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Pillai M, Posada J, Gardner RM, Hernandez-Boussard T, Bannett Y. Measuring quality-of-care in treatment of young children with attention-deficit/hyperactivity disorder using pre-trained language models. J Am Med Inform Assoc 2024; 31:949-957. [PMID: 38244997 PMCID: PMC10990536 DOI: 10.1093/jamia/ocae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To measure pediatrician adherence to evidence-based guidelines in the treatment of young children with attention-deficit/hyperactivity disorder (ADHD) in a diverse healthcare system using natural language processing (NLP) techniques. MATERIALS AND METHODS We extracted structured and free-text data from electronic health records (EHRs) of all office visits (2015-2019) of children aged 4-6 years in a community-based primary healthcare network in California, who had ≥1 visits with an ICD-10 diagnosis of ADHD. Two pediatricians annotated clinical notes of the first ADHD visit for 423 patients. Inter-annotator agreement (IAA) was assessed for the recommendation for the first-line behavioral treatment (F-measure = 0.89). Four pre-trained language models, including BioClinical Bidirectional Encoder Representations from Transformers (BioClinicalBERT), were used to identify behavioral treatment recommendations using a 70/30 train/test split. For temporal validation, we deployed BioClinicalBERT on 1,020 unannotated notes from other ADHD visits and well-care visits; all positively classified notes (n = 53) and 5% of negatively classified notes (n = 50) were manually reviewed. RESULTS Of 423 patients, 313 (74%) were male; 298 (70%) were privately insured; 138 (33%) were White; 61 (14%) were Hispanic. The BioClinicalBERT model trained on the first ADHD visits achieved F1 = 0.76, precision = 0.81, recall = 0.72, and AUC = 0.81 [0.72-0.89]. Temporal validation achieved F1 = 0.77, precision = 0.68, and recall = 0.88. Fairness analysis revealed low model performance in publicly insured patients (F1 = 0.53). CONCLUSION Deploying pre-trained language models on a variable set of clinical notes accurately captured pediatrician adherence to guidelines in the treatment of children with ADHD. Validating this approach in other patient populations is needed to achieve equitable measurement of quality of care at scale and improve clinical care for mental health conditions.
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Affiliation(s)
- Malvika Pillai
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Jose Posada
- Computer Science Department, University of the North, Barranquilla 080020, Colombia
| | - Rebecca M Gardner
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Tina Hernandez-Boussard
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Yair Bannett
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, United States
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Baweja R, Baweja R, Weidlich H, Nyland JE, Waschbusch DA, Waxmonsky JG. Treatment Utilization Pattern of Preschool Children With Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2024; 28:708-721. [PMID: 38084067 DOI: 10.1177/10870547231215287] [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: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to identify patterns of ADHD care, including factors that guide selection and sequencing of treatments in a large nationwide sample of preschool-aged youth over the past 6 years. METHOD A retrospective cohort study utilizing a large electronic health record (TriNetX) of nearly 24,000 children ages 3 to 6 diagnosed with ADHD. RESULTS One in three preschoolers with ADHD were prescribed psychotropic medication, most commonly methylphenidate and guanfacine. One in 10 had at least one psychotherapy billing code during the entire assessment with most youth starting medication before psychotherapy. Rates of most treatments, including polypharmacy, increased with comorbid psychiatric disorders or sleep problems and over the course of the coronavirus pandemic. CONCLUSION Rates of treatment have increased over time but are still largely inconsistent with published care guidelines that advise therapy before medication. Clinicians appear to prioritize psychiatric comorbidity and sleep problems when selecting treatments.
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Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Ritika Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
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Fraiman YS, Guyol G, Acevedo-Garcia D, Beck AF, Burris H, Coker TR, Tiemeier H. A Narrative Review of the Association between Prematurity and Attention-Deficit/Hyperactivity Disorder and Accompanying Inequities across the Life-Course. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1637. [PMID: 37892300 PMCID: PMC10605109 DOI: 10.3390/children10101637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Preterm birth is associated with an increased risk of neurodevelopmental and neurobehavioral impairments including attention-deficit/hyperactivity disorder (ADHD), the most common neurobehavioral disorder of childhood. In this narrative review, we examine the known associations between prematurity and ADHD and highlight the impact of both prematurity and ADHD on multiple domains across the pediatric life-course. We develop a framework for understanding the health services journey of individuals with ADHD to access appropriate services and treatments for ADHD, the "ADHD Care Cascade". We then discuss the many racial and ethnic inequities that affect the risk of preterm birth as well as the steps along the "ADHD Care Cascade". By using a life-course approach, we highlight the ways in which inequities are layered over time to magnify the neurodevelopmental impact of preterm birth on the most vulnerable children across the life-course.
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Affiliation(s)
- Yarden S. Fraiman
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Genevieve Guyol
- Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02218, USA
| | - Dolores Acevedo-Garcia
- Heller School of Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Andrew F. Beck
- Cincinnati Children’s, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Heather Burris
- Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tumaini R. Coker
- Seattle Children’s, University of Washington School of Medicine, Seattle, WA 98105, USA
| | - Henning Tiemeier
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Morgan PL, Woods AD, Wang Y. Sociodemographic Disparities in Attention-Deficit/Hyperactivity Disorder Overdiagnosis and Overtreatment During Elementary School. JOURNAL OF LEARNING DISABILITIES 2023; 56:359-370. [PMID: 35674454 PMCID: PMC10426255 DOI: 10.1177/00222194221099675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) overdiagnosis and overtreatment unnecessarily exposes children to potential harm and contributes to provider and community skepticism toward those with moderate or severe symptoms and significant impairments, resulting in less supportive care. Yet, which sociodemographic groups of children are overdiagnosed and overtreated for ADHD is poorly understood. We conducted descriptive and logistic regression analyses of a population-based subsample of 1,070 U.S. elementary schoolchildren who had displayed above-average levels of independently assessed behavioral, academic, or executive functioning the year prior to their initial ADHD diagnoses and who did not have prior diagnostic histories. Among these children, (a) 27% of White children versus 19% of non-White children were later diagnosed with ADHD and (b) 20% of White children versus 14% of non-White children were later using medication. In adjusted analyses, White children are more likely to later be diagnosed (odds ratio [OR] range = 1.70-2.62) and using medication (OR range = 1.70-2.37) among those whose prior behavioral, academic, and executive functioning suggested that they were unlikely to have ADHD.
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5
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Almeida ML, Garon-Carrier G, Cinar E, Frizzo GB, Fitzpatrick C. Prospective associations between child screen time and parenting stress and later inattention symptoms in preschoolers during the COVID-19 pandemic. Front Psychol 2023; 14:1053146. [PMID: 37303895 PMCID: PMC10249107 DOI: 10.3389/fpsyg.2023.1053146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/21/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Child attention skills are critical for supporting self-regulation abilities, especially during the first years of life. On the other hand, inattention symptoms in preschoolers have been associated with poor school readiness, literacy skills and academic achievement. Previous research has linked excessive screen time with increased inattention symptoms in early childhood. However, most research has only focused on TV exposure and did not investigate this association during the COVID-19 pandemic. This atypical context has increased screen time in children worldwide, including preschoolers. We hypothesize that higher levels of child screen media and parenting stress at age 3.5 will be associated with higher child inattention symptoms at age 4.5. Method This study draws on participants followed longitudinally over the span of 2-years for an investigation of Canadian preschoolers' screen media use during the pandemic (N = 315, 2020). A follow-up with this sample was completed in 2021 (N = 264). Results Analyses using multiple linear regression, revealed a positive association between child screen time at age 3.5 and inattention symptoms at 4.5 years. Parental stress was also positively associated with child inattention symptoms. Associations were observed above individual (child age, inhibitory control, and sex) and family (parent education and family income) characteristics. Discussion These results confirmed our hypothesis and highlight that preschooler screen use and parenting stress may undermine attentional skills. Since attention is a crucial component for children development, behavior and academic outcomes, our study reinforces the importance for parents of adopting healthy media habits.
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Affiliation(s)
- Maíra Lopes Almeida
- Département de l’enseignement au préscolaire et au primaire, Faculté d`Éducation, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Gabrielle Garon-Carrier
- Département de psychoéducation, Faculté d`Éducation, Université de Sherbrooke, Sherbrook, QC, Canada
| | - Eda Cinar
- Département de psychoéducation, Faculté d`Éducation, Université de Sherbrooke, Sherbrook, QC, Canada
| | - Giana Bitencourt Frizzo
- Departamento de Psicologia do Desenvolvimento e Personalidade, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Caroline Fitzpatrick
- Département de l’enseignement au préscolaire et au primaire, Faculté d`Éducation, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Childhood Education, Faculty of Education, University of Johannesburg, Johannesburg, South Africa
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Dennis M, Krasner A, Shoulberg EK, Hoza B, Scott H, Martin CP. Language Problems and ADHD Behaviors: Unique and Interactive Associations with School Readiness in a Socioeconomically Disadvantaged Preschool Sample. Child Psychiatry Hum Dev 2023; 54:597-608. [PMID: 34694560 DOI: 10.1007/s10578-021-01272-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
This study examined the unique and interactive effects of receptive language ability and ADHD behaviors on six school readiness outcomes, over and above the effects of socioeconomic status, in 49 preschoolers (Mage = 3.98, SDage = .58; 53.06% female) recruited from Head Start-affiliated classrooms. Hierarchical regression analyses revealed unique positive associations between receptive language ability and cognitive and mathematics readiness, and unique negative associations between ADHD behaviors and social-emotional, physical, cognitive, and literacy readiness. Moderation analyses indicated that at higher, but not lower, levels of ADHD behaviors, lower receptive language ability was associated with lower social-emotional readiness. Results highlight that, when considered together, children's receptive language ability and ADHD behaviors vary in how they predict school readiness. Further, results provide preliminary evidence for ADHD behaviors as a risk factor in the association between receptive language deficits and social-emotional school readiness. Educational and clinical practice implications are discussed.
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Affiliation(s)
- Marissa Dennis
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405, USA.
| | - Allison Krasner
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405, USA
| | - Erin K Shoulberg
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405, USA
| | - Betsy Hoza
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405, USA
| | - Hannah Scott
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405, USA
| | - Caroline P Martin
- Department of Psychological Science, University of Vermont, 2 Colchester Avenue, Burlington, VT, 05405, USA
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Episodic and prospective memory difficulties in 13-year-old children born very preterm. J Int Neuropsychol Soc 2023; 29:257-265. [PMID: 35388789 DOI: 10.1017/s1355617722000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Children born very preterm (VP) are susceptible to a range of cognitive impairments, yet the effects of VP birth on long-term, episodic, and prospective memory remains unclear. This study examined episodic and prospective memory functioning in children born VP compared with their term-born counterparts at 13 years. METHOD VP (n = 81: born <30 weeks' gestation) and term (n = 26) groups were aged between 12 and 14 years. Children completed: (i) standardized verbal and visuospatial episodic memory tests; and (ii) an experimental time- and event-based prospective memory test that included short-term (within assessment session) and long-term (up to 1-week post-session) tasks. Parents completed a questionnaire assessing memory functions in everyday life. RESULTS The VP group performed worse on all measures of verbal and visuospatial episodic memory than the term group. While there were no group differences in event-based or long-term prospective memory, the VP group performed worse on time-based and short-term prospective memory tasks than term-born counterparts. Parents of children born VP reported more everyday memory difficulties than parents of children born at term, with parent-ratings indicating significantly elevated rates of everyday memory challenges in children born VP. CONCLUSIONS Children born VP warrant long-term surveillance, as challenges associated with VP birth include memory difficulties at 13 years. This study highlights the need for greater research and clinical attention into childhood functional memory outcomes.
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Hails KA, Garbacz SA, Stormshak EA, McIntyre LL. Engagement in a brief preventive parenting intervention during the transition to kindergarten: Effects of parent stress and child behavior concerns. J Sch Psychol 2023; 96:24-35. [PMID: 36641222 DOI: 10.1016/j.jsp.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/07/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
Although school-based preventive parenting interventions have been found to promote children's social-emotional skill development and behavioral functioning, it is important to understand potential barriers to engagement in such programs to ensure that intervention access is equitable and likely to reach those who could most benefit. In the present study, we tested independent and interactive associations between parents' concerns about their child's hyperactivity behavior and their perceived stress in relation to their participation in a preventive parenting intervention, the Family Check-Up (FCU), delivered when children were in kindergarten. Participants were parents of 164 children who were randomized to the intervention group of a randomized controlled trial that took place at five elementary schools. Results indicated that parents who reported higher levels of hyperactivity in their children and high levels of perceived stress were less likely to initially engage in the FCU, but if they did engage, they were more likely to participate more intensively as measured by total treatment time. Parents' motivation to change mediated the association between high parent stress and child hyperactivity in relation to total treatment time. This study has important implications for the use of motivational interviewing strategies to engage parents in school-based, family-centered interventions.
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Affiliation(s)
- Katherine A Hails
- University of Oregon, Prevention Science Institute, 1600 Millrace Dr Eugene, OR 97403, United States of America.
| | - S Andrew Garbacz
- University of Wisconsin-Madison, Department of Educational Psychology, 1025, West, Johnson St Madison, WI 53706, United States of America.
| | - Elizabeth A Stormshak
- University of Oregon, Prevention Science Institute, 1600 Millrace Dr Eugene, OR 97403, United States of America.
| | - Laura Lee McIntyre
- University of Oregon, Prevention Science Institute, 1600 Millrace Dr Eugene, OR 97403, United States of America.
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Nair MKC, Radhakrishnan R, Olusanya BO. Promoting school readiness in children with developmental disabilities in LMICs. Front Public Health 2023; 11:993642. [PMID: 36908404 PMCID: PMC9992638 DOI: 10.3389/fpubh.2023.993642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
The United Nations' Sustainable Development Goals (SDGs) explicitly acknowledge inclusive and equitable quality education as the primary goal of any global initiatives for early childhood development for children under 5 years with developmental delays and disabilities. Primary education provides the foundation for lifelong learning, vocational attainment, and economically independent living. Globally, the majority (over 90%) of children with developmental disabilities reside in low- and middle-income countries (LMICs). These children are significantly less likely to have foundational reading and numeracy skills, more likely to have never attended school and more likely to be out of primary school, compared to children without disabilities. Concerted and well-coordinated efforts to prepare these children in early childhood for inclusive education constitute a moral and ethical priority for all countries. This paper sets out to examine the concept and dimensions of school readiness for children under 5 years from an extensive narrative review of the literature. It identifies the barriers and challenges for school readiness for children with disabilities and the limitations of the available tools for evaluating school readiness. It concludes by emphasizing the critical role of inter-disciplinary engagement among pediatric caregivers in promoting school readiness in partnership with the families and community where the children reside. Overall, the paper highlights the need for appropriate policy initiatives at the global and national levels to promote school readiness specifically for children under 5 years with developmental disabilities in LMICs, if the aspirational goal of inclusive education by 2030 under the SDGs is to be realized.
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Affiliation(s)
- M K C Nair
- NIMS-Spectrum Child Development Research Centre, Thiruvananthapuram, Kerala, India
| | - Rekha Radhakrishnan
- Honorary Preschool Consultant, NIMS-Spectrum Child Development Research Centre, Thiruvananthapuram, Kerala, India
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Childress AC, Lloyd E, Jacobsen L, Gunawardhana L, Johnson SA, Findling RL. Efficacy and Safety of Lisdexamfetamine in Preschool Children With Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:1423-1434. [PMID: 35577034 DOI: 10.1016/j.jaac.2022.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/03/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the acute efficacy, safety, and tolerability of lisdexamfetamine dimesylate (LDX) vs placebo (PBO) in preschool-aged children with attention-deficit/hyperactivity disorder (ADHD). METHOD This phase 3, double-blind, fixed-dose study randomly assigned children (aged 4-5 years) with ADHD to 6 weeks of LDX (5, 10, 20, 30 mg) or PBO. The prespecified primary (change from baseline at week 6 in ADHD Rating Scale IV, Preschool version, total score [ADHD-RS-IV-PS-TS]) and key secondary (Clinical Global Impression-Improvement [CGI-I] score at week 6) efficacy endpoints were assessed using linear mixed-effects models for repeated measures. Safety and tolerability assessments included treatment-emergent adverse events (TEAEs) and changes in pulse and blood pressure (BP). RESULTS The study comprised 199 participants randomly asigned 5:5:5:5:6 to receive 5, 10, 20, 30 mg LDX or PBO, respectively. Least squares (LS) mean (95% CI) treatment difference at week 6 between pooled LDX (10, 20, 30 mg) and PBO was statistically significant for ADHD-RS-IV-PS-TS change (-5.9 [-11.01, -0.78], p = .0242; effect size [ES], -0.43). CGI-I scores improved (ie, 1-2 on CGI-I) in 41.7% for pooled LDX and 24.3% for PBO (p = .0857). The LS mean (95% CI) treatment difference between pooled LDX and PBO for CGI-I score at week 6 was -0.6 (-1.03, -0.16; p = .0074; ES, -0.52). Frequency of TEAEs was 46.6% across all 4 LDX doses vs 42.2% with PBO; the most frequent TEAEs were decreased appetite (13.7% vs 8.9%, respectively) and irritability (9.6% vs 0%). Discontinuations because of TEAEs were 5.5% for all LDX doses and 4.4% for PBO. Mean ± SD pulse/BP changes from baseline at week 6/early termination were numerically greater with LDX vs PBO (pulse beats/min: 2.7 ± 10.79 vs 1.2 ± 9.90; systolic BP, mm Hg: 1.0 ± 7.51 vs 0.3 ± 6.06; diastolic BP, mm Hg: 1.7 ± 5.90 vs 0.0 ± 6.88). CONCLUSION In children aged 4 to 5 years with ADHD, LDX was more efficacious than PBO in reducing symptoms. The observed ES for change in ADHD-RS-IV-PS-TS appears to be smaller in magnitude than has been reported for studies of LDX conducted in older children and adolescents. LDX was generally well tolerated, and no new safety signals were identified. CLINICAL TRIAL REGISTRATION INFORMATION Safety and Efficacy Study in Preschool Children Aged 4-5 Years With Attention-Deficit/Hyperactivity Disorder; http://www. CLINICALTRIALS gov; NCT03260205.
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Affiliation(s)
- Ann C Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, Nevada.
| | - Eric Lloyd
- Takeda Development Center Americas, Inc., Lexington, Massachusetts
| | - Leslie Jacobsen
- Neurogene Inc., New York; Shire, a member of the Takeda group of companies, Lexington, Massachusetts
| | | | - Steven A Johnson
- Takeda Development Center Americas, Inc., Lexington, Massachusetts
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11
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Spittle AJ, Olsen JE, FitzGerald TL, Cameron KL, Albesher RA, Mentiplay BF, Treyvaud K, Burnett A, Lee KJ, Pascoe L, Roberts G, Doyle LW, Anderson P, Cheong JLY. School Readiness in Children Born <30 Weeks' Gestation at Risk for Developmental Coordination Disorder: A Prospective Cohort Study. J Dev Behav Pediatr 2022; 43:e312-e319. [PMID: 34723933 DOI: 10.1097/dbp.0000000000001031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether school readiness differs between children born <30 weeks' gestation who are classified as at risk for developmental coordination disorder (DCD) and those who are not. METHODS This study was a prospective cohort study of children born <30 weeks' gestation. Children were classified as at risk for DCD at a corrected age of 4 to 5 years if they scored <16th centile on the Movement Assessment Battery for Children-Second Edition (MABC-2), had a full scale IQ score of ≥80 on the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV), and had no cerebral palsy. Children were assessed on 4 school readiness domains: (1) health/physical development [Physical Health domain of Pediatric Quality of Life Inventory (PedsQL), Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and Little Developmental Coordination Disorder Questionnaire], (2) social-emotional development (Strengths and Difficulties Questionnaire and PedsQL psychosocial domains), (3) cognitive skills/general knowledge (WPPSI-IV), and (4) language skills (WPPSI-IV). RESULTS Of 123 children assessed, 16 were ineligible (IQ < 80 or cerebral palsy: n = 15; incomplete MABC-2: n = 1); 28 of 107 (26%) eligible children were at risk for DCD. Children at risk for DCD had poorer performance on all school readiness domains, with group differences of more than 0.4 SD in health/physical development, social-emotional development, and language skills and up to 0.8 SD for cognitive skills/general knowledge compared with those not at risk of DCD. CONCLUSION Being at risk for DCD in children born <30 weeks' gestation is associated with challenges in multiple school readiness domains, not only the health/physical domain.
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Affiliation(s)
- Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
| | - Joy E Olsen
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
| | - Tara L FitzGerald
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kate L Cameron
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Reem A Albesher
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Benjamin F Mentiplay
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Karli Treyvaud
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Alice Burnett
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Leona Pascoe
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Gehan Roberts
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Lex W Doyle
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Peter Anderson
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Jeanie L Y Cheong
- Victorian Infant Brain Studies, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Shephard E, Zuccolo PF, Idrees I, Godoy PBG, Salomone E, Ferrante C, Sorgato P, Catão LFCC, Goodwin A, Bolton PF, Tye C, Groom MJ, Polanczyk GV. Systematic Review and Meta-analysis: The Science of Early-Life Precursors and Interventions for Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:187-226. [PMID: 33864938 DOI: 10.1016/j.jaac.2021.03.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate which early neurocognitive and behavioral precursors are associated with the development of attention-deficit/hyperactivity disorder (ADHD) and whether these are currently targeted in early interventions. METHOD We conducted 2 systematic reviews and meta-analyses of empirical studies to examine the following: (1) early-life (0-5 years) neurocognitive and behavioral precursors associated with familial likelihood for ADHD, an early ADHD diagnosis/elevated ADHD symptoms, and/or the presence of later-childhood ADHD; and (2) interventions delivered to children aged 0 to 5 years targeting the identified precursors or measuring these as outcomes. Standardized mean differences (Hedges' g) and pre-post-treatment change scores (SMD) were computed. RESULTS A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multi-level random-effects meta-analyses on 136 studies revealed significant associations between ADHD and poorer cognitive (g = -0.46 [95% CIs: -0.59, -0.33]), motor (g = -0.35 [CIs: -0.48, -0.21]) and language (g = -0.43 [CIs: -0.66, -0.19]) development, social (g = 0.23 [CIs: 0.03, 0.43]) and emotional (g = 0.46 [CIs: 0.33, 0.58]) difficulties, early regulatory (g = 0.30 [CIs: 0.18, 0.43]) and sleep (g = 0.29 [CIs: 0.14, 0.44]) problems, sensory atypicalities (g = 0.52 [CIs: 0.16, 0.88]), elevated activity levels (g = 0.54 [CIs: 0.37, 0.72]), and executive function difficulties (g = 0.34 [CIs: 0.05, 0.64] to -0.87 [CIs: -1.35, -0.40]). A total of 32 trials (28 randomized, 4 nonrandomized, 3,848 participants) testing early interventions that targeted the identified precursors met inclusion criteria for part 2. Multi-level random-effects meta-analyses on 22 studies revealed significant intervention-related improvements in ADHD symptoms (SMD = 0.43 [CIs: 0.22, 0.64]) and working memory (SMD = 0.37 [CIs: 0.06, 0.69]). CONCLUSION Children aged 0 to 5 years with current or later-emerging ADHD are likely to experience difficulties in multiple neurocognitive/behavioral functions. Early interventions show some effectiveness in reducing ADHD symptoms, but their effects on neurocognitive/behavioral difficulties require further study.
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Affiliation(s)
- Elizabeth Shephard
- Drs. Shephard, Zuccolo, Prof. Polanczyk, Ms. Godoy, and Mr. Catão are with Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil; Drs. Shephard, Goodwin, Tye, and Prof. Bolton are with Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, United Kingdom.
| | - Pedro F Zuccolo
- Drs. Shephard, Zuccolo, Prof. Polanczyk, Ms. Godoy, and Mr. Catão are with Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Iman Idrees
- Ms. Idrees and Dr. Groom are with Institute of Mental Health, University of Nottingham, United Kingdom
| | - Priscilla B G Godoy
- Drs. Shephard, Zuccolo, Prof. Polanczyk, Ms. Godoy, and Mr. Catão are with Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Erica Salomone
- Dr. Salomone and Mss. Ferrante and Sorgato are with the University of Milan-Bicocca, Italy
| | - Camilla Ferrante
- Dr. Salomone and Mss. Ferrante and Sorgato are with the University of Milan-Bicocca, Italy
| | - Paola Sorgato
- Dr. Salomone and Mss. Ferrante and Sorgato are with the University of Milan-Bicocca, Italy
| | - Luís F C C Catão
- Drs. Shephard, Zuccolo, Prof. Polanczyk, Ms. Godoy, and Mr. Catão are with Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Amy Goodwin
- Drs. Shephard, Goodwin, Tye, and Prof. Bolton are with Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, United Kingdom
| | - Patrick F Bolton
- Drs. Shephard, Goodwin, Tye, and Prof. Bolton are with Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, United Kingdom; Prof. Bolton is also with The Maudsley NIHR Biomedical Research Centre in Mental Health, King's College London and South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Charlotte Tye
- Drs. Shephard, Goodwin, Tye, and Prof. Bolton are with Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, United Kingdom
| | - Madeleine J Groom
- Ms. Idrees and Dr. Groom are with Institute of Mental Health, University of Nottingham, United Kingdom
| | - Guilherme V Polanczyk
- Drs. Shephard, Zuccolo, Prof. Polanczyk, Ms. Godoy, and Mr. Catão are with Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
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Masterton JM, Savage TA, Walsh SM, Guzman AB, Shah R. Improving Referrals to Preschool Special Education in Pediatric Primary Care. J Pediatr Health Care 2021; 35:461-470. [PMID: 34210554 DOI: 10.1016/j.pedhc.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The American Academy of Pediatrics created evidence-based guidelines that encourage early identification and referral for children with developmental delays. Although pediatric primary care providers are poised to link 3-to-5-year-old children to school-based services, there are gaps in making referrals. METHOD Educational dissemination of streamlined referral packets was introduced. Knowledge and perceived confidence were measured following an educational presentation. Retrospective chart reviews compared referral rates to preschool special education services when developmental delays were identified. RESULTS Mean pretest to posttest knowledge and perceived confidence to refer children to preschool special education increased following education. Referral rates for 3-5 years-old by pediatric primary care providers doubled during the initial 8-week implementation period and remained constant 9 months later. DISCUSSION Educational dissemination of a streamlined referral process in pediatric primary care is a sustainable approach that ensures preschool-aged children with developmental delays receive timely referrals for further school-based evaluations and interventions.
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Attention-Deficit/Hyperactivity Disorder in 2- to 5-Year-Olds: A Primary Care Network Experience. Acad Pediatr 2021; 21:280-287. [PMID: 32360494 DOI: 10.1016/j.acap.2020.04.009] [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: 01/16/2020] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess 1) rates of primary care provider (PCP) diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children, 2) documented PCP adherence to ADHD clinical practice guidelines, and 3) patient factors influencing PCP variation in diagnosis and management. METHODS Retrospective cohort study of electronic health records from all office visits of children aged 2 to 5 years, seen ≥2 times between 2015 and 2019, in 10 practices of a community-based primary health care network. Outcomes included ADHD diagnosis (symptom or disorder), and adherence to guidelines in 1) comorbidity documentation at or after ADHD diagnosis, 2) ADHD medication choice, and 3) follow-up of medicated patients. Logistic regressions assessed associations between outcomes and patient characteristics. RESULTS Of 29,408 eligible children, 195 (0.7%) had ADHD diagnoses. Of those, 56% had solely symptom-level diagnoses (eg, hyperactivity); 54% had documented comorbidities. ADHD medications were prescribed only to 4- to 5-year olds (40 of 195 [21%]); 85% received stimulants as first-line medication; 48% had follow-up visits within 2 months. Likelihood of ADHD diagnosis was higher for children with public or military insurance (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.40-2.66; OR 3.17; 95% CI 1.93-4.96). Likelihood of comorbidity documentation was lower for older ADHD patients (OR 0.48; 95% CI 0.32-0.71) and higher for those with military insurance (OR 3.11; 95% CI 1.13-9.58). CONCLUSION PCPs in this network frequently used symptom-level ADHD diagnoses in 2- to 5-year olds; ADHD diagnosis rates were below estimated population prevalence, with evidence for sociodemographic disparities. PCP comorbidity documentation and choice of stimulant medications were consistent with guidelines. Rates of timely follow-up were low.
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Larsen SA, Little CW, Coventry WL. Exploring the Associations Between Delayed School Entry and Achievement in Primary and Secondary School. Child Dev 2020; 92:774-792. [PMID: 32767760 DOI: 10.1111/cdev.13440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This research investigated whether delayed school entry was associated with higher achievement in national tests of reading and numeracy in Grades 3, 5, 7, and 9 (n = 2,823). Delayed entry was related to advantages in reading (0.14 SD) and numeracy (0.08 SD) at Grade 3, although little variance was explained (1%-2%). This slight advantage persisted for both domains in Grades 5 and 7, albeit with smaller effects. In Grade 9 there was no association between delayed entry and either reading or numeracy. Exploratory analyses with subsamples in each grade (n = 424-667) revealed no associations between delayed entry and achievement after controlling for inattention and hyperactivity, and negative associations between inattention and achievement in all grades in both domains (-0.33, -0.49 SD).
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Suravi P, Ashis P. Neurobiology of Attention Deficit Hyperactivity Disorder in moya moya disease. Indian J Psychiatry 2020; 62:441. [PMID: 33165360 PMCID: PMC7597703 DOI: 10.4103/psychiatry.indianjpsychiatry_682_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/18/2019] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Patra Suravi
- Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India
| | - Patnaik Ashis
- Department of Neurosurgery, AIIMS, Bhubaneswar, Odisha, India. E-mail:
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Childress AC, Findling RL, Wu J, Kollins SH, Wang Y, Martin P, Robertson B. Lisdexamfetamine Dimesylate for Preschool Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:128-136. [PMID: 32233956 PMCID: PMC7153646 DOI: 10.1089/cap.2019.0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives: Describe the safety and tolerability of lisdexamfetamine dimesylate (LDX) and provide data on clinical effects for efficacy-related endpoints and pharmacokinetics in preschool-aged children with attention-deficit/hyperactivity disorder (ADHD). Methods: This phase 2, multicenter, open-label, dose-optimization study (ClinicalTrials.gov registry: NCT02402166) was conducted at seven U.S. sites between April 15, 2015, and June 30, 2016. Children (4-5 years of age) meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for ADHD and having ADHD Rating Scale-IV Preschool version (ADHD-RS-IV-PS) total scores ≥28 (boys) or ≥24 (girls) were eligible. Open-label LDX (8-week duration) was initiated at 5 mg and titrated to 30 mg until achieving an optimal dose. Assessments included treatment-emergent adverse events (TEAEs), vital sign changes, ADHD-RS-IV-PS total score changes, and pharmacokinetic evaluations. Results: Among 24 participants, the most frequently reported TEAE was decreased appetite (8/24; 33%). At week 8/early termination, mean (standard deviation) systolic and diastolic blood pressure and pulse changes from baseline were -1.1 (7.31) and 1.5 (6.93) mmHg and -0.8 (12.75) bpm, respectively. The mean (95% confidence interval) change from baseline ADHD-RS-IV-PS total score at the final on-treatment assessment was -26.1 (-32.2 to -20.0). Pharmacokinetic parameters of d-amphetamine, a major active metabolite of LDX, were characterized: d-amphetamine exposure increased with LDX dose; mean tmax and t1/2, respectively, ranged from 4.00 to 4.23 hours and 7.18 to 8.46 hours. Conclusions: In preschool-aged children with ADHD, LDX was generally well tolerated and reduced ADHD symptoms, consistent with observations in children 6-17 years of age. Based on these findings, a starting LDX dose as low as 5 mg in phase 3 studies in preschool-aged children is supported.
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Affiliation(s)
- Ann C. Childress
- Center for Psychiatry and Behavioral Medicine, Las Vegas, Nevada.,Address correspondence to: Ann C. Childress, MD, Center for Psychiatry and Behavioral Medicine, 7351 Prairie Falcon Road, Suite 160, Las Vegas, NV 89128
| | - Robert L. Findling
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - James Wu
- Biostatistics, Shire, a member of the Takeda group of companies, Lexington, Massachusetts
| | - Scott H. Kollins
- Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina
| | - Yi Wang
- Clinical Pharmacology and Pharmacokinetics, Shire, a member of the Takeda group of companies, Lexington, Massachusetts
| | - Patrick Martin
- Clinical Pharmacology and Pharmacokinetics, Shire, a member of the Takeda group of companies, Lexington, Massachusetts
| | - Brigitte Robertson
- Global Clinical Development, Shire, a member of the Takeda group of companies, Lexington, Massachusetts
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