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Dyresen A, Stubberud J, Fjermestad KW, Haugen I, Øie MG. Executive control training for adolescents with ADHD: Study protocol for a randomised controlled trial. Contemp Clin Trials 2024; 136:107404. [PMID: 38070766 DOI: 10.1016/j.cct.2023.107404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/18/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental conditions diagnosed during childhood and adolescence. In addition to the commonly observed symptoms of inattention, hyperactivity, and impulsivity, individuals with ADHD often experience impairments in executive functions (EFs). Goal management training (GMT) is a cognitive remediation intervention targeting EFs, with empirical support from studies with adult populations, including ADHD. The objective of the upcoming trial is to assess the effectiveness of GMT for adolescents with ADHD. METHODS This pre-registered protocol outlines a multi-centre randomised controlled trial (RCT) comparing GMT to treatment as usual (TAU) to improve EFs. We aim to recruit 120 participants, aged 12 to 18 years, recently diagnosed with ADHD. Participants will be randomly allocated to the group-based GMT intervention in addition to TAU, or the TAU condition, through block randomisation with site stratification. GMT will be delivered in groups of four to six participants, with weekly two-hour sessions for seven weeks, complemented by separate parent and teacher sessions. TAU is standard community mental health treatment. The primary outcome measure will be parent-reported EF assessed with the Behaviour Rating Inventory of Executive Function 2 (BRIEF-2). Secondary outcomes will include ADHD symptom measures, social functioning, quality of life, and neuropsychological tests (attention span, inhibition, working memory, and visuo-motor speed). The outcome assessments will be conducted at baseline, 12 weeks, 12 months, and 24 months post-treatment. CONCLUSION The study findings will contribute to determine the effectiveness of a non-pharmacological ADHD treatment, including outcome trajectories up to 24 months post-treatment.
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Affiliation(s)
- Agnete Dyresen
- Department of Psychology, University of Oslo, Norway; Lovisenberg Diaconal Hospital, Nic Waals Institute, Oslo, Norway.
| | - Jan Stubberud
- Department of Psychology, University of Oslo, Norway; Department of Research, Lovisenberg Diaconal Hospital, Norway
| | - Krister Westlye Fjermestad
- Department of Psychology, University of Oslo, Norway; Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | | | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Norway; Innlandet Hospital Trust, Norway
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2
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Anning KL, Langley K, Hobson C, Van Goozen SHM. Dimensional associations between executive function processes and symptoms of ADHD, ASD, oppositional defiance and anxiety in young school-referred children. Cortex 2023; 167:132-147. [PMID: 37557009 DOI: 10.1016/j.cortex.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/28/2023] [Accepted: 06/20/2023] [Indexed: 08/11/2023]
Abstract
Executive function (EF) difficulties are implicated in Neurodevelopmental Disorders (NDDs), such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Because NDDs are highly comorbid and frequently co-occur with additional clinical problems, it is unclear how specific EF problems are associated with symptoms of ASD and ADHD, whilst accounting for co-occurring anxiety or oppositional defiance disorder (ODD) symptoms. The current study utilised a large sample of young children (n = 438, aged 4-8) referred to Cardiff University's Neurodevelopment Assessment Unit (NDAU) by teachers for cognitive and/or socio-emotional problems. As part of the referral process, the teachers completed the Strengths and Difficulties Questionnaire (SDQ), which revealed that most children displayed moderate to high hyperactivity (86%) and prosocial (73%) problems, as well as high levels of symptoms in other clinical domains (41% emotional, 61% conduct and 68% peer problems). Children completed tasks to assess episodic memory, cognitive inhibition, cognitive flexibility and visuomotor control, whilst parents completed questionnaires to measure symptoms of ASD, ADHD, anxiety and ODD. Dimensional analyses showed that poorer cognitive inhibition and visuospatial episodic memory were significantly associated with ADHD symptoms, whereas cognitive flexibility was negatively associated with ODD symptoms. Having more ASD symptoms was associated with fewer cognitive inhibition problems, whereas anxiety was associated with better cognitive flexibility. Our approach to assessment and analysis shows that specific cognitive processes are associated with distinct neurodevelopmental and clinical symptoms, which is ultimately relevant to early identification of and intervention for young children at risk of cognitive and/or socio-emotional problems.
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Affiliation(s)
- Kate L Anning
- School of Psychology, Cardiff University, Cardiff, UK.
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | | | - Stephanie H M Van Goozen
- School of Psychology, Cardiff University, Cardiff, UK; Department of Clinical Neurodevelopmental Studies, Leiden University, Leiden, the Netherlands.
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3
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McDougal E, Tai C, Stewart TM, Booth JN, Rhodes SM. Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers. J Autism Dev Disord 2023; 53:3406-3421. [PMID: 35776263 PMCID: PMC10465390 DOI: 10.1007/s10803-022-05639-3] [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] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
Children with Attention Deficit Hyperactivity Disorder (ADHD) are more at risk for academic underachievement compared to their typically developing peers. Understanding their greatest strengths and challenges at school, and how these can be supported, is vital in order to develop focused classroom interventions. Ten primary school pupils with ADHD (aged 6-11 years) and their teachers (N = 6) took part in semi-structured interviews that focused on (1) ADHD knowledge, (2) the child's strengths and challenges at school, and (3) strategies in place to support challenges. Thematic analysis was used to analyse the interview transcripts and three key themes were identified; classroom-general versus individual-specific strategies, heterogeneity of strategies, and the role of peers. Implications relating to educational practice and future research are discussed.
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Affiliation(s)
- Emily McDougal
- Centre for Clinical Brain Sciences, Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Claire Tai
- Centre for Clinical Brain Sciences, Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Tracy M Stewart
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | - Josephine N Booth
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
| | - Sinéad M Rhodes
- Centre for Clinical Brain Sciences, Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom.
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4
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Türk S, Korfmacher AK, Gerger H, van der Oord S, Christiansen H. Interventions for ADHD in childhood and adolescence: A systematic umbrella review and meta-meta-analysis. Clin Psychol Rev 2023; 102:102271. [PMID: 37030086 DOI: 10.1016/j.cpr.2023.102271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
There are several meta-analyses of treatment effects for children and adolescents with attention deficit hyperactivity disorder (ADHD). The conclusions of these meta-analyses vary considerably. Our aim was to synthesize the latest evidence of the effectiveness of psychological, pharmacological treatment options and their combination in a systematic overview and meta-meta-analyses. A systematic literature search until July 2022 to identify meta-analyses investigating effects of treatments for children and adolescents with ADHD and ADHD symptom severity as primary outcome (parent and teacher rated) yielded 16 meta-analyses for quantitative analyses. Meta-meta-analyses of pre-post data showed significant effects for pharmacological treatment options for parent (SMD = 0.67, 95% CI 0.60 to 0.74) and teacher ADHD symptom ratings (SMD = 0.68, 95% CI 0.54 to 0.82) as well as for psychological interventions for parent (SMD = 0.42, 95% CI 0.33 to 0.51) and teacher rated symptoms (SMD = 0.25, 95% CI 0.12 to 0.38). We were unable to calculate effect sizes for combined treatments due to the lack of meta-analyses. Our analyses revealed that there is a lack of research on combined treatments and for therapy options for adolescents. Finally, future research efforts should adhere to scientific standards as this allows comparison of effects across meta-analyses.
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Affiliation(s)
- Selina Türk
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Ann-Kathrin Korfmacher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Heike Gerger
- Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, Netherlands
| | | | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Sonuga-Barke EJS, Becker SP, Bölte S, Castellanos FX, Franke B, Newcorn JH, Nigg JT, Rohde LA, Simonoff E. Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause. J Child Psychol Psychiatry 2023; 64:506-532. [PMID: 36220605 PMCID: PMC10023337 DOI: 10.1111/jcpp.13696] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 12/20/2022]
Abstract
The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
- Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Sven Bölte
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
- Division of Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Sweden
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Joel T. Nigg
- Department of Psychiatry, Oregon Health and Science University, USA
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil
| | - Emily Simonoff
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
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Tanguy D, Rametti-Lacroux A, Bouzigues A, Saracino D, Le Ber I, Godefroy V, Morandi X, Jannin P, Levy R, Batrancourt B, Migliaccio R, Azuar C, Dubois B, Lecouturier K, Araujo CM, Janvier E, Jourdain A, Rametti-Lacroux A, Coriou S, Brochard VB, Gaudebout C, Ferrand-Verdejo J, Bonnefous L, Pochan-Leva F, Jeanne L, Joulié M, Provost M, Renaud R, Hachemi S, Guillemot V, Bendetowicz D, Carle G, Socha J, Pineau F, Marin F, Liu Y, Mullot P, Mousli A, Blossier A, Visentin G, Tanguy D, Godefroy V, Sezer I, Boucly M, Cabrol-Douat B, Odobez R, Marque C, Tessereau-Barbot D, Raud A, Funkiewiez A, Chamayou C, Cognat E, Le Bozec M, Bouzigues A, Le Du V, Bombois S, Simard C, Fulcheri P, Guitton H, Peltier C, Lejeune FX, Jorgensen L, Mariani LL, Corvol JC, Valero-Cabre A, Garcin B, Volle E, Le Ber I, Migliaccio R, Levy R. Behavioural disinhibition in frontotemporal dementia investigated within an ecological framework. Cortex 2023; 160:152-166. [PMID: 36658040 DOI: 10.1016/j.cortex.2022.11.013] [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: 02/02/2022] [Revised: 09/29/2022] [Accepted: 11/09/2022] [Indexed: 12/29/2022]
Abstract
Disinhibition is a core symptom in behavioural variant frontotemporal dementia (bvFTD) particularly affecting the daily lives of both patients and caregivers. Yet, characterisation of inhibition disorders is still unclear and management options of these disorders are limited. Questionnaires currently used to investigate behavioural disinhibition do not differentiate between several subtypes of disinhibition, encompass observation biases and lack of ecological validity. In the present work, we explored disinhibition in an original semi-ecological situation, by distinguishing three categories of disinhibition: compulsivity, impulsivity and social disinhibition. First, we measured prevalence and frequency of these disorders in 23 bvFTD patients and 24 healthy controls (HC) in order to identify the phenotypical heterogeneity of disinhibition. Then, we examined the relationships between these metrics, the neuropsychological scores and the behavioural states to propose a more comprehensive view of these neuropsychiatric manifestations. Finally, we studied the context of occurrence of these disorders by investigating environmental factors potentially promoting or reducing them. As expected, we found that patients were more compulsive, impulsive and socially disinhibited than HC. We found that 48% of patients presented compulsivity (e.g., repetitive actions), 48% impulsivity (e.g., oral production) and 100% of the patients group showed social disinhibition (e.g., disregards for rules or investigator). Compulsivity was negatively related with emotions recognition. BvFTD patients were less active if not encouraged in an activity, and their social disinhibition decreased as activity increased. Finally, impulsivity and social disinhibition decreased when patients were asked to focus on a task. Summarising, this study underlines the importance to differentiate subtypes of disinhibition as well as the setting in which they are exhibited, and points to stimulating area for non-pharmacological management.
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Affiliation(s)
- Delphine Tanguy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Armelle Rametti-Lacroux
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Arabella Bouzigues
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Dario Saracino
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtriѐre, Department of Neurology, IM2A, Paris, France
| | - Isabelle Le Ber
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtriѐre, Department of Neurology, IM2A, Paris, France
| | - Valérie Godefroy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Xavier Morandi
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Pierre Jannin
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Richard Levy
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France; AP-HP, Groupe Hospitalier Pitié-Salpêtriѐre, Department of Neurology, IM2A, Paris, France
| | - Bénédicte Batrancourt
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France.
| | - Raffaella Migliaccio
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, FrontLab, Inserm, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtriѐre, Department of Neurology, IM2A, Paris, France.
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Russell AE, Moore D, Sanders A, Dunn B, Hayes R, Kidger J, Sonuga-Barke E, Pfiffner L, Ford T. Synthesising the existing evidence for non-pharmacological interventions targeting outcomes relevant to young people with ADHD in the school setting: systematic review protocol. Syst Rev 2022; 11:28. [PMID: 35168685 PMCID: PMC8848797 DOI: 10.1186/s13643-022-01902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have impairing levels of difficulty paying attention, impulsive behaviour and/or hyperactivity. ADHD causes extensive difficulties for young people at school, and as a result these children are at high risk for a wide range of poor outcomes. We ultimately aim to develop a flexible, modular 'toolkit' of evidence-based strategies that can be delivered by primary school staff to improve the school environment and experience for children with ADHD; the purpose of this review is to identify and quantify the evidence-base for potential intervention components. This protocol sets out our plans to systematically identify non-pharmacological interventions that target outcomes that have been reported to be of importance to key stakeholders (ADHD symptoms, organisation skills, executive-global- and classroom-functioning, quality of life, self-esteem and conflict with teachers and peers). We plan to link promising individual intervention components to measured outcomes, and synthesise the evidence of effectiveness for each outcome. METHODS A systematic search for studies published from the year 2000 that target the outcomes of interest in children and young people aged 3-12 will be conducted. Titles and abstracts will be screened using prioritisation software, and then full texts of potentially eligible studies will be screened. Systematic reviews, RCTs, non-randomised and case-series studies are eligible designs. Synthesis will vary by the type of evidence available, potentially including a review of reviews, meta-analysis and narrative synthesis. Heterogeneity of studies meta-analysed will be assessed, along with publication bias. Intervention mapping will be applied to understand potential behaviour change mechanisms for promising intervention components. DISCUSSION This review will highlight interventions that appear to effectively ameliorate negative outcomes that are of importance for people with ADHD, parents, school staff and experts. Components of intervention design and features that are associated with effective change in the outcome will be delineated and used to inform the development of a 'toolkit' of non-pharmacological strategies that school staff can use to improve the primary school experience for children with ADHD. TRIAL REGISTRATION PROSPERO number CRD42021233924.
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Affiliation(s)
- Abigail E Russell
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Darren Moore
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Amy Sanders
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Barnaby Dunn
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Rachel Hayes
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | | | | | - Linda Pfiffner
- University of California San Francisco, San Francisco, USA
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Welch V, Dewidar O, Tanjong Ghogomu E, Abdisalam S, Al Ameer A, Barbeau VI, Brand K, Kebedom K, Benkhalti M, Kristjansson E, Madani MT, Antequera Martín AM, Mathew CM, McGowan J, McLeod W, Park HA, Petkovic J, Riddle A, Tugwell P, Petticrew M, Trawin J, Wells GA. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst Rev 2022; 1:MR000028. [PMID: 35040487 PMCID: PMC8764740 DOI: 10.1002/14651858.mr000028.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions. OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness. SEARCH METHODS We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies. SELECTION CRITERIA We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility. AUTHORS' CONCLUSIONS There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.
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Affiliation(s)
- Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | | | | | - Kevin Brand
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | | | | | | | | | | | | | - Jessie McGowan
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Marmora, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Petticrew
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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9
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The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG). Eur Child Adolesc Psychiatry 2021:10.1007/s00787-021-01871-x. [PMID: 34677682 PMCID: PMC8532460 DOI: 10.1007/s00787-021-01871-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022]
Abstract
ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems.
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10
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Powell V, Riglin L, Ng-Knight T, Frederickson N, Woolf K, McManus C, Collishaw S, Shelton K, Thapar A, Rice F. Investigating Friendship Difficulties in the Pathway from ADHD to Depressive Symptoms. Can Parent-Child Relationships Compensate? Res Child Adolesc Psychopathol 2021; 49:1031-1041. [PMID: 33655375 PMCID: PMC8222013 DOI: 10.1007/s10802-021-00798-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 01/13/2023]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is associated with friendship difficulties. This may partly account for the increasingly recognised association between ADHD and subsequent depression. Little is known about the types of friendship difficulties that could contribute to the association between ADHD and depressive symptoms and whether other relationships, such as parent-child relationships, can mitigate against potential adverse effects of friendship difficulties. In a representative UK school sample (n = 1712), three main features of friendship (presence of friends, friendship quality and characteristics of the individual's classroom friendship group) were assessed in a longitudinal study with two assessment waves (W1, W2) during the first year of secondary school (children aged 11-12 years). These friendship features (W1) were investigated as potential mediators of the prospective association between teacher-rated ADHD symptoms (W1) and self-rated depressive symptoms (W2) seven months later. Parent-child relationship quality (W1) was tested as a moderator of any indirect effects of ADHD on depression via friendship. ADHD symptoms were inversely associated with friendship presence, friendship quality and positive characteristics of classroom friendship groups. Depressive symptoms were inversely associated with presence and quality of friendships. Friendship quality had indirect effects in the association between ADHD and subsequent depressive symptoms. There was some evidence of moderated mediation, whereby indirect effects via friendship quality attenuated slightly as children reported warmer parent-child relationships. This highlights the importance of considering the quality of friendships and parent-child relationships in children with ADHD symptoms. Fostering good quality relationships may help disrupt the link between ADHD symptomology and subsequent depression risk.
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11
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Bonete S, Osuna Á, Molinero C, García-Font I. MAGNITIVE: Effectiveness and Feasibility of a Cognitive Training Program Through Magic Tricks for Children With Attention Deficit and Hyperactivity Disorder. A Second Clinical Trial in Community Settings. Front Psychol 2021; 12:649527. [PMID: 33868126 PMCID: PMC8049719 DOI: 10.3389/fpsyg.2021.649527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022] Open
Abstract
Previous studies have explored the impact of magic tricks on different basic cognitive processes yet there is a need of examining effectiveness of a cognitive training program through magic tricks for children with attention deficit hyperactivity disorder (ADHD). The present study examines the effectiveness and feasibility of the MAGNITIVE program, a manualized intervention for cognitive training through the learning of magic tricks. A total of 11 children with ADHD (from 8 to 12 years) participated in separated groups of two different community settings (hospital center and school), and were assessed at pre-treatment, post-treatment, and a 3-month later follow-up in different tasks involving processing speed, sustained attention, selective attention, and mental flexibility. Using non parametric statistical analyses and Reliable Change Index, the results showed that these children receiving MAGNITIVE particularly improved their performance in sustained attention, shifting attention, and mental flexibility, changes were also observed in processing speed performance yet further research is needed in terms of selective attention and inhibition, given the great individual differences within this sample. Changes were maintained when the program was finished. In terms of viability, the study proved a good treatment integrity in different contexts (hospital and school setting), adherence to the curriculum (attendance and some practice at home), and high levels of engagement satisfaction. In this second clinical trial, MAGNITIVE program appears to be a feasible training program for children with ADHD, as an alternative for medication when possible.
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Affiliation(s)
- Saray Bonete
- Department of Psychology, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ángela Osuna
- Department of Psychology, Universidad Francisco de Vitoria, Madrid, Spain
| | - Clara Molinero
- Department of Psychology, Universidad Francisco de Vitoria, Madrid, Spain
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12
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Rice F, Ng-Knight T, Riglin L, Powell V, Moore GF, McManus IC, Shelton KH, Frederickson N. Pupil Mental Health, Concerns and Expectations About Secondary School as Predictors of Adjustment Across the Transition to Secondary School: A Longitudinal Multi-informant Study. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThe transition from primary to secondary schooling is challenging and involves a degree of apprehension. The extent to which pre-existing mental health difficulties, as well as pupil, parent, and teacher concerns and expectations about secondary school predict adaptation to secondary school, is unclear. In a three-wave, prospective longitudinal study, we examined associations between pre-transition concerns and expectations about moving to secondary school with mental health difficulties and demographic factors. We then evaluated whether these constructs predicted multiple indicators of adaptive pupil functioning at the end of the first year of secondary school (academic attainment, classmate behaviour rating, school liking and loneliness at school). We found children’s concerns reduced across the transition period. Concurrent associations were identified between both concerns about secondary school and lower parent and teacher expectations that children would settle in well at secondary school, with mental health difficulties and special educational needs. Investigating associations with multiple indicators of adaptive functioning at secondary school, multivariable regression analyses controlling for a range of baseline factors (e.g. special educational needs), found children’s concerns about secondary school to be specifically associated with loneliness. In contrast, children’s mental health difficulties and both parent and teacher expectations of how well children would settle into secondary school were associated with a wider range of indicators of adaptive functioning at secondary school. When examining all predictors simultaneously, primary school teacher expectations showed longitudinal association with a wide range of indicators of successful transition. These findings suggest that assessing primary school teacher expectations may be useful for monitoring and supporting pupils through this transition period and could usefully inform school-based interventions to support transition and mental health.
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13
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Perry RC, Ford TJ, O’Mahen H, Russell AE. Prioritising Targets for School-Based ADHD Interventions: A Delphi Survey. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-020-09408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractMany studies have investigated the effectiveness of school-based ADHD interventions at modifying different social, emotional and behavioural target outcomes. However, there is a lack of evidence about which targets stakeholders perceive to be most important. This study sought to obtain consensus on which outcomes are perceived to be most important. A total of 114 people with ADHD, educational professionals, parents of children with ADHD, clinicians and researchers participated in a Delphi survey with 3 rounds. The importance of 52 intervention targets was rated on a scale from 0 to 8 (8 being extremely important). Consensus was reached if >70% of a stakeholder group rated a target as between 6–8 and <15% rated it as 0–2. Targets were dropped from subsequent rounds if more than 50% of stakeholder groups rated it as 0–5. Targets that all four stakeholder groups reached consensus on in any round were automatically included in our final outcome set. Comments were analysed using Thematic Analysis. All four stakeholder groups reached consensus on the importance of seven targets: ability to pay attention, conflict with teachers and peers, executive functioning, global functioning and quality of life, inattention symptoms, organisation skills and self-esteem. Four overarching themes were identified: Complexity of ADHD, Relationships, School Context, and What ADHD means to me. School-based ADHD interventions should target outcomes identified as most important to those who stand to benefit from such interventions. Some outcomes prioritised by our participants have not yet been targeted in school-based ADHD interventions. Implications of our findings for intervention and research design are discussed.
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14
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Hughes A, Wade KH, Dickson M, Rice F, Davies A, Davies NM, Howe LD. Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study. NPJ SCIENCE OF LEARNING 2021; 6:1. [PMID: 33398003 PMCID: PMC7782810 DOI: 10.1038/s41539-020-00080-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/19/2020] [Indexed: 05/30/2023]
Abstract
Good health is positively related to children's educational outcomes, but relationships may not be causal. Demonstrating a causal influence would strongly support childhood and adolescent health as important for education policy. We applied genetic causal inference methods to assess the causal relationship of common health conditions at age 10 (primary/elementary school) and 13 (mid-secondary/mid-high school) with educational attainment at 16 and school absence at 14-16. Participants were 6113 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Exposures were symptoms of attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depression, asthma, migraines and BMI. Genetic liability for these conditions and BMI was indexed by polygenic scores. In non-genetic, multivariate-adjusted models, all health conditions except asthma and migraines were associated with poorer attainment and greater school absence. School absence substantially mediated effects of BMI (39.9% for BMI at 13) and migraines (72.0% at 10), on attainment with more modest mediation for emotional and neurodevelopmental conditions. In genetic models, a unit increase in standardized BMI at 10 predicted a 0.19 S.D. decrease (95% CI: 0.11, 0.28) in attainment at 16, equivalent to around a 1/3 grade lower in all subjects, and 8.7% more school absence (95% CI:1.8%,16.1%). Associations were similar at 13. Genetic liability for ADHD predicted lower attainment but not more absence. Triangulation across multiple approaches supports a causal, negative influence on educational outcomes of BMI and ADHD, but not of ASD, depression, asthma or migraine. Higher BMI in childhood and adolescence may causally impair educational outcomes.
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Affiliation(s)
- Amanda Hughes
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK.
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Kaitlin H Wade
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Matt Dickson
- Institute for Policy Research, University of Bath, Bath, UK
| | | | | | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Laura D Howe
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
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Cavonius‐Rintahaka D, Aho AL, Billstedt E, Gillberg C. Dialogical Family Guidance (dfg)-Development and implementation of an intervention for families with a child with neurodevelopmental disorders. Nurs Open 2021; 8:17-28. [PMID: 33318808 PMCID: PMC7729547 DOI: 10.1002/nop2.627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
Aim To describe the development and implementation of a Dialogical Family Guidance (DFG) intervention, aimed at families with a child with neurodevelopmental disorders (NDD). Design The DFG components are presented and the content of a DFG training course. Professionals' experiences after the DFG training were evaluated. Methods Dialogical Family Guidance development phases and implementation process are examined. The Revised Standards for Quality Improvement Reporting Excellence checklist (SQUIRE 2.0) was used to provide a framework for reporting new knowledge. Results The DFG training course seemed to increase possibilities of a more independent role as a nurse to deliver the DFG family intervention. The project showed that the use of dialogue can be difficult for some professionals. Analysis of the questionnaire completed after DFG training reported a high level of satisfaction. DFG training offered a new approach to deliver knowledge and understanding to families using dialogue, including tailored psychoeducation and emotional and practical guidance.
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Affiliation(s)
- Diana Cavonius‐Rintahaka
- Gillberg Neuropsychiatry CentreInstitute of Neuroscience and PhysiologyUniversity of GothenburgSahlgrenska AcademyGothenburgSweden
- Child PsychiatryNeuropsychiatric UnitHelsinki University HospitalHelsinkiFinland
| | - Anna Liisa Aho
- Faculty of Social SciencesNursing ScienceUniversity of TampereTampereFinland
| | - Eva Billstedt
- Gillberg Neuropsychiatry CentreInstitute of Neuroscience and PhysiologyUniversity of GothenburgSahlgrenska AcademyGothenburgSweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry CentreInstitute of Neuroscience and PhysiologyUniversity of GothenburgSahlgrenska AcademyGothenburgSweden
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Powell V, Riglin L, Hammerton G, Eyre O, Martin J, Anney R, Thapar A, Rice F. What explains the link between childhood ADHD and adolescent depression? Investigating the role of peer relationships and academic attainment. Eur Child Adolesc Psychiatry 2020; 29:1581-1591. [PMID: 31932968 PMCID: PMC7595988 DOI: 10.1007/s00787-019-01463-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 12/16/2019] [Indexed: 01/05/2023]
Abstract
There is increasing evidence that childhood Attention-Deficit Hyperactivity Disorder (ADHD) elevates risk of later depression, but the mechanisms behind this association are unclear. We investigated the relationship between childhood ADHD symptoms and late-adolescent depressive symptoms in a population cohort, and examined whether academic attainment and peer problems mediated this association. ALSPAC (Avon Longitudinal Study of Parents and Children) is an ongoing prospective longitudinal population-based UK cohort that has collected data since September 1990. 2950 individuals with data on parent-reported ADHD symptoms in childhood (7.5 years) and self-reported depressive symptoms in late adolescence (17.5 years) were included in analyses. 2161 individuals with additional data at age 16 years on parent-reported peer problems as an indicator of peer relationships and formal examination results (General Certificate of Secondary Education; GCSE) as an indicator of academic attainment were included in mediation analyses. Childhood ADHD symptoms were associated with higher depressive symptoms (b = 0.49, SE = 0.11, p < 0.001) and an increased odds of clinically significant depressive symptoms in adolescence (OR = 1.27, 95% CI 1.15-1.41, p < 0.001). The association with depressive symptoms was mediated in part by peer problems and academic attainment which accounted for 14.68% and 20.13% of the total effect, respectively. Childhood ADHD is associated with increased risk of later depression. The relationship is mediated in part by peer relationships and academic attainment. This highlights peer relationships and academic attainment as potential targets of depression prevention and intervention in those with ADHD. Future research should investigate which aspects of peer relationships are important in conferring later risk for depression.
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Affiliation(s)
- Victoria Powell
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Lucy Riglin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Gemma Hammerton
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Olga Eyre
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Joanna Martin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Richard Anney
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Frances Rice
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
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17
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Drechsler R, Brem S, Brandeis D, Grünblatt E, Berger G, Walitza S. ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics 2020; 51:315-335. [PMID: 32559806 PMCID: PMC7508636 DOI: 10.1055/s-0040-1701658] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/28/2019] [Indexed: 12/17/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of over 5%. Nosological systems, such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and the International Classification of Diseases, editions 10 and 11 (ICD-10/11) continue to define ADHD according to behavioral criteria, based on observation and on informant reports. Despite an overwhelming body of research on ADHD over the last 10 to 20 years, valid neurobiological markers or other objective criteria that may lead to unequivocal diagnostic classification are still lacking. On the contrary, the concept of ADHD seems to have become broader and more heterogeneous. Thus, the diagnosis and treatment of ADHD are still challenging for clinicians, necessitating increased reliance on their expertise and experience. The first part of this review presents an overview of the current definitions of the disorder (DSM-5, ICD-10/11). Furthermore, it discusses more controversial aspects of the construct of ADHD, including the dimensional versus categorical approach, alternative ADHD constructs, and aspects pertaining to epidemiology and prevalence. The second part focuses on comorbidities, on the difficulty of distinguishing between "primary" and "secondary" ADHD for purposes of differential diagnosis, and on clinical diagnostic procedures. In the third and most prominent part, an overview of current neurobiological concepts of ADHD is given, including neuropsychological and neurophysiological researches and summaries of current neuroimaging and genetic studies. Finally, treatment options are reviewed, including a discussion of multimodal, pharmacological, and nonpharmacological interventions and their evidence base.
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Affiliation(s)
- Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Silvia Brem
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, Swiss Federal Institute of Technology and University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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18
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Moore DA, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, Heyman I, Anderson R, Dickens C, Viner R, Bennett S, Logan S, Lockhart F, Thompson Coon J. Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses. Health Technol Assess 2020; 23:1-164. [PMID: 31122334 DOI: 10.3310/hta23220] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness of interventions to treat them. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (review 1) and explore the factors that may enhance or limit their delivery (review 2). DATA SOURCES For review 1, 13 electronic databases were searched, including MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Science Citation Index. For review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted. REVIEW METHODS The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post intervention (Cohen's d). When appropriate, random-effects meta-analyses produced pooled effect sizes (d). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and well-being of CYP with LTCs. Synthesis followed the principles of metaethnography. An overarching synthesis integrated the findings from review 1 and review 2 using a deductive approach. End-user involvement, including topic experts and CYP with LTCs and their parents, was a feature throughout the project. RESULTS Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests that cognitive-behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention-LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies evaluating 21 types of intervention. Most studies were of individuals with cancer, a human immunodeficiency virus (HIV) infection or mixed LTCs. Interventions often aimed to improve broader mental health and well-being, rather than symptoms of mental health disorder. The metaethnography identified five main constructs, described in an explanatory line of argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research. LIMITATIONS Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in review 1, limiting the applicability of findings. The mental health status of participants in review 2 was usually unknown, limiting comparability with review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis. CONCLUSIONS There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high-quality RCTs integrating process evaluations. End-user involvement enriched the project. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Erin Walker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Child Mental Health Group, University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Obi Ukoumunne
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Penny Titman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roz Shafran
- University College London Institute of Child Health, London, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rob Anderson
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Chris Dickens
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Russell Viner
- University College London Institute of Child Health, London, UK
| | - Sophie Bennett
- University College London Institute of Child Health, London, UK
| | - Stuart Logan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Fiona Lockhart
- Biomedical Research Centre Patient & Public Involvement Group, University College London Hospitals, London, UK
| | - Jo Thompson Coon
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
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19
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Price A, Newlove-Delgado T, Eke H, Paul M, Young S, Ford T, Janssens A. In transition with ADHD: the role of information, in facilitating or impeding young people's transition into adult services. BMC Psychiatry 2019; 19:404. [PMID: 31847827 PMCID: PMC6918680 DOI: 10.1186/s12888-019-2284-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many national and regional clinical guidelines emphasise the need for good communication of information to young people and their parent/carers about what to expect during transition into adult services. Recent research indicates only a minority of young people in need of transition for Attention Deficit Hyperactivity Disorder (ADHD) experience continuity of care into adulthood, with additional concerns about quality of transition. This qualitative study explored the role that information plays in experiences of transition from the perspectives of parent/carers and young people. METHODS Participants were recruited from 10 National Health Service Trusts, located across England, with varying service configurations. Ninety two qualitative interviews were conducted: 64 with young people with ADHD at different stages relative to transition, and 28 with parent/carers. Thematic analysis of data was completed using the Framework Method. RESULTS Interviewees reported a range of experiences; however reliance on parent/carers to gather and translate key information, and negative experiences associated with poor communication of information, were universal. Three themes emerged: Navigating information with help from parents; Information on ADHD into adulthood; Information about the transition process. The first revealed the essential role of parent in the translation and application of information, the other two explored distinct types of information necessary for a smooth transition. Interviewees made recommendations for clinical practice similar to UK (United Kingdom) National Institute for Health and Care Excellence (NICE) guidelines, with an additional emphasis on providing nuanced information on ADHD as a potentially long term condition. It was important to interviewees that General Practitioners had a basic understanding of adult ADHD and also had access to information about service provision. CONCLUSIONS Our findings illustrate that the availability and communication of information to young people and their parent/carers is an essential component of the transition process between child and adult ADHD services. How and when it is provided may support or impede transition. This study constitutes a substantial contribution to the evidence base, drawing on interviews from a range of participants across England and from Trusts offering different types of services.
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Affiliation(s)
- Anna Price
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | | | - Helen Eke
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Moli Paul
- Stratford CAMHS, Coventry and Warwickshire Partnership Trust, Stratford Healthcare, Stratford upon Avon, CV37 6NQ UK
- Honorary Associate Clinical Professor of Psychiatry, University of Warwick, Coventry, CV4 7AL UK
| | | | - Tamsin Ford
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Astrid Janssens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
- Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, DK-5000 Odense, Denmark
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20
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Thompson Coon J, Gwernan-Jones R, Garside R, Nunns M, Shaw L, Melendez-Torres GJ, Moore D. Developing methods for the overarching synthesis of quantitative and qualitative evidence: The interweave synthesis approach. Res Synth Methods 2019; 11:507-521. [PMID: 31725951 PMCID: PMC7383598 DOI: 10.1002/jrsm.1383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/30/2019] [Accepted: 10/16/2019] [Indexed: 01/30/2023]
Abstract
The incorporation of evidence derived from multiple research designs into one single synthesis can enhance the utility of systematic reviews making them more worthwhile, useful, and insightful. Methodological guidance for mixed-methods synthesis continues to emerge and evolve but broadly involves a sequential, parallel, or convergent approach according to the degree of independence between individual syntheses before they are combined. We present two case studies in which we used novel and innovative methods to draw together the findings from individual but related quantitative and qualitative syntheses to aid interpretation of the overall evidence base. Our approach moved beyond making a choice between parallel, sequential, or convergent methods to interweave the findings of individual reviews and offers three key innovations to mixed-methods synthesis methods: The use of intersubjective questions to understand the findings of the individual reviews through different lenses, Immersion of key reviewers in the entirety of the evidence base, and Commencing the process during the final stages of the synthesis of individual reviews, at a point where reviewers are developing an understanding of initial findings. Underlying our approach is the process of exploration and identification of links between and across review findings, an approach that is fundamental to all evidence syntheses but usually occurs at the level of the study. Adapting existing methods for exploring and identifying patterns and links between and across studies to interweave the findings between and across reviews may prove valuable.
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Affiliation(s)
- Jo Thompson Coon
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Ruth Gwernan-Jones
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter, United Kingdom
| | - Michael Nunns
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Liz Shaw
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - G J Melendez-Torres
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Darren Moore
- Graduate School of Education, University of Exeter, United Kingdom of Great Britain and Northern Ireland
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Abbott R, Orr N, McGill P, Whear R, Bethel A, Garside R, Stein K, Thompson‐Coon J. How do "robopets" impact the health and well-being of residents in care homes? A systematic review of qualitative and quantitative evidence. Int J Older People Nurs 2019; 14:e12239. [PMID: 31070870 PMCID: PMC6766882 DOI: 10.1111/opn.12239] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Robopets are small animal-like robots which have the appearance and behavioural characteristics of pets. OBJECTIVE To bring together the evidence of the experiences of staff, residents and family members of interacting with robopets and the effects of robopets on the health and well-being of older people living in care homes. DESIGN Systematic review of qualitative and quantitative research. DATA SOURCES We searched 13 electronic databases from inception to July 2018 and undertook forward and backward citation chasing. METHODS Eligible studies reported the views and experiences of robopets from residents, family members and staff (qualitative studies using recognised methods of qualitative data collection and analysis) and the effects of robopets on the health and well-being of care home residents (randomised controlled trials, randomised crossover trials and cluster randomised trials). Study selection was undertaken independently by two reviewers. We used the Wallace criteria and the Cochrane Risk of Bias tool to assess the quality of the evidence. We developed a logic model with stakeholders and used this as a framework to guide data extraction and synthesis. Where appropriate, we used meta-analysis to combine effect estimates from quantitative studies. RESULTS Nineteen studies (10 qualitative, 2 mixed methods and 7 randomised trials) met the inclusion criteria. Interactions with robopets were described as having a positive impact on aspects of well-being including loneliness, depression and quality of life by residents and staff, although there was no corresponding statistically significant evidence from meta-analysis for these outcomes. Meta-analysis showed evidence of a reduction in agitation with the robopet "Paro" compared to control (-0.32 [95% CI -0.61 to -0.04, p = 0.03]). Not everyone had a positive experience of robopets. CONCLUSIONS Engagement with robopets appears to have beneficial effects on the health and well-being of older adults living in care homes, but not all chose to engage. Whether the benefits can be sustained are yet to be investigated. IMPLICATIONS FOR PRACTICE Robopets have the potential to benefit people living in care homes, through increasing engagement and interaction. With the robopet acting as a catalyst, this engagement and interaction may afford comfort and help reduce agitation and loneliness.
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Affiliation(s)
- Rebecca Abbott
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Noreen Orr
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Paige McGill
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Rebecca Whear
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Alison Bethel
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Ruth Garside
- European Centre for Environment and Human HealthUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Ken Stein
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Jo Thompson‐Coon
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
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22
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Russell G, Mandy W, Elliott D, White R, Pittwood T, Ford T. Selection bias on intellectual ability in autism research: a cross-sectional review and meta-analysis. Mol Autism 2019; 10:9. [PMID: 30867896 PMCID: PMC6397505 DOI: 10.1186/s13229-019-0260-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/12/2019] [Indexed: 01/05/2023] Open
Abstract
Background Current global estimates suggest the proportion of the population with autism spectrum disorder (ASD) who have intellectual disability (ID) is approximately 50%. Our objective was to ascertain the existence of selection bias due to under-inclusion of populations with ID across all fields of autism research. A sub-goal was to evaluate inconsistencies in reporting of findings. Methods This review covers all original research published in 2016 in autism-specific journals with an impact factor greater than 3. Across 301 included studies, 100,245 participants had ASD. A random effects meta-analysis was used to estimate the proportion of participants without ID. Selection bias was defined as where more than 75% of participants did not have ID. Results Meta-analysis estimated 94% of all participants identified as being on the autism spectrum in the studies reviewed did not have ID (95% CI 0.91–0.97). Eight out of ten studies demonstrated selection bias against participants with ID. The reporting of participant characteristics was generally poor: information about participants’ intellectual ability was absent in 38% of studies (n = 114). Where there was selection bias on ID, only 31% of studies mentioned lack of generalisability as a limitation. Conclusions We found selection bias against ID throughout all fields of autism research. We recommend transparent reporting about ID and strategies for inclusion for this much marginalised group. Electronic supplementary material The online version of this article (10.1186/s13229-019-0260-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ginny Russell
- 1College House, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
| | - William Mandy
- 2UCL Research Department of Clinical, Educational and Health Psychology, Gower Street, London, WC1E 6BT UK
| | - Daisy Elliott
- 3College of Social Science and International Studies, Byrne House, University of Exeter, Exeter, EX4 4PJ UK
| | - Rhianna White
- 3College of Social Science and International Studies, Byrne House, University of Exeter, Exeter, EX4 4PJ UK
| | - Tom Pittwood
- 4Brain in Hand, Innovations Centre, University of Exeter, Exeter, EX4 4QJ UK
| | - Tamsin Ford
- 1College House, University of Exeter Medical School, University of Exeter, Exeter, EX1 2LU UK
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23
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Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, Cormand B, Faraone SV, Ginsberg Y, Haavik J, Kuntsi J, Larsson H, Lesch KP, Ramos-Quiroga JA, Réthelyi JM, Ribases M, Reif A. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol 2018; 28:1059-1088. [PMID: 30195575 PMCID: PMC6379245 DOI: 10.1016/j.euroneuro.2018.08.001] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 06/25/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.
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Affiliation(s)
- Barbara Franke
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Giorgia Michelini
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Philip Asherson
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andrea Bilbow
- Attention Deficit Disorder Information and Support Service (ADDISS), Edgware, UK; ADHD-Europe, Brussels, Belgium
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
| | - Bru Cormand
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, Universitat de Barcelona, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York Upstate Medical University, New York, USA; K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Ylva Ginsberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Jan Haavik
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jonna Kuntsi
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Center of Mental Health, University of Würzburg, Würzburg, Germany; Laboratory of Psychiatric Neurobiology, Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - János M Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE NAP-B Molecular Psychiatry Research Group, Hungarian Academy of Sciences, Budapest, Hungary
| | - Marta Ribases
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
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Yan L, Zhang J, Yuan Y, Cortese S. Effects of neurofeedback versus methylphenidate for the treatment of attention-deficit/hyperactivity disorder protocol for a systematic review and meta-analysis of head-to-head trials. Medicine (Baltimore) 2018; 97:e12623. [PMID: 30278582 PMCID: PMC6181550 DOI: 10.1097/md.0000000000012623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is developmental disorder characterized by inattention and/or hyperactivity/impulsivity. Psychostimulants, including methylphenidate (MPH), are recommended as a first-line pharmacological intervention, whereas neurofeedback (NF) has been proposed as a nonpharmacological option. The comparative effects of MPH and NF need further exploration. We will conduct a systematic review and meta-analysis of head-to-head randomized controlled trials (RCTs) comparing the efficacy and/or tolerability of MPH and NF in children/adolescents and adults with ADHD. METHOD AND ANALYSIS We will include published as well as unpublished data. Two investigators will independently search PubMed, OVID, ERIC, Web of Science, ClinialTrials.gov, and a set of Chinese databases, including CNKI, CQVIP, and WanFang for head-to-head RCTs comparing MPH and NF. Experts will be contacted for unpublished data. The primary outcome will be the efficacy on ADHD core symptoms, measured by the change in the severity of ADHD symptoms, from baseline to endpoint and, if available, at follow-up (at any available time point). Secondary outcomes will be: dropouts for any reasons; efficacy on neuropsychological measures (working memory, inattention, and inhibition). We will conduct subgroup analyses to assess the impact of the following variables: age; type of NF; language of publication; comorbidities. Additionally, we will carry out meta-regression analyses to investigate the effect of sponsorship, year of publication, duration of intervention, and age of participants. Sensitivity analyses will be conducted to test the robustness of the findings. Risk of bias of individual studies will be assessed using the Cochrane risk of bias tool. Analyses will be performed using Comprehensive Meta-Analysis Software. ETHICS AND DISSEMINATION No ethical issues are foreseen. Results from this study will be published in a peer-reviewed journal and presented at relevant national and international conferences. TRIALS REGISTRATION NUMBER PROSPERO CRD42018090256.
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Affiliation(s)
- Lixia Yan
- School of Education, Soochow University, Soochow
- School of Education, Jiangsu Key Laboratory for Big Data of Psychology and Cognitive Science, Yancheng Teachers University
| | - Junhua Zhang
- School of Education, Jiangsu Key Laboratory for Big Data of Psychology and Cognitive Science, Yancheng Teachers University
| | - Yang Yuan
- Department of Paediatrics, Yancheng traditional Chinese medicine hospital, Yancheng, China
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton
- Solent NHS Trust, Southampton, UK
- New York University Child Study Center, New York, NY
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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Newlove-Delgado T, Ford TJ, Stein K, Garside R. ‘You’re 18 now, goodbye’: the experiences of young people with attention deficit hyperactivity disorder of the transition from child to adult services. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2018. [DOI: 10.1080/13632752.2018.1461476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Tamsin J. Ford
- Child and Adolescent Psychiatry, University of Exeter Medical School, Exeter, UK
| | - Ken Stein
- Public Health, NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- Evidence Synthesis, European Centre for Environment & Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
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Finning K, Harvey K, Moore D, Ford T, Davis B, Waite P. Secondary school educational practitioners’ experiences of school attendance problems and interventions to address them: a qualitative study. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2017. [DOI: 10.1080/13632752.2017.1414442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, The University of Reading Earley Gate, Reading, UK
| | | | - Tamsin Ford
- University of Exeter Medical School, Exeter, UK
| | - Becky Davis
- School of Psychology & Clinical Language Sciences, The University of Reading Earley Gate, Reading, UK
| | - Polly Waite
- School of Psychology & Clinical Language Sciences, The University of Reading Earley Gate, Reading, UK
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Catalá-López F, Hutton B, Núñez-Beltrán A, Page MJ, Ridao M, Macías Saint-Gerons D, Catalá MA, Tabarés-Seisdedos R, Moher D. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS One 2017; 12:e0180355. [PMID: 28700715 PMCID: PMC5507500 DOI: 10.1371/journal.pone.0180355] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders in childhood. A wide variety of treatments have been used for the management of ADHD. We aimed to compare the efficacy and safety of pharmacological, psychological and complementary and alternative medicine interventions for the treatment of ADHD in children and adolescents. METHODS AND FINDINGS We performed a systematic review with network meta-analyses. Randomised controlled trials (≥ 3 weeks follow-up) were identified from published and unpublished sources through searches in PubMed and the Cochrane Library (up to April 7, 2016). Interventions of interest were pharmacological (stimulants, non-stimulants, antidepressants, antipsychotics, and other unlicensed drugs), psychological (behavioural, cognitive training and neurofeedback) and complementary and alternative medicine (dietary therapy, fatty acids, amino acids, minerals, herbal therapy, homeopathy, and physical activity). The primary outcomes were efficacy (treatment response) and acceptability (all-cause discontinuation). Secondary outcomes included discontinuation due to adverse events (tolerability), as well as serious adverse events and specific adverse events. Random-effects Bayesian network meta-analyses were conducted to obtain estimates as odds ratios (ORs) with 95% credibility intervals. We analysed interventions by class and individually. 190 randomised trials (52 different interventions grouped in 32 therapeutic classes) that enrolled 26114 participants with ADHD were included in complex networks. At the class level, behavioural therapy (alone or in combination with stimulants), stimulants, and non-stimulant seemed significantly more efficacious than placebo. Behavioural therapy in combination with stimulants seemed superior to stimulants or non-stimulants. Stimulants seemed superior to behavioural therapy, cognitive training and non-stimulants. Behavioural therapy, stimulants and their combination showed the best profile of acceptability. Stimulants and non-stimulants seemed well tolerated. Among medications, methylphenidate, amphetamine, atomoxetine, guanfacine and clonidine seemed significantly more efficacious than placebo. Methylphenidate and amphetamine seemed more efficacious than atomoxetine and guanfacine. Methylphenidate and clonidine seemed better accepted than placebo and atomoxetine. Most of the efficacious pharmacological treatments were associated with harms (anorexia, weight loss and insomnia), but an increased risk of serious adverse events was not observed. There is lack of evidence for cognitive training, neurofeedback, antidepressants, antipsychotics, dietary therapy, fatty acids, and other complementary and alternative medicine. Overall findings were limited by the clinical and methodological heterogeneity, small sample sizes of trials, short-term follow-up, and the absence of high-quality evidence; consequently, results should be interpreted with caution. CONCLUSIONS Clinical differences may exist between the pharmacological and non-pharmacological treatment used for the management of ADHD. Uncertainties about therapies and the balance between benefits, costs and potential harms should be considered before starting treatment. There is an urgent need for high-quality randomised trials of the multiple treatments for ADHD in children and adolescents. PROSPERO, number CRD42014015008.
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Affiliation(s)
- Ferrán Catalá-López
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
- * E-mail:
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amparo Núñez-Beltrán
- Centro de Atención Integral a Drogodependientes (CAID) Norte, Regional Health Council, Madrid, Spain
| | - Matthew J. Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Manuel Ridao
- Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Zaragoza, Spain
| | - Diego Macías Saint-Gerons
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Madrid, Spain
| | | | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Moore DA, Russell AE, Arnell S, Ford TJ. Educators' experiences of managing students with ADHD: a qualitative study. Child Care Health Dev 2017; 43:489-498. [PMID: 28233330 DOI: 10.1111/cch.12448] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 11/20/2016] [Accepted: 01/08/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND The symptoms of attention-deficit/hyperactivity disorder are associated with difficulty coping with the social, behavioural and academic components of school. Compared with medication and other non-pharmacological treatment, there is less evidence relating to school-based interventions to support children with ADHD. There is additionally an absence of any research focused on the experiences and practices of educators in the UK around how they work with children who are inattentive, impulsive and hyperactive. METHODS Forty-two educational practitioners from primary, secondary and alternate provision schools in the UK participated in focus groups or individual interviews that explored (1) their experiences of managing students with ADHD in the classroom and (2) factors that helped and hindered them in this endeavour. Transcripts were analysed using thematic analysis. RESULTS Analysis identified six themes: broad strategies, student-centred, inclusive strategies, labelling, medication and relationships. Participants' experiences of managing students with ADHD drew upon a wide range of strategies that typically involved responding to individual needs in an inclusive manner, so individuals with ADHD could access the classroom with their peers. Participants spoke about three factors that helped and hindered managing students with ADHD. Labelling of students with ADHD was reported, with the negative aspects of labelling, such as stigmatization, affecting the classroom. Educators reported mixed experiences regarding the helpfulness of medication; where helpful, it allowed the use of strategies in the classroom. Although students with ADHD were described as having rollercoaster relationships, positive relationships were considered key to the support of children with these difficulties. CONCLUSIONS This study suggests that factors such as attitudes towards ADHD, relationships experienced by students with ADHD and other treatments being delivered need to be carefully considered before strategies are put in place in the classroom. This study supports the need for further work on the implementation of evidence-based school interventions for ADHD.
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Affiliation(s)
- D A Moore
- University of Exeter Medical School, Exeter, UK
| | - A E Russell
- University of Exeter Medical School, Exeter, UK
| | - S Arnell
- Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - T J Ford
- University of Exeter Medical School, Exeter, UK
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Coon JT, Gwernan-Jones R, Moore D, Richardson M, Shotton C, Pritchard W, Morris C, Stein K, Ford T. End-user involvement in a systematic review of quantitative and qualitative research of non-pharmacological interventions for attention deficit hyperactivity disorder delivered in school settings: reflections on the impacts and challenges. Health Expect 2016; 19:1084-97. [PMID: 26389784 PMCID: PMC5053289 DOI: 10.1111/hex.12400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The benefits of end-user involvement in health-care research are widely recognized by research agencies. There are few published evaluations of end-user involvement in systematic reviews. OBJECTIVES (i) Describe end-user involvement in a complex mixed-methods systematic review of ADHD in schools, (ii) reflect on the impact of end-user involvement, (iii) highlight challenges and benefits experienced and (iv) provide suggestions to inform future involvement. METHODS End-users were involved in all stages of the project, both as authors and as members of an advisory group. In addition, several events were held with groups of relevant end-users during the project. RESULTS End-user input (i) guided the direction of the research, (ii) contributed to a typology of interventions and outcomes, (iii) contributed to the direction of data analysis and (iv) contributed to the robustness of the syntheses by demonstrating the alignment of interim findings with lived experiences. Challenges included (i) managing expectations, (ii) managing the intensity of emotion, (iii) ensuring that involvement was fruitful for all not just the researcher, (iv) our capacity to communicate and manage the process and (v) engendering a sense of involvement amongst end-users. CONCLUSIONS End-user involvement was an important aspect of this project. To minimize challenges in future projects, a recognition by the project management team and the funding provider that end-user involvement even in evidence synthesis projects is resource intensive is essential to allow appropriate allocation of time and resources for meaningful engagement.
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Affiliation(s)
- Jo Thompson Coon
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK.
| | | | - Darren Moore
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK
| | - Michelle Richardson
- Health Service and Population Research Department, Kings College London, London, UK
| | - Catherine Shotton
- Child Health Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Ken Stein
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK
| | - Tamsin Ford
- Child Health Group, University of Exeter Medical School, University of Exeter, Exeter, UK
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Satapathy S, Choudhary V, Sharma R, Sagar R. Nonpharmacological Interventions for Children with Attention Deficit Hyperactivity Disorder in India: A Comprehensive and Comparative Research Update. Indian J Psychol Med 2016; 38:376-385. [PMID: 27833218 PMCID: PMC5052948 DOI: 10.4103/0253-7176.191382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The nonpharmacological treatments for children with attention deficit hyperactivity disorder (ADHD) have witnessed a sea change from a rudimentary and haphazard psychosocial to cognitive interventions to social and behavioral skills to body oriented interventions to more sophisticated neurocognitive interventions. As the objective of each treatment varied, the method or procedure of each treatment also differed across studies. Indian research although not very rigorous, did witness changes emphasizing on exploring interventions in reducing symptoms and improving overall behavior. The research literature between 2005 and 2015 was searched using PubMed, Google Scholar, IndMED, MedIND, ResearchGate, and other indexed databases. Results of 110 studies were organized into five broad categories of themes of interventions such as psychosocial, body-focused, cognitive/neuro-cognitive, and cognitive behavioral. Effects of ADHD on cognitive, academic, and behavioral outcomes were also highlighted before the themes of intervention to establish linkage with discussion. However, a limited number (n = 9) of reported Indian studies focusing either on the impact of ADHD on the function of children or on interventions were found, suggesting a huge gap between global and Indian research in the area of children with ADHD. It also highlights the need for development and efficacy testing of indigenous intervention program in different areas of intervention for research and clinical practice.
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Affiliation(s)
- Sujata Satapathy
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
| | - Vandana Choudhary
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
| | - Renu Sharma
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, #200, 233-16th Avenue North West, Calgary, Alberta T2M 0H5, Canada.
| | - Kam Lun Hon
- Department of Paediatrics, Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, China
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Beckman L, Janson S, von Kobyletzki L. Associations between neurodevelopmental disorders and factors related to school, health, and social interaction in schoolchildren: Results from a Swedish population-based survey. Disabil Health J 2016; 9:663-72. [PMID: 27343047 DOI: 10.1016/j.dhjo.2016.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/12/2016] [Accepted: 05/03/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Children and adolescents with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) are more likely to be surrounded by different risk factors. In order to work preventively with decreasing ADHD and ASD symptoms, there is a need of more knowledge concerning risk factors. OBJECTIVE This study aimed to investigate school, health, lifestyle and social interactions association with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) among schoolchildren aged 6-17 years. METHODS Data for 18,416 children and adolescents aged 6-17 years in the county of Värmland, Sweden, from the school year 2012/2013 and 2013/2014 were obtained from the Student Health Database, which includes information on health examinations by school nurses and self-reported information of mental and physical health, social relations, physical activity, and school conditions. RESULTS Of all participants, 2.4% reported only ADHD and 1.6% reported only ASD. The results confirmed that ADHD or ASD was significantly associated with worse school experiences, lower socioeconomic status, less physical activity, more substance use, weaker social network and more impairments than those without ADHD or ASD. CONCLUSIONS Knowledge of risk or protective factors during school years is needed to develop interventions to reduce symptoms of neurodevelopmental disorders in children and adolescents.
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Affiliation(s)
- Linda Beckman
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden.
| | - Staffan Janson
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Laura von Kobyletzki
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden; Lund University, Skåne University Hospital, Department of Dermatology, Malmö, Sweden
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Schulte-Körne G. Mental Health Problems in a School Setting in Children and Adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:183-90. [PMID: 27118666 PMCID: PMC4850518 DOI: 10.3238/arztebl.2016.0183] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND 10-20% of children and adolescents have a mental health problem of some type. Manifestations such as attention deficits, cognitive disturbances, lack of motivation, and negative mood all adversely affect scholastic development. It is often unclear what factors associated with school affect children's mental development and what preventive measures and interventions at school might be effective. METHODS This review is based on systematic reviews, meta-analyses, and randomized and non-randomized controlled trials that were retrieved by a selective search in the PubMed, PsycInfo, and Google Scholar databases. RESULTS The prevalence of hyperkinetic disorder is 1-6%. Its main manifestations are motor hyperactivity, an attention deficit, and impulsive behavior. Learning disorders such as dyscalculia and dyslexia affect 4-6% of children each, while 4-5% of children and adolescents suffer from depression, which is twice as prevalent in girls as in boys. Mental health problems increase the risk of repeating a grade, truancy, and dropping out of school. The risk of developing an internalizing or externalizing mental health problem can be lessened by changes in the school environment and by the implementation of evidencebased school programs. CONCLUSION Physicians, in collaboration with school social workers and psychologists, should help teachers recognize and contend with mental health problems among the children and adolescents whom they teach, to enable the timely detection of stress factors at school and the initiation of the necessary measures and aids. In particular, the school-entrance examination and screening for risk factors at school can make a positive contribution. Evidence-based preventive programs should be implemented in schools, and beneficial changes of the school environment should be a further goal.
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Affiliation(s)
- Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität München
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Gwernan-Jones R, Moore DA, Cooper P, Russell AE, Richardson M, Rogers M, Thompson-Coon J, Stein K, Ford TJ, Garside R. A systematic review and synthesis of qualitative research: the influence of school context on symptoms of attention deficit hyperactivity disorder. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2016. [DOI: 10.1080/13632752.2015.1120055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moore DA, Gwernan-Jones R, Richardson M, Racey D, Rogers M, Stein K, Thompson-Coon J, Ford TJ, Garside R. The experiences of and attitudes toward non-pharmacological interventions for attention-deficit/hyperactivity disorder used in school settings: a systematic review and synthesis of qualitative research. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2016. [DOI: 10.1080/13632752.2016.1139296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Russell AE, Moore DA, Ford T. Educational practitioners’ beliefs and conceptualisation about the cause of ADHD: A qualitative study. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2016. [DOI: 10.1080/13632752.2016.1139297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fazel M, Hoagwood K, Stephan S, Ford T. Mental health interventions in schools 1: Mental health interventions in schools in high-income countries. Lancet Psychiatry 2014; 1:377-387. [PMID: 26114092 PMCID: PMC4477835 DOI: 10.1016/s2215-0366(14)70312-8] [Citation(s) in RCA: 253] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Mental health services embedded within school systems can create a continuum of integrative care that improves both mental health and educational attainment for children. To strengthen this continuum, and for optimum child development, a reconfiguration of education and mental health systems to aid implementation of evidence-based practice might be needed. Integrative strategies that combine classroom-level and student-level interventions have much potential. A robust research agenda is needed that focuses on system-level implementation and maintenance of interventions over time. Both ethical and scientific justifications exist for integration of mental health and education: integration democratises access to services and, if coupled with use of evidence-based practices, can promote the healthy development of children.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Kimberly Hoagwood
- Department of Child Psychiatry, New York University Langone Medical Center and School of Medicine, New York, NY, USA
| | - Sharon Stephan
- Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tamsin Ford
- Child and Adolescent Psychiatry, University of Exeter Medical School, Veysey Building, Exeter, Devon, UK
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