant interaction between age and tap water fluoride level (p = .03) indicated a stronger association between tap water fluoride and hyperactivity/inattention symptoms among older youth. A 1 mg/L increase in water fluoride level was associated with a 1.5 SDQ score increase (95% CI: 0.23, 2.68, p = .02) for youth at the 75th percentile of age (14 years old). Similarly, there was a significant interaction between age and CWF. At the 75th percentile of age (14 years old), those living in a fluoridated region had a 0.7-point higher SDQ score (95% CI = 0.34, 1.06, p < .01) and the predicted odds of an ADHD diagnosis was 2.8 times greater compared with youth in a non-fluoridated region (aOR = 2.84, 95% CI: 1.40, 5.76, p < .01). DISCUSSION Exposure to higher levels of fluoride in tap water is associated with an increased risk of ADHD symptoms and diagnosis of ADHD among Canadian youth, particularly among adolescents. Prospective studies are needed to confirm these results.
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Affiliation(s)
| | - Ashley J Malin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David Flora
- Faculty of Health, York University, Ontario, Canada
| | - Hugh McCague
- Institute for Social Research, York University, Ontario, Canada
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Leung BMY, Kellett P, Youngson E, Hathaway J, Santana M. Trends in psychiatric disorders prevalence and prescription patterns of children in Alberta, Canada. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1565-1574. [PMID: 31129714 DOI: 10.1007/s00127-019-01714-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the trends in the prevalence and incidence of children with psychiatric disorders, the types of medication prescribed, and the type of physician providing the prescriptions. METHOD This retrospective study linked six population-based administrative databases (2008-2015) in Alberta, Canada. RESULTS The prevalence of paediatric psychiatric disorders increased from 12.6 per 100 population in 2008 to 15.0 per 100 population in 2015, while the incidence rate increased from 2.0 per 100 population to 2.2 per 100 population in the same period. The proportion of patients dispensed any psychiatric medication increased from 21.4% in 2008 to 28.2% in 2015. Over the same period, dispensations for antidepressants increased from 7.0% to 11.2% and stimulants to treat ADHD, from 11.9% to 15.9%. For antidepressants, general practitioners (GPs) wrote the highest proportion of prescriptions (44.3% in 2011-48.1% in 2015), while paediatricians wrote the lowest proportion (8.7% in 2011-11.0% in 2015) and the proportion by psychiatrists decreased from 33.4% in 2011 to 27.2% in 2015. For stimulants to treat ADHD, paediatricians were the most frequent prescribers (36.9% in 2011-39.3% in 2015) followed by GPs as the second most frequent (33.1% in 2011-33.5% in 2015), while psychiatrists were the least likely to prescribe stimulants for ADHD. CONCLUSION The increasing trend of psychiatric diagnoses and medication prescriptions in the paediatric population is evident using population-based administrative databases. The lack of safety and adverse consequences of medication use in this cohort warrants additional monitoring data.
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Affiliation(s)
- Brenda M Y Leung
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
| | - Peter Kellett
- Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - Erik Youngson
- Health Research Methods and Analytics/SPOR Data Platform, Alberta Health Services, University of Alberta, Edmonton, Canada
| | - Josh Hathaway
- Health Research Methods and Analytics/SPOR Data Platform, Alberta Health Services, University of Alberta, Edmonton, Canada
| | - Maria Santana
- Departments of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Huang J, Ulke C, Strauss M. Brain arousal regulation and depressive symptomatology in adults with attention-deficit/hyperactivity disorder (ADHD). BMC Neurosci 2019; 20:43. [PMID: 31429702 PMCID: PMC6701141 DOI: 10.1186/s12868-019-0526-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/14/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The aim of the present study was to evaluate the stability of brain arousal in adult attention-deficit/hyperactivity disorder (ADHD) outpatients with and without depressive symptomatology, and its association with depressive symptom severity and absolute electroencephalogram (EEG) power in different frequency bands. METHODS We included 31 outpatient adults (45.16% females), who were diagnosed according to DSM-IV and received no medication. Their arousal stability score (index of the steepness of arousal decline during a 15-min EEG under resting conditions), the absolute EEG power and self-reports, including depressive and ADHD-related symptoms, were analyzed. Participants were split into an unstable and stable arousal group based on the median (= 6) of the arousal stability score. RESULTS ADHD patients in the stable group reported more severe depressive symptoms (p = 0.018) and showed reduced absolute EEG power in the delta (0.002 ≤ p ≤ 0.025) and theta (0.011 ≤ p ≤ 0.034) bands compared to those in the unstable group. There was no correlation between the arousal stability score and self-report-scales concerning ADHD-related symptoms (0.214 ≤ p ≤ 0.989), but a positive association with self-reported depressive severity (p = 0.018) and negative association with powers in the EEG delta and theta bands (0.001 ≤ p ≤ 0.033). CONCLUSIONS In view of high comorbidity of depression and ADHD in adult patients, these findings support the assumption that brain arousal regulation could be considered as a helpful marker for the clinical differentiation between ADHD and depression.
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Affiliation(s)
- Jue Huang
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstrasse 10, 04103, Leipzig, Germany.
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstrasse 10, 04103, Leipzig, Germany
| | - Maria Strauss
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstrasse 10, 04103, Leipzig, Germany
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Cheung K, Verhamme KMC, Herings R, Visser LE, Stricker BH. Methylphenidate Treatment Initiated During Childhood Is Continued in Adulthood in Half of the Study Population. J Child Adolesc Psychopharmacol 2019; 29:426-432. [PMID: 31157978 DOI: 10.1089/cap.2018.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: To estimate the number of patients who started methylphenidate during childhood and continued treatment beyond the age of 18 years and to study the determinants that may be associated with continuing treatment. Methods: Patients 17 years of age and younger who have received at least one prescription of methylphenidate were identified in the Integrated Primary Care Information database (1996-2017). Logistic regression analyses were performed to assess the association between potential determinants and continuation with methylphenidate treatment at the age of 18 years. Results: Fifty-three percent of all methylphenidate users (n = 1020) continued their treatment after the age of 18 years. Patients were more likely to continue treatment with methylphenidate if they started treatment at the age of 15-17 years compared with patients of 11 years and younger (adjusted odds ratio [OR]: 5.74, 95% confidence interval [CI]: 1.48-22.31), if they had a medication possession ratio (MPR) between 0.80 and 1.00 compared with a low MPR (adjusted OR: 2.18, 95% CI: 1.23-3.85) and if they lived in an area with a medium level of urbanization (adjusted OR: 1.98, 95% CI: 1.06-3.69). Furthermore, a relatively high number of patients had a MPR >1.0 (24.8%), of whom 91.3% started their treatment when they were between 15 and 17 years of age. Conclusions: Methylphenidate treatment initiated during childhood was continued in half of the study population when reaching the age of 18, where adolescents were more likely to continue treatment than young children. We also found that ∼25% of our study population had a MPR >1, mainly patients 15-17 years of age, which may suggest misuse or abuse of methylphenidate.
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Affiliation(s)
- Kiki Cheung
- 1Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,2Health and Youth Care Inspectorate, Utrecht, The Netherlands
| | - Katia M C Verhamme
- 3Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.,4Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | | | - Loes E Visser
- 1Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,6Haga Teaching Hospital, The Hague, The Netherlands
| | - Bruno H Stricker
- 1Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,2Health and Youth Care Inspectorate, Utrecht, The Netherlands
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Potential Explanations for Increasing Methylphenidate Use in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder in Germany From 2004 to 2013. J Clin Psychopharmacol 2019; 39:39-45. [PMID: 30489381 DOI: 10.1097/jcp.0000000000000980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite a decreasing population of children and adolescents, the cumulative total amount of dispensed methylphenidate (MPH), the first-choice treatment of attention-deficit/hyperactivity disorder (ADHD) in this age group, has increased dramatically in Germany. We investigated potential reasons for this increase such as changes in the ADHD prevalence over time and other potential explanations including the cumulative amount of dispensed MPH per person. METHODS Based on German claims data, we calculated standardized annual ADHD prevalence rates, proportions of ADHD cases treated with MPH and/or psychotherapy, and mean cumulative defined daily doses of ADHD drugs for 3- to 17-year-old children and adolescents from 2004 to 2013. RESULTS The ADHD prevalence increased continuously from 2004 to 2011 and remained stable thereafter. In ADHD cases, there was little variation in the proportion of individuals treated with drugs and in the frequency of psychotherapeutic treatment during the whole study period. The annual cumulative mean amount of MPH defined daily doses increased by approximately 30% from 2004 to 2008. CONCLUSIONS Our analyses suggest that the increase in MPH use in Germany was mainly influenced by an increasing ADHD prevalence and increasing amounts of dispensed MPH per person.
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Baker C, Feinstein JA, Ma X, Bolen S, Dawson NV, Golchin N, Horace A, Kleinman LC, Meropol SB, Pestana Knight EM, Winterstein AG, Bakaki PM. Variation of the prevalence of pediatric polypharmacy: A scoping review. Pharmacoepidemiol Drug Saf 2019; 28:275-287. [PMID: 30724414 PMCID: PMC6461742 DOI: 10.1002/pds.4719] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies. METHODS We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy. RESULTS Two hundred eighty-four studies reported prevalence of polypharmacy. They were more likely to be conducted in North America (37.7%), published after 2010 (44.4%), cross-sectional (67.3%), in outpatient settings (59.5%). Prevalence ranged from 0.9% to 98.4%, median 39.7% (interquartile range [IQR] 22.0%-54.0%). Studies from Asia reported the highest median prevalence of 45.4% (IQR 27.3%-61.0%) while studies from North America reported the lowest median prevalence of 30.4% (IQR 14.7%-50.2%). Prevalence decreased over time: median 45.6% before 2001, 38.1% during 2001 to 2010, and 34% during 2011 to 2017. Studies involving children under 12 years had a higher median prevalence (46.9%) than adolescent studies (33.7%). Inpatient setting studies had a higher median prevalence (50.3%) than studies in outpatient settings (38.8%). Community level samples, higher number and duration of medications defining polypharmacy, and psychotropic medications were associated with lower prevalence. CONCLUSIONS The prevalence of pediatric polypharmacy is high and variable. Studies reporting pediatric polypharmacy should account for context, design, polypharmacy definition, and medications evaluated.
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Affiliation(s)
- Courtney Baker
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - James A. Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Xuan Ma
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Shari Bolen
- Center for Health Care Research and Policy, MetroHealth, Cleveland, OH
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH
| | - Neal V. Dawson
- Center for Health Care Research and Policy, MetroHealth, Cleveland, OH
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH
| | - Negar Golchin
- School of Pharmacy, University of Washington, Seattle, WA
| | - Alexis Horace
- Department of Clinical Sciences, University of Louisiana at Monroe College of Pharmacy, Monroe, LA
| | - Lawrence C. Kleinman
- UH Rainbow The Center for Child Health and Policy, University Hospitals, Cleveland, OH and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sharon B. Meropol
- UH Rainbow The Center for Child Health and Policy, University Hospitals, Cleveland, OH and School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine
| | | | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy and Department of Epidemiology, University of Florida, Gainesville, FL
| | - Paul M. Bakaki
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
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Khan S, Down J, Aouira N, Bor W, Haywood A, Littlewood R, Heussler H, McDermott B. Current pharmacotherapy options for conduct disorders in adolescents and children. Expert Opin Pharmacother 2019; 20:571-583. [PMID: 30702354 DOI: 10.1080/14656566.2018.1561862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Conduct disorder (CD) is a common mental health disorder of childhood and adolescence. CD's complexity, with its heterogenous clinical manifestations and overlapping comorbidities makes the application of evidence-based management approaches challenging. This article aims to combine a systematic review of the available literature, with a consensus opinion from both child and adolescent psychiatrists and developmental pediatricians on the clinical and pharmacological management of children and adolescents with conduct disorder (CD). AREAS COVERED The authors review the CD population and provide a systematic review and meta-analysis of the effectiveness and safety of pharmacotherapies using preferred reporting items for systematic review and meta-analysis (PRISMA) and strength of evidence recommendation taxonomy (SORT) guidelines. The authors then provide an expert clinical opinion for the use of different pharmacotherapies to address aggressive and disruptive behavior in children. EXPERT OPINION Atypical antipsychotics (e.g. risperidone) demonstrate evidence for efficacy in CD. Other pharmacotherapies (e.g. mood stabilizers, anticonvulsants, psychostimulants and selective norepinephrine reuptake inhibitors) have a low level of evidence for CD alone, however, can sometimes be effective in managing the symptoms of CD when other psychiatric disorders are also present.
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Affiliation(s)
- Sohil Khan
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia.,b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,c Manipal College of Pharmaceutical Sciences , Manipal University , Manipal , India
| | - John Down
- d Children's Health Queensland Hospital and Health Service , Lady Cilento Children's Hospital , South Brisbane , Australia
| | - Nisreen Aouira
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia
| | - William Bor
- b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,e Child and Youth Mental Health Service , Children's Health Queensland Hospital and Health Service , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia
| | - Alison Haywood
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia.,b Mater Research Institute , The University of Queensland , South Brisbane , Australia
| | - Robyn Littlewood
- e Child and Youth Mental Health Service , Children's Health Queensland Hospital and Health Service , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia.,g School of Human Movement and Nutrition Sciences , The University of Queensland , South Brisbane , Australia
| | - Helen Heussler
- b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,d Children's Health Queensland Hospital and Health Service , Lady Cilento Children's Hospital , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia
| | - Brett McDermott
- h Townsville Clinical School, College of Medicine and Dentistry , James Cook University , Townsville , Australia
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Waddell C, Schwartz C, Andres C, Barican JL, Yung D. Fifty years of preventing and treating childhood behaviour disorders: a systematic review to inform policy and practice. EVIDENCE-BASED MENTAL HEALTH 2018; 21:45-52. [PMID: 29703717 PMCID: PMC5950520 DOI: 10.1136/eb-2017-102862] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 01/16/2023]
Abstract
QUESTION Oppositional defiant and conduct disorders (ODD and CD) start early and persist, incurring high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders? STUDY SELECTION AND ANALYSIS We sought randomised controlled trials (RCTs) evaluating interventions addressing the prevention or treatment of behaviour problems in individuals aged 18 years or younger. Our criteria were tailored to identify higher-quality RCTs that were also relevant to policy and practice. We searched the CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science databases, updating our initial searches in May 2017. Thirty-seven RCTs met inclusion criteria-evaluating 15 prevention programmes, 8 psychosocial treatments and 5 medications. We then conducted narrative synthesis. FINDINGS For prevention, 3 notable programmes reduced behavioural diagnoses: Classroom-Centered Intervention; Good Behavior Game; and Fast Track. Five other programmes reduced serious behaviour symptoms such as criminal activity. Prevention benefits were long term, up to 35 years. For psychosocial treatment, Incredible Years reduced behavioural diagnoses. Three other interventions reduced criminal activity. Psychosocial treatment benefits lasted from 1 to 8 years. While 4 medications reduced post-test symptoms, all caused important adverse events. CONCLUSIONS Considerable RCT evidence favours prevention. CLINICAL IMPLICATIONS Effective prevention programmes should therefore be made widely available. Effective psychosocial treatments should also be provided for all children with ODD/CD. But medications should be a last resort given associated adverse events and given only short-term evidence of benefits. Policymakers and practitioners can help children and populations by acting on these findings.
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Affiliation(s)
- Charlotte Waddell
- Faculty of Health Sciences, Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Christine Schwartz
- Faculty of Health Sciences, Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Caitlyn Andres
- Faculty of Health Sciences, Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Jenny Lou Barican
- Faculty of Health Sciences, Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Donna Yung
- Faculty of Health Sciences, Children's Health Policy Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Wigal SB, Childress A, Berry SA, Belden HW, Chappell P, Wajsbrot DB, Nagraj P, Abbas R, Palumbo D. Optimization of Methylphenidate Extended-Release Chewable Tablet Dose in Children with ADHD: Open-Label Dose Optimization in a Laboratory Classroom Study. J Child Adolesc Psychopharmacol 2018; 28:314-321. [PMID: 29641237 PMCID: PMC5994665 DOI: 10.1089/cap.2017.0138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine methylphenidate extended-release chewable tablets (MPH ERCT) dose patterns, attention-deficit/hyperactivity disorder (ADHD) symptom scores, and safety during the 6-week, open-label (OL) dose-optimization period of a phase 3, laboratory classroom study. METHODS Boys and girls (6-12 years) diagnosed with ADHD were enrolled. MPH ERCT was initiated at 20 mg/day; participants were titrated in 10-20 mg/day increments weekly based on efficacy and tolerability (maximum dose, 60 mg/day). Dose-optimization period efficacy assessments included the ADHD Rating Scale (ADHD-RS-IV), analyzed by week in a post hoc analysis using a mixed-effects model for repeated measures with final optimized dose (20, 30/40, or 50/60 mg), visit, final optimized dose and visit interaction, and baseline score as terms. Adverse events (AEs) and concomitant medications were collected throughout the study. RESULTS Mean MPH ERCT daily dose increased weekly from 29.4 mg/day after the first dose adjustment at week 1 (n = 90) to 42.8 mg/day after the final adjustment at week 5 (n = 86). Final optimized MPH ERCT dose ranged from 20 to 60 mg/day. Mean final optimized MPH ERCT dose ranged from 40.0 mg/day in 6-8 year-old participants to 44.8 mg/day for 11-12 year-old participants. There was a progressive decrease in mean (standard deviation) ADHD-RS-IV total score from 40.1 (8.72) at baseline to 12.4 (7.88) at OL week 5, with similar improvement patterns for hyperactivity/impulsivity and inattentiveness subscale scores. Participants optimized to MPH ERCT 50/60 mg/day had a significantly higher mean (standard error) ADHD-RS-IV score at baseline compared with participants optimized to MPH ERCT 20 mg/day (42.4 [1.34] vs. 35.1 [2.55]; p = 0.013). Treatment-emergent AEs were reported by 65/90 (72.2%) participants in the dose-optimization period. CONCLUSIONS Dose-optimization period results describing relationships between change in ADHD symptom scores and final optimized MPH ERCT dose will be valuable for clinicians optimizing MPH ERCT dose.
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Affiliation(s)
| | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Inc., Las Vegas, Nevada
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Coughlin M, Goldie CL, Tregunno D, Tranmer J, Kanellos-Sutton M, Khalid-Khan S. Enhancing metabolic monitoring for children and adolescents using second-generation antipsychotics. Int J Ment Health Nurs 2018; 27:1188-1198. [PMID: 29205757 DOI: 10.1111/inm.12417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 01/08/2023]
Abstract
The prevalence of children and adolescents using second-generation antipsychotics (SGAs) has increased significantly in recent years. In this population, SGAs are used to treat mood and behavioural disorders although considered 'off-label' or not approved for these indications. Metabolic monitoring is the systematic physical health assessment of antipsychotic users utilized to detect cardiovascular and endocrine side effects and prevent adverse events such as weight gain, hyperglycaemia, hyperlipidemia, and arrhythmias. This practice ensures safe and efficacious SGA use among children and adolescents. Despite widely available, evidence-based metabolic monitoring guidelines, rates of monitoring continue to be suboptimal; this exposes children to the unnecessary risk of developing poor cardiovascular health and long-term disease. In this discursive paper, existing approaches to metabolic monitoring as well as challenges to implementing monitoring guidelines in practice are explored. The strengths and weaknesses of providing metabolic monitoring across outpatient psychiatry, primary care, and collaborative community settings are discussed. We suggest that there is no one-size-fits-all solution to improving metabolic monitoring care for children and adolescents using SGA in all settings. However, we advocate for a pragmatic global approach to enhance safety of children and adolescents taking SGAs through collaboration among healthcare disciplines with a focus on integrating nurses as champions of metabolic monitoring.
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Affiliation(s)
- Mary Coughlin
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Catherine L Goldie
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Deborah Tregunno
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Joan Tranmer
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
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Abbas R, Childress AC, Nagraj P, Rolke R, Berry SA, Palumbo DR. Relative Bioavailability of Methylphenidate Extended-release Chewable Tablets Chewed Versus Swallowed Whole. Clin Ther 2018; 40:733-740. [PMID: 29703430 DOI: 10.1016/j.clinthera.2018.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/28/2018] [Accepted: 03/26/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Methylphenidate hydrochloride extended-release chewable tablet (MPH ERCT) is approved for treatment of attention deficit hyperactivity disorder in patients aged 6 years and older. This article evaluates the pharmacokinetic parameters and relative bioavailability of MPH ERCT when chewed versus swallowed whole. METHODS In this open-label, single-dose, 3-period, 3-treatment crossover study, 12 healthy adult volunteers were randomly assigned to treatment sequence. In each period, subjects received a single 40-mg dose of the assigned treatment (MPH ERCT chewed, MPH ERCT swallowed whole, or methylphenidate extended-release oral suspension [MEROS]). Blood samples for pharmacokinetic analysis were collected for 24 hours postdose. Key pharmacokinetic parameters included Cmax, AUC0-t, and AUC0-∞. FINDINGS The geometric mean values for AUC0-t, AUC0-∞, and Cmax were similar for MPH ERCT chewed, MPH ERCT swallowed whole, and MEROS. In all pairwise between-treatment comparisons, the 90% CIs of the geometric mean ratios for AUC0-t, AUC0-∞, and Cmax were fully contained within the bioequivalence range of 80% to 125%. Early exposure over the first 4 hours after dosing (AUC0-4) was similar for MPH ERCT chewed versus swallowed whole; AUC0-4 was approximately 15% lower for MPH ERCT, either chewed or swallowed, compared with MEROS. Each treatment was generally well tolerated. IMPLICATIONS There was no difference in overall rate or extent of exposure of methylphenidate when MPH ERCT was chewed versus swallowed whole by healthy volunteers.
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Affiliation(s)
| | - Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Inc, Las Vegas, Nevada
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Coughlin M, Goldie CL, Tranmer J, Khalid-Khan S, Tregunno D. Patient, Treatment, and Health Care Utilization Variables Associated with Adherence to Metabolic Monitoring Practices in Children and Adolescents Taking Second-Generation Antipsychotics. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63. [PMID: 29528720 PMCID: PMC5894916 DOI: 10.1177/0706743717751693] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Children and adolescents with a range of psychiatric disorders are increasingly being prescribed atypical or second-generation antipsychotics (SGAs). While SGAs are effective at treating conduct and behavioural symptoms, they infer significant cardiometabolic risk. This study aims to explore what patient, treatment, and health care utilization variables are associated with adherence to Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) metabolic monitoring guidelines. METHOD A retrospective chart review of 294 children and adolescents accessing a large outpatient psychiatry setting within a 2-year study period (2014-2016) was conducted. Baseline and follow-up metabolic monitoring, demographic, treatment, and health care utilization variables were then assessed over a 1-year period of interest. RESULTS Metabolic monitoring practices did not adhere to CAMESA guidelines and were very poor over the 1-year observation period. There were significant differences between children (ages 4-12 years, n = 99) and adolescents (ages 13-18 years, n = 195). In adolescents, factors associated with any baseline metabolic monitoring were a higher number of psychiatry visits (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.10 to 1.41), longer duration of contact (OR, 14; 95% CI, 2.31 to 82.4), and use of other non-SGA medications (OR, 3.2; 95% CI, 1.17 to 8.94). Among children, having an emergency room visit (OR, 3.4; 95% CI, 1.01 to 11.71) and taking aripiprazole (OR, 7.4; 95% CI, 2.02 to 27.45) increased the odds of receiving baseline metabolic monitoring. CONCLUSION Findings from this study highlight the need for better metabolic monitoring for children and adolescents taking SGAs. Enhanced focus on opportunities for multidisciplinary collaboration is needed to improve the quality of care offered to this population.
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Affiliation(s)
- Mary Coughlin
- 1 Department of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario
| | | | - Joan Tranmer
- 1 Department of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario
| | | | - Deborah Tregunno
- 1 Department of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario
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Waddell C, Schwartz C, Andres C. Making Children’s Mental Health a Public Policy Priority: For the One and the Many. Public Health Ethics 2017. [DOI: 10.1093/phe/phx018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Charlotte Waddell
- Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University
| | - Christine Schwartz
- Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University
| | - Caitlyn Andres
- Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University
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