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Almai AM, Salpekar JA. Healthcare utilisation in the United Arab Emirates for children with attention-deficit hyperactivity disorder and comorbidities. BJPsych Int 2023; 20:61-63. [PMID: 37531226 PMCID: PMC10387415 DOI: 10.1192/bji.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/23/2023] [Indexed: 08/04/2023] Open
Abstract
The prevalence of attention-deficit hyperactivity disorder is consistent worldwide. Psychiatric comorbidities are common, although less is known about how those comorbidities affect utilisation of healthcare services. Access to paediatric mental healthcare is a challenge in many regions. However, access to care in the United Arab Emirates (UAE) is supported by a well-established healthcare infrastructure with widely available primary care physicians. A review of diagnosis codes suggests that a clear correlation exists between the number of comorbidities and increased utilisation of available mental health services. Infrastructure in the UAE may represent a successful model for paediatric mental healthcare.
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Affiliation(s)
- Ahmad M Almai
- Consultant child and adolescent psychiatrist; Director of Residency Training, Department of Psychiatry, Johns Hopkins Aramco Health Center, Dhahran, Kingdom of Saudi Arabia. Email
| | - Jay A Salpekar
- Director of the Neuropsychiatry Center, Kennedy Krieger Institute, Baltimore, Maryland, USA; Associate Professor of Psychiatry and Neurology, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Bitsko RH, Holbrook JR, Fisher PW, Lipton C, van Wijngaarden E, Augustine EF, Mink JW, Vierhile A, Piacentini J, Walkup J, Firchow B, Ali AR, Badgley A, Adams HR. Validation of the Diagnostic Interview Schedule for Children (DISC-5) Tic Disorder and Attention-Deficit/Hyperactivity Disorder Modules. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:231-244. [PMID: 38883232 PMCID: PMC11177540 DOI: 10.1080/23794925.2023.2191352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Effective methods to assess mental disorders in children are necessary for accurate prevalence estimates and to monitor prevalence over time. This study assessed updates of the tic disorder and attention-deficit/hyperactivity disorder (ADHD) modules of the Diagnostic Interview Schedule for Children, Version 5 (DISC-5) that reflect changes in diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (Fifth edition, DSM-5). The DISC-5 tic disorder and ADHD parent- and child-report modules were compared to expert clinical assessment for 100 children aged 6-17 years (40 with tic disorder alone, 17 with tic disorder and ADHD, 9 with ADHD alone, and 34 with neither) for validation. For the tic disorder module, parent-report had high (>90%) sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, while the youth-report had high specificity and PPV, moderate accuracy (81.4%), and lower sensitivity (69.8%) and NPV (67.3%). The ADHD module performed less well: parent-report had high NPV (91.4%), moderate sensitivity (80.8%), and lower specificity (71.6%), PPV (50.0%), and accuracy (74.0%); youth-report had moderate specificity (82.8%) and NPV (88.3%), and lower sensitivity (65.0%), PPV (54.2%), and accuracy (78.6%). Adding teacher-report of ADHD symptoms to DISC-5 parent-report of ADHD increased sensitivity (94.7%) and NPV (97.1%), but decreased specificity (64.2%), PPV (48.7%), and accuracy (72.2%). These findings support using the parent-report tic disorder module alone or in combination with the child report module in future research and epidemiologic studies; additional validation studies are warranted for the ADHD module.
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Affiliation(s)
- Rebecca H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Prudence W Fisher
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute - Columbia University - Vagelos College of Physicians and Surgeons, New York, NY
| | - Corey Lipton
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center (URMC), Rochester, NY
| | - Erika F Augustine
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD; Adjunct Associate Professor, Department of Neurology, URMC, Rochester, NY
| | - Jonathan W Mink
- Departments of Neurology, Neuroscience, and Pediatrics, University of Rochester, Rochester, NY
| | - Amy Vierhile
- Departments of Neurology, Neuroscience, and Pediatrics, University of Rochester, Rochester, NY
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - John Walkup
- Pritzker Department of Psychiatry and Behavioral Health, Lurie Children's Hospital & Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley Firchow
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Akilah R Ali
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allison Badgley
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Heather R Adams
- Departments of Neurology, Neuroscience, and Pediatrics, University of Rochester, Rochester, NY
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Tzang RF, Chang YC. Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy. World J Psychiatry 2022; 12:787-800. [PMID: 35978969 PMCID: PMC9258275 DOI: 10.5498/wjp.v12.i6.787] [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: 08/20/2021] [Revised: 10/15/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder (ADHD) is reported to be poor, possibly due to heterogeneity of ADHD symptoms. Little is known about poor treatment efficacy owing to ADHD heterogeneity.
AIM To use generalized structural equation modeling (GSEM) to show how the heterogeneous nature of hyperactivity/impulsivity (H/I) symptoms in ADHD, irritable oppositional defiant disorder (ODD), and the presentation of aggression in children interferes with treatment responses in ADHD.
METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests. ODD scores from the Swanson, Nolan, and Pelham, version IV scale were obtained. The child behavior checklist (CBCL) and parent’s satisfaction questionnaire were completed. The relationships were analyzed by GSEM.
RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD, ODD symptoms, and childhood aggressive behavior. ODD directly mediated ADHD symptom severity. The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494% [= exp (2.602)] in children with comorbid ADHD and ODD [odds ratio (OR) = 2.602, 95% confidence interval (CI): 1.832-3.373, P = 0.000] after adjusting for the effects of other factors. Childhood aggression mediated ODD symptom severity. The chance of reaching remission based on ODD symptoms was lowered by 11.000% [= 1 - exp (-0.117)] in children with more severe baseline symptoms of aggression based on the CBCL score at study entry [OR = -0.117, 95%CI: (-0.190)-(-0.044), P = 0.002].
CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity. More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment, e.g., symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.
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Affiliation(s)
- Ruu-Fen Tzang
- Department of Child and Adolescent Psychiatry, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Childhood Care and Education, Mackay Junior College of Medicine, Nursing, and Management, New Taipei City 112, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 251, Taiwan
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Lukomski M, Caruso D, Thompson K, Di Natale M. A program to improve the assessment of a child for attention deficit hyperactivity disorder. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 35:164-170. [PMID: 34796571 DOI: 10.1111/jcap.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022]
Abstract
PROBLEM Due to the number of children diagnosed with attention deficit hyperactivity disorder (ADHD), increased risk of these children having comorbidities and/or an adverse childhood experience and insufficient documentation of the Diagnostic and Statistical manual of Mental Disorders, fifth edition (DSM-5) criteria for an ADHD diagnosis, an ADHD evaluation program was developed for a child presenting for an initial ADHD evaluation. METHODS A quantitative design method evaluated provider's documentation by the percentage of DSM-5 criteria met before and after the implementation of the ADHD program. Descriptive statistics evaluated the system change by the percentage of providers who utilized the ADHD template and the use of the unspecified ADHD International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10) code, F90.9 by the percentage of code use before and after implementation of the ADHD program. FINDINGS The two-tailed Mann-Whitney U test was significantly based on p < 0.001. Providers met 100% of the DSM-5 criteria after implementation of the ADHD program in the electronic health record, compared to 50% before implementation. CONCLUSIONS The ADHD program increased the provider's documentation and consistency to the DSM-5 criteria, decreasing the use of the unspecified ADHD ICD-10 code, allowing the provider to develop a more successful plan of care for children between the ages of 5 and 18.
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Affiliation(s)
| | - Diane Caruso
- Lenoir-Rhyne University, Hickory, North Carolina, USA
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Morgan TC, O'Keefe LC. Does a Behavioral Parent Training Program for Parents of ADHD Children Improve Outcomes? A Pilot Project. Compr Child Adolesc Nurs 2021; 45:1-11. [PMID: 34130566 DOI: 10.1080/24694193.2021.1933263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is the most common chronic neurobehavioral disorder of childhood. Research suggests increased parent-child conflict exists in families with an ADHD child. The evidence indicates links between child behavior problems and parenting practices. Behavioral Parent Training (BPT) is an evidence-based intervention recommended for the treatment of ADHD. BPT is recommended as first-line treatment in ADHD children under age six and as a combination treatment approach for children older than the age six. BPT programs have demonstrated significant improvement in frequency of the problem behaviors of inattention, hyperactivity, and impulsivity associated with ADHD. Pre- and Post-BPT Parenting Scales and Vanderbilt ADHD Diagnostic Rating Scales for Parents and Teachers were used to evaluate the efficacy of the BPT program. Percent changes for each participant pre- and post-BPT were calculated. The Parenting Scale overall score and overreactivity factor score showed significant improvement post-BPT (p = .05). Participation in a BPT program can affect parenting practices and improve outcomes for ADHD children. BPT programs are effective in reducing negative parenting practices and improving outcomes for this population.
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Affiliation(s)
- Tracie Clark Morgan
- The College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama, USA
| | - Louise C O'Keefe
- The College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama, USA
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