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Elzohairy NW, Elzlbany GAM, Khamis BI, El-Monshed AH, Atta MHR. Mindfulness-based training effect on attention, impulsivity, and emotional regulation among children with ADHD: The role of family engagement in randomized controlled trials. Arch Psychiatr Nurs 2024; 53:204-214. [PMID: 39615936 DOI: 10.1016/j.apnu.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/21/2024] [Accepted: 10/03/2024] [Indexed: 12/19/2024]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is among the most common psychiatric conditions affecting school-aged children, marked by diverse levels of inattention, hyperactivity, and impulsivity. Mindfulness-based training intervention throughout childhood enhances those symptoms, improving emotional regulation and well-being, hence improving their quality of life. AIM To investigate the effects of mindfulness-based training on attention, impulsivity, and emotional regulation among children diagnosed with ADHD. DESIGN A randomized controlled trial (RCT) was used to carry out this study. SETTING This study was conducted at the outpatient Medical National Institute in Damanhur. The subjects were 60 children and their parents for the control and study groups (30 in each group). TOOLS Researchers used three tools to collect the necessary data: Tool I, A Socio-demographic and Academic Data Questionnaire; Tool II, the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); and Tool III, The Emotion Regulation Questionnaire. RESULTS The difference in the level of attention, impulsivity, and emotional regulation between the study and control groups after the mindfulness-based training intervention was statistically significant. CONCLUSION Mindfulness-based interventions are effective in improving inattention, impulsivity, and emotional regulation among children with ADHD and increasing their performance in all activities. RECOMMENDATIONS Health care professionals should consider incorporating mindfulness-based techniques into standard treatment protocols for children with ADHD. Families should be educated about the benefits of mindfulness as family involvement appears to strengthen the effectiveness of these interventions. These programs should be accessible in schools, community centers, and therapeutic settings to guarantee general distribution. RCT: NCT06131190, Date: 11-9-2023.
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Affiliation(s)
- Nadia Waheed Elzohairy
- Lecturer, Psychiatric Nursing and Mental Health, Damanhur University, Damanhur City, Egypt.
| | | | - Basma Ibrahim Khamis
- Lecturer of Pediatric Nursing Department, Faculty of Nursing, Damanhur University, Egypt.
| | - Ahmed Hashem El-Monshed
- Department of Nursing, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain; Department of Psychiatric and Mental Health Nursing, Faculty of Nursing-Mansoura University, Egypt.
| | - Mohamed Hussein Ramadan Atta
- Assistant Professor, Nursing Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Wadi Addawasir, Saudi Arabia; Lecturer of Psychiatric and mental health Nursing, Psychiatric and mental- health nursing Department, Faculty of Nursing, Alexandria University, Alexandria City, Egypt.
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Abd Elhamid SA, Abdelaziz EA, Youssef AM, Mahmoud MAZ, Abdel Raouf BM. Assessment of Psychological Impact among Hospitalized Children; Single Centre Study. INTERNATIONAL JOURNAL OF CHILD HEALTH AND NUTRITION 2024; 13:272-285. [DOI: 10.6000/1929-4247.2024.13.04.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Background: The goal of the contemporary hospital setting is to give patients suffering from a range of diseases a secure and therapeutic space. Aim: Psychosocial and mental health assessment among hospitalized children between 7 to 12 years of age.
Methods: This Cross-Sectional Study was carried out at the Children's Hospital Faculty of Medicine for 1-year duration.
Results: Higher statistically significant positive results were found in cases than in control regarding all Vanderbilt subscales except in the conduct subscale. Higher results were found in chronic cases than control in all subscales except for oppositional defiant disorder results.
Conclusion: Hospitalized Children, due to chronic or acute conditions, are at a higher risk for Psychosocial and mental health disorders such as depression, anxiety, ADHD, PTSD, and pain in comparison with healthy children.
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He L, Zhao Y, Gong JX, Zhao L, Ma ZR, Xiong QW, Cai SZ, Yan XM. Contrasting presentations of children with ADHD and subthreshold ADHD. Pediatr Res 2024:10.1038/s41390-024-03502-y. [PMID: 39179877 DOI: 10.1038/s41390-024-03502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND We aimed to explore the differences and relationships in body composition, social function, and comorbidities between children with attention-deficit/hyperactivity disorder (ADHD) and subthreshold ADHD. METHODS A case-control study was conducted to analyze the differences between children with ADHD and subthreshold ADHD. Logistic regression models were used to analyze the factors influencing social functional impairments and comorbidities. RESULTS Children with ADHD and subthreshold ADHD had a higher fat mass index than healthy children (p < 0.05). The scores of all six social functional domains were higher in the subthreshold ADHD and ADHD groups than in the control group (p < 0.05). The prevalence of comorbidity was higher in children with subthreshold ADHD and ADHD compared to the control group (p < 0.05). Inattention and comorbid anxiety/depression increased the risk of functional impairments in children with ADHD (full syndrome/subthreshold), whereas a higher fat-free mass index reduced the risk. The severity of hyperactivity was associated with a higher risk of comorbidity in children with ADHD (full syndrome/subthreshold). CONCLUSION Children with subthreshold ADHD and ADHD had more fat mass and higher rates of social functional impairments and comorbidities than healthy children. There were clinical correlations between body composition, social functional impairments, and comorbidities in ADHD. IMPACT 1. Children with subthreshold ADHD and ADHD had higher fat mass levels than normal children. 2. The social function impairments and comorbidities of children with subthreshold ADHD were similar to those with ADHD. 3. Inattentiveness and anxiety/depression increased the risk of functional impairments in children with ADHD (full syndrome/subthreshold), while a higher fat-free mass index and skeletal muscle-to-body fat ratio reduced the risk.
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Affiliation(s)
- Lu He
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Yan Zhao
- Department of Pediatrics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jin-Xin Gong
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Lu Zhao
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Zhou-Rui Ma
- Department of Surgery, Children's Hospital of Soochow University, Suzhou, China
- Suzhou Key Laboratory of Children's Structural Deformities, Suzhou, China
| | - Qian-Wei Xiong
- Suzhou Key Laboratory of Children's Structural Deformities, Suzhou, China
- Department of Urology, Children's Hospital of Soochow University, Suzhou, China
| | - Shi-Zhong Cai
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China.
- Suzhou Key Laboratory of Children's Structural Deformities, Suzhou, China.
| | - Xiang-Ming Yan
- Suzhou Key Laboratory of Children's Structural Deformities, Suzhou, China.
- Department of Urology, Children's Hospital of Soochow University, Suzhou, China.
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Hoy BA, Bi M, Lam M, Krishnasamy G, Abdalmalak A, Fenesi B. Hyperactivity in ADHD: Friend or Foe? Brain Sci 2024; 14:719. [PMID: 39061459 PMCID: PMC11274564 DOI: 10.3390/brainsci14070719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Hyperactivity may play a functional role in upregulating prefrontal cortical hypoarousal and executive functioning in ADHD. This study investigated the neurocognitive impact of movement during executive functioning on children with ADHD. METHODS Twenty-four children with and without ADHD completed a Stroop task and self-efficacy ratings while remaining stationary (Stationary condition) and while desk cycling (Movement condition). Simultaneous functional near-infrared spectroscopy (fNIRS) recorded oxygenated and deoxygenated changes in hemoglobin within the left dorsolateral prefrontal cortex (DLPFC). RESULTS Among children with ADHD, the Movement condition produced superior Stroop reaction time compared to the Stationary condition (p = 0.046, d = 1.00). Self-efficacy improved in the Movement condition (p = 0.033, d = 0.41), whereas it did not in the Stationary condition (p = 0.323). Seventy-eight percent of participants showed greater oxygenation in the left DLPFC during the Movement condition vs. the Stationary condition. Among children without ADHD, there were no differences in Stroop or self-efficacy outcomes between Stationary and Movement conditions (ps > 0.085, ts < 1.45); 60% of participants showed greater oxygenation in the left DLPFC during the Movement vs. the Stationary condition. CONCLUSIONS This work provides supportive evidence that hyperactivity in ADHD may be a compensatory mechanism to upregulate PFC hypoarousal to support executive functioning and self-efficacy.
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Affiliation(s)
- Beverly-Ann Hoy
- Faculty of Education, Western University, London, ON N6G 1G7, Canada; (B.-A.H.); (M.B.); (M.L.); (G.K.)
| | - Michelle Bi
- Faculty of Education, Western University, London, ON N6G 1G7, Canada; (B.-A.H.); (M.B.); (M.L.); (G.K.)
| | - Matthew Lam
- Faculty of Education, Western University, London, ON N6G 1G7, Canada; (B.-A.H.); (M.B.); (M.L.); (G.K.)
| | - Gayuni Krishnasamy
- Faculty of Education, Western University, London, ON N6G 1G7, Canada; (B.-A.H.); (M.B.); (M.L.); (G.K.)
| | - Androu Abdalmalak
- Department of Physiology and Pharmacology, Western University, London, ON N6A 5C1, Canada;
| | - Barbara Fenesi
- Faculty of Education, Western University, London, ON N6G 1G7, Canada; (B.-A.H.); (M.B.); (M.L.); (G.K.)
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Subara-Zukic E, McGuckian TB, Cole MH, Steenbergen B, Wilson PH. Locomotor-cognitive dual-tasking in children with developmental coordination disorder. Front Psychol 2024; 15:1279427. [PMID: 38510308 PMCID: PMC10951910 DOI: 10.3389/fpsyg.2024.1279427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Children with Developmental Coordination Disorder (DCD) demonstrate deficits in predictive motor control and aspects of cognitive control compared with their typically developing (TD) peers. Adjustment to dynamic environments depends on both aspects of control and the deficits for children with DCD may constrain their ability to perform daily actions that involve dual-tasking. Under the assumption that motor-cognitive integration is compromised in children with DCD, we examined proportional dual-task costs using a novel locomotor-cognitive dual-task paradigm that enlisted augmented reality. We expect proportional dual-task performance costs to be greater for children with DCD compared to their TD peers. Methods Participants were 34 children aged 6-12 years (16 TD, 18 DCD) who walked along a straight 12 m path under single- and dual-task conditions, the cognitive task being visual discrimination under simple or complex stimulus conditions presented via augmented reality. Dual-task performance was measured in two ways: first, proportional dual-task costs (pDTC) were computed for cognitive and gait outcomes and, second, within-trial costs (p-WTC) were measured as the difference on gait outcomes between pre- and post-stimulus presentation. Results On measures of pDTC, TD children increased their double-limb support time when walking in response to a dual-task, while the children with DCD increased their locomotor velocity. On p-WTC, both groups increased their gait variability (step length and step width) when walking in response to a dual-task, of which the TD group had a larger proportional change than the DCD group. Greater pDTCs on motor rather than cognitive outcomes were consistent across groups and method of dual-task performance measurement. Discussion Contrary to predictions, our results failed to support dramatic differences in locomotor-cognitive dual-task performance between children with DCD and TD, with both groups tending to priorities the cognitive over the motor task. Inclusion of a within-trial calculation of dual-task interference revealed an expectancy effect for both groups in relation to an impending visual stimulus. It is recommended that dual-task paradigms in the future continue to use augmented reality to present the cognitive task and consider motor tasks of sufficient complexity to probe the limits of performance in children with DCD.
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Affiliation(s)
- Emily Subara-Zukic
- Healthy Brain and Mind Research Center, School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Thomas B. McGuckian
- Healthy Brain and Mind Research Center, School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Michael H. Cole
- Healthy Brain and Mind Research Center, School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Bert Steenbergen
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Peter Henry Wilson
- Healthy Brain and Mind Research Center, School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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Rosenthal SL, Simpson TS, Kirkwood M, Peterson RL. Quality of Life in Youth Soccer Players After Mild Traumatic Brain Injury. J Athl Train 2024; 59:130-136. [PMID: 37459368 PMCID: PMC10895396 DOI: 10.4085/1062-6050-0011.23] [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] [Indexed: 02/13/2024]
Abstract
CONTEXT Pediatric mild traumatic brain injuries (mTBIs) represent an evolving field of interest in youth athletics. Although most players recover within 4 weeks, some have symptoms that last longer. Little is known about youth health-related quality of life (HRQoL) after mTBI. OBJECTIVES To characterize youth HRQoL after soccer-related mTBI and to identify predictors of individual differences in HRQoL recovery. DESIGN Prospective cohort study. SETTING Youth soccer. PARTICIPANTS Soccer players, aged 8 to 17 years, who sustained an mTBI (n = 23) or orthopaedic injury (OI, n = 24) or remained uninjured (n = 23) during a single season. MAIN OUTCOME MEASURE(S) We assessed HRQoL via the Pediatric Quality of Life Inventory, version 4.0, and postconcussive symptoms via the Health and Behavior Index. Serial assessments occurred at 24 to 48 hours, 7 days, 30 days, and 90 days postinjury via telephone interview. RESULTS At 7 days postinjury, the mTBI and OI groups had poorer total HRQoL (F2,67 = 11.35, P < .001) than the uninjured control group. At 7 days, the mTBI group had the poorest psychosocial HRQoL, whereas the OI group had the poorest physical HRQoL. Differences between the mTBI and uninjured control groups resolved by 30 days. Within the mTBI group, players with significant postconcussive symptoms at 7 days had poorer total (F1,21 = 23.071, P ≤ .001; F1,21 = 5.798, P = .028), psychosocial (F1,21 = 16.488, P = < .001; F1,21 = 5.050, P = .039), and physical (F1,21 = 21.671, P = < .001; F1,21 = 5.119, P = .038) HRQoL at 7 and 30 days, respectively, than players with minimal symptoms; these differences resolved by 90 days. CONCLUSIONS As a group, youth soccer players who sustained mTBI had transient impairments in HRQoL that resolved by 30 days. A subset of players with significant postconcussive symptoms at 7 days postinjury had poorer HRQoL for at least 30 days postinjury than those whose postconcussive symptoms had resolved within a week of injury. This suggests ongoing recovery in this subset at 30 days and the potential utility of HRQoL as a measure of recovery.
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Affiliation(s)
| | - Tess S. Simpson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Michael Kirkwood
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
| | - Robin L. Peterson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora
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Chatpreecha P, Usanavasin S. Design of a Collaborative Knowledge Framework for Personalised Attention Deficit Hyperactivity Disorder (ADHD) Treatments. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1288. [PMID: 37628287 PMCID: PMC10453366 DOI: 10.3390/children10081288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/27/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. From the data collected by the Ministry of Public Health, Thailand, it has been reported that more than one million Thai youths (6-12 years) have been diagnosed with ADHD (2012-2018) This disorder is more likely to occur in males (12%) than females (4.2%). If ADHD goes untreated, there might be problems for individuals in the long run. This research aims to design a collaborative knowledge framework for personalised ADHD treatment recommendations. The first objective is to design a framework and develop a screening tool for doctors, parents, and teachers for observing and recording behavioural symptoms in ADHD children. This screening tool is a combination of doctor-verified criteria and the ADHD standardised screening tool (Vanderbilt). The second objective is to introduce practical algorithms for classifying ADHD types and recommending appropriate individual behavioural therapies and activities. We applied and compared four well-known machine-learning methods for classifying ADHD types. The four algorithms include Decision Tree, Naïve Bayes, neural network, and k-nearest neighbour. Based on this experiment, the Decision Tree algorithm yielded the highest average accuracy, which was 99.60%, with F1 scores equal to or greater than 97% for classifying each type of ADHD.
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Affiliation(s)
| | - Sasiporn Usanavasin
- School of Information, Computer and Communication Technology, Sirindhorn International Institute of Technology, Thammasat University, Pathum Thani 12000, Thailand;
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Zhou Q, Ye X, Wei C, Wu Y, Ren P, Lin X, Li L, Xiang W, Xiao L. Network Analysis of ADHD Symptoms and Cognitive Profiles in Children. Neuropsychiatr Dis Treat 2023; 19:1207-1219. [PMID: 37223654 PMCID: PMC10202214 DOI: 10.2147/ndt.s409503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Although many studies have reported the cognitive profiles in attention-deficit/hyperactivity disorder (ADHD), the interactions between ADHD symptoms and the patients' cognitive profiles have not been carefully examined through the network analysis. Here, in this study, we systematically analyzed the ADHD patents' symptoms and cognitive profiles, and identified a set of interactions between ADHD symptoms and cognitive domains using the network approach. Patients and Methods A total of 146 children with ADHD, 6 to 15 years of age, were included in the study. All participants were assessed by the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) test. The patients' ADHD symptoms were evaluated by the Vanderbilt ADHD parent and teacher rating scales. GraphPad Prism 9.1.1 software was used for descriptive statistics and R 4.2.2 was used for network model construction. Results The ADHD children in our sample showed lower scores for full scale intelligence quotient (FSIQ), verbal comprehension index (VCI), processing speed index (PSI) and working memory index (WMI). Among all the ADHD core symptoms and comorbid symptoms, the academic ability, inattention symptoms and mood disorder showed direct interaction with the cognitive domains of WISC-IV. In addition, oppositional defiant of the ADHD comorbid symptoms, and perceptual reasoning of the cognitive domains exhibited the highest strength centrality in the ADHD-Cognition network based on parent ratings. Classroom behaviors of the ADHD functional impairment, and verbal comprehension of the cognitive domains exhibited the highest strength centrality in the network based on teacher ratings. Conclusion We highlighted the importance of considering the interactions between the ADHD symptoms and cognitive properties when designing the intervention plans for the ADHD children.
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Affiliation(s)
- Qionglin Zhou
- Hainan Medical University, Haikou, People’s Republic of China
| | - Xiaoshan Ye
- Hainan Medical University, Haikou, People’s Republic of China
| | - Chongxia Wei
- Hainan Women and Children’s Medical Center, Haikou, People’s Republic of China
| | - Yufan Wu
- Hainan Medical University, Haikou, People’s Republic of China
| | - Pengcheng Ren
- Hainan Medical University, Haikou, People’s Republic of China
| | - Xuewei Lin
- Hainan Women and Children’s Medical Center, Haikou, People’s Republic of China
| | - Ling Li
- Hainan Women and Children’s Medical Center, Haikou, People’s Republic of China
| | - Wei Xiang
- Hainan Medical University, Haikou, People’s Republic of China
- Hainan Women and Children’s Medical Center, Haikou, People’s Republic of China
| | - Le Xiao
- Hainan Medical University, Haikou, People’s Republic of China
- Hainan Women and Children’s Medical Center, Haikou, People’s Republic of China
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Carrick A, Hamilton CJ. Heated Behaviour in the Classroom for Children with FASD: The Relationship between Characteristics Associated with ADHD, ODD and ASD, Hot Executive Function and Classroom Based Reward Systems. CHILDREN 2023; 10:children10040685. [PMID: 37189934 DOI: 10.3390/children10040685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
Possession of characteristics related to Attention Deficit Hyperactive Disorder, Oppositional Defiance Disorder, and Autism Spectrum Disorder in children prenatally exposed to alcohol contributes to challenges within the diagnostic pathway for Foetal Alcohol Spectrum Disorder (FASD). The presentation of these characteristics, though problematic for the children affected, may not result in referral for diagnosis; focusing on diagnostic thresholds masks the dimensional nature of these characteristics. Children with traits which are undiagnosed may not receive effective support and are often identified as exhibiting challenging behaviour. In the UK, children with undiagnosed Special Educational Needs (SEN) are more likely to experience school exclusion. Common across each condition are challenges to executive function associated with emotional regulation (hot-executive function). This study explored the relationship between characteristics of Attention Deficit Hyperactive Disorder, Oppositional Defiance Disorder, Autistic-Like Traits, and hot executive functions on the helpfulness of reward-based interventions for children with suspected or diagnosed FASD. Data were collected online using caregiver referral questionnaire screeners for each measure (Child Autism Quotient Questionnaire, Vanderbilt ADHD Parental Rating Scale and The Childhood Executive Functioning Inventory) for children aged 6–12 years with suspected or diagnosed FASD (n = 121). Between-group comparisons showed no significant difference in the reporting of Attention Deficit Hyperactive Disorder characteristics, Oppositional Defiance Disorder characteristics, Autistic-Like Traits, and executive function, regardless of diagnostic state. Multiple regression analyses indicated that these personality characteristics and executive functions were associated with the perception of the reward system helpfulness. However, this pattern was qualified by both the type of hot executive function challenged (significant for Regulation not Inhibition) and whether the child had an FASD diagnosis. Thus, a dimensional approach may strengthen our understanding of the child’s classroom experience and help overcome barriers to effective intervention and support.
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Affiliation(s)
- Andrea Carrick
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Colin J. Hamilton
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
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Feldman SJ, Beslow LA, Felling RJ, Malone LA, Waak M, Fraser S, Bakeer N, Lee JEM, Sherman V, Howard MM, Cavanaugh BA, Westmacott R, Jordan LC. Consensus-Based Evaluation of Outcome Measures in Pediatric Stroke Care: A Toolkit. Pediatr Neurol 2023; 141:118-132. [PMID: 36812698 PMCID: PMC10042484 DOI: 10.1016/j.pediatrneurol.2023.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Following a pediatric stroke, outcome measures selected for monitoring functional recovery and development vary widely. We sought to develop a toolkit of outcome measures that are currently available to clinicians, possess strong psychometric properties, and are feasible for use within clinical settings. A multidisciplinary group of clinicians and scientists from the International Pediatric Stroke Organization comprehensively reviewed the quality of measures in multiple domains described in pediatric stroke populations including global performance, motor and cognitive function, language, quality of life, and behavior and adaptive functioning. The quality of each measure was evaluated using guidelines focused on responsiveness and sensitivity, reliability, validity, feasibility, and predictive utility. A total of 48 outcome measures were included and were rated by experts based on the available evidence within the literature supporting the strengths of their psychometric properties and practical use. Only three measures were found to be validated for use in pediatric stroke: the Pediatric Stroke Outcome Measure, the Pediatric Stroke Recurrence and Recovery Questionnaire, and the Pediatric Stroke Quality of Life Measure. However, multiple additional measures were deemed to have good psychometric properties and acceptable utility for assessing pediatric stroke outcomes. Strengths and weaknesses of commonly used measures including feasibility are highlighted to guide evidence-based and practicable outcome measure selection. Improving the coherence of outcome assessment will facilitate comparison of studies and enhance research and clinical care in children with stroke. Further work is urgently needed to close the gap and validate measures across all clinically significant domains in the pediatric stroke population.
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Affiliation(s)
- Samantha J Feldman
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Malone
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, Maryland
| | - Michaela Waak
- Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Queensland, Australia; Pediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia
| | - Stuart Fraser
- Division of Vascular Neurology, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas
| | - Nihal Bakeer
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - Jo Ellen M Lee
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Melissa M Howard
- Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Beth Anne Cavanaugh
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
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Putnick DL, Bell EM, Ghassabian A, Polinski KJ, Robinson SL, Sundaram R, Yeung E. Associations of toddler mechanical/distress feeding problems with psychopathology symptoms five years later. J Child Psychol Psychiatry 2022; 63:1261-1269. [PMID: 35048380 PMCID: PMC9294067 DOI: 10.1111/jcpp.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Feeding problems are common in early childhood, and some evidence suggests that feeding problems may be associated with psychopathology. Few prospective studies have explored whether toddler feeding problems predict later psychopathology. METHODS Mothers of 1,136 children from the Upstate KIDS cohort study provided data when children were 2.5 and 8 years of age. Food refusal (picky eating) and mechanical/distress feeding problems and developmental delays were assessed at 2.5 years. Child eating behaviors (enjoyment of food, food fussiness, and emotional under and overeating) and child psychopathology (attention-deficit/hyperactivity (ADHD), oppositional-defiant (OD), conduct disorder (CD), and anxiety/depression) symptoms were assessed at 8 years. RESULTS Mechanical/distress feeding problems at age 2.5, but not food refusal problems, were associated with ADHD, problematic behavior (OD/CD), and anxiety/depression symptoms at 8 years in models adjusting for eating behaviors at 8 years and child and family covariates. Associations with mechanical/distress feeding problems were larger for ADHD and problematic behavior than anxiety/depression symptoms, though all were modest. Model estimates were similar for boys and girls. CONCLUSIONS Much of the research on feeding problems focuses on picky eating. This study suggests that early mechanical and mealtime distress problems may serve as better predictors of later psychopathology than food refusal. Parents and pediatricians could monitor children with mechanical/distress feeding problems for signs of developing psychopathology.
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Affiliation(s)
- Diane L. Putnick
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Erin M. Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health
| | - Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University Grossman School of Medicine
| | - Kristen J. Polinski
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Sonia L. Robinson
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Edwina Yeung
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
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Kapogiannis A, Makris G, Darviri C, Artemiadis A, Klonaris D, Tsoli S, Bachourou T, Stefanaki C, Papanikolaou K, Chrousos G, Pervanidou P. The Greek Version of the Vanderbilt ADHD Diagnostic Parent Rating Scale for Follow-up Assessment in Prepubertal Children with ADHD. INTERNATIONAL JOURNAL OF DISABILITY, DEVELOPMENT AND EDUCATION 2022; 69:1726-1735. [DOI: 10.1080/1034912x.2020.1802647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- August Kapogiannis
- Unit of Developmental and Behavioural Pediatrics, First Department of Pediatrics, School of Medicine National and Kapodistrian University of Athens Ringgold Standard Institution, Athens, Greece
| | - Gerasimos Makris
- Unit of Developmental and Behavioural Pediatrics, First Department of Pediatrics, School of Medicine National and Kapodistrian University of Athens Ringgold Standard Institution, Athens, Greece
| | - Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian, University of Athens Ringgold Standard Institution, Athens, Greece
| | - Artemios Artemiadis
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian, University of Athens Ringgold Standard Institution, Athens, Greece
| | - Dionysios Klonaris
- Center of Continuing Education and Lifelong Learning, University of Ioannina, Ioannina, Greece
| | - Sofia Tsoli
- Postgraduate Course Stress Management and Health Promotion, School of Medicine, National and Kapodistrian, University of Athens Ringgold Standard Institution, Athens, Greece
| | - Theodora Bachourou
- School of Psychology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charikleia Stefanaki
- Unit of Developmental and Behavioural Pediatrics, First Department of Pediatrics, School of Medicine National and Kapodistrian University of Athens Ringgold Standard Institution, Athens, Greece
| | - Katerina Papanikolaou
- Unit of Developmental and Behavioural Pediatrics, First Department of Pediatrics, School of Medicine National and Kapodistrian University of Athens Ringgold Standard Institution, Athens, Greece
| | - George Chrousos
- Unit of Developmental and Behavioural Pediatrics, First Department of Pediatrics, School of Medicine National and Kapodistrian University of Athens Ringgold Standard Institution, Athens, Greece
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioural Pediatrics, First Department of Pediatrics, School of Medicine National and Kapodistrian University of Athens Ringgold Standard Institution, Athens, Greece
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13
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Anderson NP, Feldman JA, Kolko DJ, Pilkonis PA, Lindhiem O. National Norms for the Vanderbilt ADHD Diagnostic Parent Rating Scale in Children. J Pediatr Psychol 2022; 47:652-661. [PMID: 34986222 PMCID: PMC9172842 DOI: 10.1093/jpepsy/jsab132] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To provide national norms and percentiles for both research and clinical scoring modalities of the Vanderbilt Attention Deficit/Hyperactivity Disorder (ADHD) Diagnostic Parent Rating Scale (VADPRS) for a representative sample of children ages 5-12 in the United States. METHOD The five clinical subscales of the VADPRS were completed by 1,570 caregivers of children ages 5-12 in the United States, with children representative of the national population on key demographic variables including race, sex, ethnicity, family income, and family educational level. Descriptive statistics and measures of internal consistency of both dimensional and symptom count scoring were provided for each of the five clinical subscales of the inventory, as well as percentiles and group comparisons for select dimensional scoring subscales based on age and child sex. RESULTS Measures of internal consistency for each subscale using both scoring modalities of the VADPRS ranged from high to acceptable. There were statistically significant differences among the different subscales for both age (ADHD hyperactivity, anxiety/depression) and sex [both presentations of ADHD, oppositional defiant disorder (ODD)] for the total sample. These differences, however, were modest in magnitude and unlikely to be clinically meaningful. CONCLUSIONS This study enhances the research and clinical utility of the VADPRS by providing national norms and percentiles for each of its subscales. Differences between age and sex across the sample were statistically significant for two of the subscales (Hyperactivity and Anxiety/Depression) with additional subscales significant for sex alone (Inattentive and ODD), but these differences were not substantial enough to indicate a need for separate cut-offs for screening purposes.
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Affiliation(s)
- Nathan P Anderson
- All correspondence concerning this article should be addressed to Nathan P. Anderson, BA, University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA. E-mail:
| | | | - David J Kolko
- Department of Psychiatry, University of Pittsburgh, USA
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14
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Morton HE, Gillis JM, Zale EL, Brimhall KC, Romanczyk RG. Development and Validation of the Assessment of Bullying Experiences Questionnaire for Neurodivergent Youth. J Autism Dev Disord 2021; 52:4651-4664. [PMID: 34713376 DOI: 10.1007/s10803-021-05330-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
Bullying victimization is a prevalent concern for neurodivergent (e.g., autistic, ADHD) youth. Bullying assessment methods vary widely and there is currently no questionnaire specific to neurodivergent youth. The Assessment of Bullying Experiences (ABE) was created to fill this gap. The ABE questionnaire was completed by 335 parents of school-age youth characterized as autistic, having ADHD, or community comparison. Exploratory and Confirmatory Factor Analysis identified a four-factor solution, aligning with verbal, physical, relational, and cyber victimization. Construct validity analyses indicate the ABE converges with an existing bullying questionnaire and diverges from disruptive behavior or internalizing symptoms. The ABE questionnaire is a valid measure of bullying that furthers understanding of nuance in peer victimization for neurodivergent youth and informs group-specific intervention.
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Affiliation(s)
- Hannah E Morton
- Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA.
| | - Jennifer M Gillis
- Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA
| | - Emily L Zale
- Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA
| | - Kim C Brimhall
- Department of Social Work, Binghamton University, Binghamton, NY, USA
| | - Raymond G Romanczyk
- Department of Psychology, Binghamton University, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA
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15
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Georgiopoulos AM, Christon LM, Filigno SS, Mueller A, Prieur MG, Boat TF, Smith BA. Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention. Pediatr Pulmonol 2021; 56 Suppl 1:S107-S122. [PMID: 32706527 DOI: 10.1002/ppul.24977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/20/2020] [Indexed: 01/04/2023]
Abstract
This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well-being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence-based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention-deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.
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Affiliation(s)
| | - Lillian M Christon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie S Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Mueller
- Departments of Pulmonology and Social Work Services, Hartford Hospital, Hartford, Connecticut
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Thomas F Boat
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Beth A Smith
- Departments of Psychiatry and Pediatrics, University at Buffalo--The State University of New York, Buffalo, New York
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Zaidman-Zait A, Shilo I. Parental ADHD Symptoms and Inhibitory Control in Relation to Parenting Among Mothers of Children With and Without ADHD. J Atten Disord 2021; 25:389-402. [PMID: 30442044 DOI: 10.1177/1087054718808063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: The study examined how the interplay between maternal ADHD symptoms and maternal inhibitory control and child ADHD is related to parenting behaviors. Method: The sample included 141 mothers and their 8- to 12-year-old children, 61 children with ADHD and 80 without. Parenting was measured using self-reports (i.e., overreactive and lax parenting) and observation (i.e., negative and supportive parenting). Maternal inhibitory control was measured using a neurocognitive task. Hierarchical multiple regressions were conducted to predict parenting, controlling for child sex, conduct behaviors, and parenting distress. Results: Interactions between maternal ADHD symptoms and maternal inhibitory control suggested that hyperactive-impulsive symptoms were linked to parenting negativity only when inhibitory control was low, and maternal inattention symptoms were related to lax parenting only when maternal inhibitory control was high or when children did not have ADHD. Conclusion: Results indicate the importance of maternal regulation processes in the mechanisms linking maternal ADHD with parenting.
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Affiliation(s)
- Anat Zaidman-Zait
- Tel Aviv University, Israel.,The University of British Columbia, Vancouver, Canada
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17
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The associations of maternal polycystic ovary syndrome and hirsutism with behavioral problems in offspring. Fertil Steril 2020; 113:435-443. [PMID: 32106995 DOI: 10.1016/j.fertnstert.2019.09.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/10/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the associations between maternal polycystic ovary syndrome (PCOS) and hirsutism with offspring attention-deficit/hyperactivity disorder (ADHD), anxiety, conduct disorder, and behavioral problems. DESIGN Prospective birth cohort study. SETTING Not applicable. PATIENT(S) A total of 1,915 mother-child dyads. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Maternal report of offspring ADHD, anxiety, or conduct disorder diagnosis at 7 to 8 years; emotional symptoms, behavioral problems (including peer relationship, conduct, hyperactivity/inattention), and prosocial problems measured with the Strengths and Difficulties Questionnaire (SDQ) at 7 years. RESULT(S) Prevalence of PCOS and hirsutism were 12.0% and 3.9%; 84% of women with hirsutism had PCOS. After adjustment for sociodemographic covariates, prepregnancy body mass index, and parental history of affective disorders, children born to mothers with PCOS had higher risk of anxiety (adjusted risk ratio [aRR] 1.62; 95% confidence interval [CI], 1.02-2.57) and borderline emotional symptoms (aRR 1.66; 95% CI, 1.18-2.33) compared with children born to mothers without PCOS. The associations between maternal PCOS and offspring ADHD were positive but imprecise. Maternal hirsutism was related to a higher risk of children's ADHD (aRR 2.33; 95% CI, 1.28-4.24), conduct disorder (aRR 2.54; 95% CI 1.18-5.47), borderline emotional symptoms, peer relationship problems, and conduct problems (aRRs 2.61; 95% CI, 1.69-4.05; 1.92; 95% CI, 1.16-3.17; and 2.22; 95% CI, 1.30-3.79, respectively). CONCLUSION(S) Maternal PCOS was associated with offspring anxiety, and hirsutism was related to other offspring behavioral problems. These findings should be interpreted with caution as replication is needed in prospective cohort studies that assess PCOS and hirsutism diagnoses using medical records.
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18
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Benefits of Methylphenidate for Long-Term Attention Problems After Traumatic Brain Injury in Childhood: A Randomized, Double-Masked, Placebo-Controlled, Dose-Titration, Crossover Trial. J Head Trauma Rehabil 2020; 34:E1-E12. [PMID: 30169436 PMCID: PMC6395577 DOI: 10.1097/htr.0000000000000432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the benefits and optimal dose of long-acting methylphenidate for management of long-term attention problems after childhood traumatic brain injury (TBI). DESIGN Phase 2, randomized, double-masked, placebo-controlled, dose-titration, crossover clinical trial. SETTING Outpatient, clinical research. PARTICIPANTS Twenty-six children aged 6 to 17 years who were at least 6 months post-TBI and met criteria for attention-deficit hyperactivity disorder (ADHD) at the time of enrollment. OUTCOME MEASURES Vanderbilt Rating Scale of attention problems, Pittsburgh Side Effects Rating Scale, and vital signs. RESULTS Among the 26 participants randomized, 20 completed the trial. The mean ages at injury and enrollment were 6.3 and 11.5 years, respectively. Eight participants had a severe TBI. On an optimal dose of medication, greater reductions were found on the Vanderbilt Parent Rating Scale for the medicated condition than for placebo (P = .022, effect size = 0.59). The mean optimal dose of methylphenidate was 40.5 mg (1.00 mg/kg/day). Preinjury ADHD diagnosis status was not associated with a differential medication response. Methylphenidate was associated with weight loss (∼1 kg), increased systolic blood pressure (∼3- to 6-point increase), and mild reported changes in appetite. CONCLUSION Findings support use of long-acting methylphenidate for management of long-term attention problems after pediatric TBI. Larger trials are warranted of stimulant medications, including comparative effectiveness and combination medication and nonmedication interventions.
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19
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Robinson SL, Ghassabian A, Sundaram R, Trinh MH, Lin TC, Bell EM, Yeung E. Parental Weight Status and Offspring Behavioral Problems and Psychiatric Symptoms. J Pediatr 2020; 220:227-236.e1. [PMID: 32067780 PMCID: PMC7186145 DOI: 10.1016/j.jpeds.2020.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/10/2019] [Accepted: 01/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess relations of prepregnancy maternal and paternal obesity with offspring behavioral problems and psychiatric symptoms at 7-8 years in the Upstate KIDS study, a prospective cohort study. STUDY DESIGN Maternal body mass index (BMI) was calculated from prepregnancy height and weight provided in vital records or self-report at 4 months postpartum. Mothers reported paternal height and weight. At 7-8 years, mothers indicated if their children had been diagnosed with ADHD or anxiety (n = 1915). Additionally, children's behavior was measured with the Strengths and Difficulties Questionnaire at 7 years of age (n = 1386) and the Vanderbilt ADHD Diagnostic Parent Rating Scale at 8 years of age (n = 1484). Based on Strengths and Difficulties Questionnaire scores, we identified children with borderline behavioral problems. Adjusted risk ratios (aRR) and 95% CIs were estimated with robust multivariable Poisson regression. RESULTS Compared with children of mothers with a BMI of <25, children whose mothers had BMI 25-30, 30-35, and ≥35 kg/m2 had higher risks of reported ADHD (aRR, 1.14, 95% CI, 0.78-1.69; aRR, 1.96, 95% CI, 1.29-2.98; and aRR, 1.82, 95% CI,1.21-2.74, respectively). Risks of hyperactivity problems identified by the Strengths and Difficulties Questionnaire and a positive screen for inattentive or hyperactive/impulsive behavior with the Vanderbilt ADHD Diagnostic Parent Rating Scale were also higher with increasing maternal prepregnancy BMI. Paternal BMI was not associated with child outcomes. CONCLUSIONS Our findings suggest that maternal, rather than paternal, obesity is associated with maternal report of child ADHD diagnosis and inattentive or hyperactivity problems. Further research is needed to understand how maternal obesity might influence these behavioral changes during or after pregnancy.
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Affiliation(s)
- Sonia L Robinson
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University School of Medicine, New York, NY
| | - Rajeshwari Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Mai-Han Trinh
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | | - Erin M Bell
- Departments of Environmental Health Sciences, and Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY
| | - Edwina Yeung
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
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20
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Froehlich TE, Brinkman WB, Peugh JL, Piedra AN, Vitucci DJ, Epstein JN. Pre-Existing Comorbid Emotional Symptoms Moderate Short-Term Methylphenidate Adverse Effects in a Randomized Trial of Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:137-147. [PMID: 31841646 PMCID: PMC7153644 DOI: 10.1089/cap.2019.0125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: We sought to ascertain whether baseline anxiety/depression and oppositional defiant disorder (ODD) symptoms impacted the experience of short-term methylphenidate (MPH) adverse effects (AEs) in 7- to 11-year-old children with attention-deficit/hyperactivity disorder (ADHD) (n = 171) undergoing a double-blind MPH crossover trial. Method: The Vanderbilt ADHD Diagnostic Parent Rating Scale measured baseline child anxiety/depression and ODD symptomology. The parent-completed Pittsburgh Side Effect Rating Scale assessed the AEs of anxiety, sadness, and irritability at baseline, on placebo, and on three MPH dosages. For each AE, we evaluated comorbidity main effects, dose main effects, and comorbidity × dose interactions. Results: Baseline anxiety/depression × dose and ODD × dose interactions were significant for the AEs of anxiety, sadness, and irritability. Compared with premedication baseline, these AEs attenuated on MPH for children with initially higher comorbidity symptoms, whereas those with initially lower comorbidity symptoms tended toward no change or increasing AE levels. Conclusion: Premedication anxiety/depressive and ODD symptoms may be important predictors of short-term MPH emotional AEs.
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Affiliation(s)
- Tanya E. Froehlich
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Address correspondence to: Tanya E. Froehlich, MD, MS, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - William B. Brinkman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James L. Peugh
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Daniel J. Vitucci
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffery N. Epstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Araz Altay M, Görker I, Demirci Şipka B, Bozatlı L, Ataş T. Attention Deficit Hyperactivity Disorder and Psychiatric Comorbidities. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: This study aims to obtain current information on the clinical features of attention deficit hyperactivity disorder cases, comorbid psychiatric disorders and psychiatric drug use.
Methods: All patients between the ages of 6 and 18 years who were admitted to our outpatient clinic and diagnosed with attention deficit hyperactivity disorder were included in the study. The files of the patients were examined and their demographic characteristics, symptoms, psychiatric diagnoses and drug profiles were recorded. The pattern of the psychiatric disorders accompanied by attention deficit hyperactivity disorder cases and the differences according to age and gender were analyzed. The differences were determined in patients with psychiatric comorbidity compared to those without.
Result: The mean age of the 777 patients included in the study was 11.1±2.94 and 76.6% were boys. 60.9% of attention deficit hyperactivity disorder patients had comorbid psychiatric disorders. The most common psychiatric comorbidities were specific learning disability (23.6%), oppositional defiant disorder (12.9%) and conduct disorder (12.1%). There was no difference between the genders in terms of the incidence of psychiatric comorbidities. The rate of psychiatric comorbidity was significantly higher in adolescents than in children. A psychotropic medication was used in 86.4% of the cases and psychotropic polypharmacy was present in 31.5%. The rate of polypharmacy was significantly higher in the group with psychiatric comorbidity.
Conclusion: Attention deficit hyperactivity disorder is frequently accompanied by other psychiatric disorders and the psychiatric comorbidity leads to a more complicated clinical profile. Approximately one-third of attention deficit hyperactivity disorder patients have psychiatric polypharmacy and these patients should be carefully monitored. Primary care physicians who are frequently confronted with attention deficit hyperactivity disorder cases should be careful about psychiatric comorbidities.
Keywords: Child psychiatry, attention deficit hyperactivity disorder, mental disorders, Family practice
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Affiliation(s)
- Mengühan Araz Altay
- Department of Child and Adolescent PsychiatryTrakya University School of Medicine,
| | - Işık Görker
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine
| | - Begüm Demirci Şipka
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine
| | - Leyla Bozatlı
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine
| | - Tuğçe Ataş
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine
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22
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Luo L, Jiang X, Cao G, Xiong P, Yang R, Zhang J, Shen M. Association between BDNF gene polymorphisms and attention deficit hyperactivity disorder in school-aged children in Wuhan, China. J Affect Disord 2020; 264:304-309. [PMID: 32056765 DOI: 10.1016/j.jad.2020.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/14/2019] [Accepted: 01/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is vital for neuronal survival and growth, regulation of synaptic plasticity, and cognitive function. Previous studies examined the role of BDNF in susceptibility to attention deficit hyperactivity disorder (ADHD). The current study examined the association between BDNF gene polymorphisms and ADHD in Chinese children. METHODS Participants were 195 medication-naive ADHD children and 263 unaffected healthy controls. ADHD symptoms were diagnosed using the Vanderbilt ADHD Diagnostic Parental Rating Scale according to the Diagnostic and Statistical Manual of Mental Disorders-5. Five BDNF single nucleotide polymorphisms were detected using improved multiplex ligation detection reaction. Alleles and genotype frequency were examined using Chi-square tests. Correlations were examined using multivariate logistic regression analysis in the ADHD and control groups. RESULTS The results revealed that rs12291186 with one or both mutated allele(s) was significantly associated with reduced likelihood of ADHD (OR = 0.13, 95% CI: 0.02-0.77) and ADHD-Combined (OR = 0.10, 95% CI: 0.01-0.85). Children with genotype AA or CA in rs10835210 exhibited increased risk of ADHD (OR = 3.29, 95% CI: 1.03-10.55) and ADHD-Combined (OR = 4.45, 95% CI: 1.10-17.96) compared with genotype CC children. No significant associations were found between rs6265, rs7103411, rs7103873 polymorphisms and ADHD. LIMITATIONS Participants were recruited from urban areas. We were unable to examine all potential confounding factors. CONCLUSIONS BDNF gene polymorphisms of rs12291186 and rs10835210 were related to the occurrence of ADHD. These findings provide new insight on mechanisms underlying BDNF gene in ADHD.
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Affiliation(s)
- Liwei Luo
- Department of Maternal and Child Health and MOE (Ministry of Education) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xueyan Jiang
- Department of Maternal and Child Health and MOE (Ministry of Education) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Guangan Cao
- Department of Maternal and Child Health and MOE (Ministry of Education) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ping Xiong
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430015, China
| | - Rong Yang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430015, China
| | - Jing Zhang
- Department of Maternal and Child Health and MOE (Ministry of Education) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Min Shen
- Department of Maternal and Child Health and MOE (Ministry of Education) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Kumar K, Sharma R, Mehra A, Saini L, Shah R, Sharma A. Quality of life, adjustment, and associative comorbid conditions in children diagnosed with attention deficit hyperactivity disorder: A comparative study. Ind Psychiatry J 2020; 29:123-129. [PMID: 33776285 PMCID: PMC7989465 DOI: 10.4103/ipj.ipj_119_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/02/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a common pediatric, neurodevelopmental disorder, with serious impacts on lives of those suffering from it. ADHD is known to be associated with social and emotional difficulties, poor self-regulation, aggression, reduced empathy, inability to regulate socially desirable behavior along with conflicts within family, and increased conflict with peers and several associated comorbid conditions. AIM The study aims at exploring quality of life (QOL) and adjustment along with associated comorbid conditions in children diagnosed with ADHD in comparison with normal children. METHODS A total sample of 60 children including 30 children diagnosed with ADHD and 30 normal children were selected and assessed using Vanderbilt ADHD Parent rating scale Childhood Psychopathology Measurement Schedule, KINDL QOL: Parent Questionnaire and Pre-Adolescent adjustment Scale to assess level of ADHD, comorbid psychopathologies, their QOL and adjustment respectively. RESULTS Overall results have indicated that parents reported lesser symptom and pathology in comparisons to teachers for ADHD. Those diagnosed with ADHD had positive and significant comorbidities associated of; low intelligence with behavioral problems and high levels of conduct problems, anxiety, depression, psychotic tendencies, physical illness with emotional problems and somatization in comparison to normal and thus a poor adjusted life, with significant report of poor self-esteem and peer relations and QOL. CONCLUSION The results of the present study has clearly stated that severe burden has been perceived by ADHD children, with a poor perceived QOL, several adjustment issues, and sufferance of one or other comorbidity. Thus, the study could help understand and emphasize the need of holistic treatment comprising medicinal and therapeutic methods, including intervention for parents, focusing exclusively on enhancing and curbing these factors.
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Affiliation(s)
| | - Rajni Sharma
- Advance Pediatric Center, PGIMER, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, PGIMER, Chandigarh, India
| | - Lokesh Saini
- Advance Pediatric Center, PGIMER, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, PGIMER, Chandigarh, India
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Jafferany M, Osuagwu FC, Khalid Z, Oberbarnscheidt T, Roy N. Prevalence and clinical characteristics of body dysmorphic disorder in adolescent inpatient psychiatric patients-a pilot study. Nord J Psychiatry 2019; 73:244-247. [PMID: 31074670 DOI: 10.1080/08039488.2019.1612943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Body dysmorphic disorder (BDD) is preoccupation with perceived body defects leading to distress and impairment in social functioning. Most of adolescent BDD literature has been done on patients within the outpatient setting with prior versions of DSM with dearth of information about BDD and comorbid psychiatric conditions among adolescents within the inpatient setting. Aims: This pilot study evaluated the prevalence rate, clinical characteristics in adolescent BDD compared to non-BDD adolescents in a psychiatric in patient setting in addition to their comorbid issues like anxiety, OCD, ADHD and substance abuse. Methods: Forty-five consecutively admitted adolescent patients participated with 17 meeting the DSM 5 criteria for BDD while 28 did not. Patients were asked four questions designed around the DSM-5 criteria for BDD after which they were asked to complete questionnaires like BDDQ child and adolescent version, BDDM, Multiaxial Anxiety Scale for Children, Children's Depression Inventory, Y-BOCS and Vanderbilt ADHD rating scales. Results: Seventeen participants had BDD. Mean age of BDD patients was 13.1 while non-BDD was 12.4. Male patients with BDD were seven (41%) while female BDD patients were 10 (58.8%). Anxiety, depression, OCD and substance use disorders were common comorbid diagnoses. Majority of patients in the BDD group classified their BDD as a severe problem with more BDD, patient's considering suicide because of their BDD. Discussion: BDD is present in adolescents admitted in inpatient psychiatric hospital with more female patients endorsing BDD versus their male counterparts. Patients with BDD are more likely to endorse more comorbid psychiatric issues such as anxiety, OCD, ADHD and substance abuse.
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Affiliation(s)
- Mohammad Jafferany
- a Department of Psychiatry , Central Michigan University College of Medicine , Saginaw , MI , USA
| | - Ferdnand C Osuagwu
- a Department of Psychiatry , Central Michigan University College of Medicine , Saginaw , MI , USA
| | - Zaira Khalid
- a Department of Psychiatry , Central Michigan University College of Medicine , Saginaw , MI , USA
| | | | - Nikita Roy
- a Department of Psychiatry , Central Michigan University College of Medicine , Saginaw , MI , USA
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Oyegbile TO, VanMeter JW, Motamedi GK, Bell WL, Gaillard WD, Hermann BP. Default mode network deactivation in pediatric temporal lobe epilepsy: Relationship to a working memory task and executive function tests. Epilepsy Behav 2019; 94:124-130. [PMID: 30909075 PMCID: PMC7333914 DOI: 10.1016/j.yebeh.2019.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/24/2019] [Accepted: 02/28/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Children with temporal lobe epilepsy (TLE) exhibit executive dysfunction on traditional neuropsychological tests. There is limited evidence of different functional network alterations associated with this clinical executive dysfunction. This study investigates working memory deficits in children with TLE by assessing deactivation of the default mode network (DMN) on functional Magnetic Resonance Imaging (fMRI) and the relationship of DMN deactivation with fMRI behavioral findings and neuropsychological test performance. EXPERIMENTAL DESIGN fMRI was conducted on 15 children with TLE and 15 healthy controls (age: 8-16 years) while performing the N-back task in order to assess deactivation of the DMN. N-back accuracy, N-back reaction time, and neuropsychological tests of executive function (Delis-Kaplan Executive Function System [D-KEFS] Color-Word Interference and Card Sort tests) were also assessed. PRINCIPAL OBSERVATIONS During the N-back task, children with TLE exhibited significantly less deactivation of the DMN, primarily in the precuneus/posterior cingulate cortex compared with controls. These alterations significantly correlated with N-back behavioral findings and D-KEFS results. CONCLUSIONS Children with TLE exhibit executive dysfunction which correlates with DMN alterations. These findings suggest that the level of deactivation of specific functional networks may contribute to cognitive impairment in children with TLE. The findings also indicate that children with TLE have network alterations in extratemporal lobe brain regions.
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Affiliation(s)
- Temitayo O. Oyegbile
- Georgetown University Medical Center, Washington, DC, United States of America,Corresponding author at: Pediatric Neurology, Sleep Medicine & Epilepsy, MedStar Georgetown University Hospital, 4200 Wisconsin Ave NW, Washington, DC 20016, United States of America. (T.O. Oyegbile)
| | - John W. VanMeter
- Georgetown University Medical Center, Washington, DC, United States of America
| | - Gholam K. Motamedi
- Georgetown University Medical Center, Washington, DC, United States of America
| | - William L. Bell
- Georgetown University Medical Center, Washington, DC, United States of America
| | - William D. Gaillard
- Georgetown University Medical Center, Washington, DC, United States of America,Children’s National Medical Center, Washington, DC, United States of America
| | - Bruce P. Hermann
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
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Oyegbile TO, VanMeter JW, Motamedi G, Zecavati N, Santos C, Lee Earn Chun C, Gaillard WD, Hermann B. Executive dysfunction is associated with an altered executive control network in pediatric temporal lobe epilepsy. Epilepsy Behav 2018; 86:145-152. [PMID: 30001910 PMCID: PMC7395827 DOI: 10.1016/j.yebeh.2018.04.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/12/2018] [Accepted: 04/29/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Children with temporal lobe epilepsy (TLE) exhibit executive dysfunction on traditional neuropsychological tests. However, there is limited evidence of neural network alterations associated with this clinical executive dysfunction. The objective of this study was to characterize working memory deficits in children with TLE via activation of the executive control network on functional magnetic resonance imaging (fMRI) and determine the relationships to fMRI behavioral findings and traditional neuropsychological tests. EXPERIMENTAL DESIGN Functional magnetic resonance imaging was conducted on 17 children with TLE and 18 healthy control participants (age 8-16 years) while they performed the N-back task in order to assess activation of the executive control network. N-back accuracy, N-back reaction time, and traditional neuropsychological tests (Delis-Kaplan Executive Function System [D-KEFS] color-word interference and card-sort test) were also assessed. PRINCIPAL OBSERVATIONS Children with TLE exhibited executive dysfunction on D-KEFS testing, reduced N-back accuracy, and increased N-back reaction time compared with healthy controls; D-KEFS and N-back behavioral findings were significantly correlated. Children with TLE also exhibited significant reduction in activation of the frontal lobe within the executive control network compared to healthy controls. These alterations were significantly correlated with N-back behavioral findings and D-KEFS testing. CONCLUSIONS Children with TLE exhibit executive dysfunction, which correlates with executive control network alterations. This lends validity to the theory that the executive control network contributes to working memory function. The findings also indicate that children with TLE have network alterations in nontemporal brain regions.
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Affiliation(s)
| | | | | | | | - Cesar Santos
- Georgetown University Medical Center, Washington, D.C
| | | | - William D. Gaillard
- Georgetown University Medical Center, Washington, D.C.,Children’s National Medical Center, Washington, DC
| | - Bruce Hermann
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Becker SP, Schindler DN, Luebbe AM, Tamm L, Epstein JN. Psychometric Validation of the Revised Child Anxiety and Depression Scales-Parent Version (RCADS-P) in Children Evaluated for ADHD. Assessment 2017; 26:811-824. [PMID: 29029564 DOI: 10.1177/1073191117735886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience comorbid internalizing symptoms. The Revised Child Anxiety and Depression Scales-Parent Version (RCADS-P) is a frequently used measure of anxiety and depression in children, though its psychometric properties remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS-P in 372 children (age 7-12 years; 68% male) referred for evaluation at an ADHD specialty clinic (89% met criteria for ADHD). In addition to the RCADS-P, parents completed the Vanderbilt ADHD Diagnostic Rating Scale and Child Behavior Checklist and were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children semistructured diagnostic interview. Teacher ratings were available for approximately half of the sample. Factor structure, reliability, convergent/discriminant validity, and sensitivity/specificity were examined. Results supported the six-factor structure of the RCADS-P. The RCADS-P demonstrated adequate internal consistency as well as convergent and discriminant validity with other parent ratings and, to a somewhat lesser extent, teacher ratings. Children with an internalizing diagnosis had higher RCADS-P scores than children without an internalizing diagnosis. Finally, the RCADS-P had good-to-excellent diagnostic efficiency, and a total sum score of 25 had excellent sensitivity and fair specificity. Findings provide psychometric support for the RCADS-P in children with ADHD.
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Affiliation(s)
- Stephen P Becker
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dana N Schindler
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Leanne Tamm
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffery N Epstein
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Bridging the Gap in Psychiatric Care for Children with a School-Based Psychiatry Program. SCHOOL MENTAL HEALTH 2017. [DOI: 10.1007/s12310-017-9222-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Impact of Mental Health Comorbidities on the Community-Based Pediatric Treatment and Outcomes of Children with Attention Deficit Hyperactivity Disorder. J Dev Behav Pediatr 2017; 38:20-28. [PMID: 27902542 PMCID: PMC5198773 DOI: 10.1097/dbp.0000000000000359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Children with attention deficit hyperactivity disorder (ADHD) often exhibit psychiatric comorbidities, which may impact illness presentation, diagnosis, and treatment outcomes. Guidelines exist for dealing with these complex cases but little is known about how comorbidities are being handled in community pediatric settings. The purpose of this study was to evaluate how mental health comorbidities affect community physicians' ADHD care practices and patients' symptom trajectories. METHOD Medical charts of 319 children presenting at primary care clinics for ADHD-related concerns were reviewed. Physician assessment and treatment behaviors were extracted and parents rated ADHD symptoms at the time of diagnosis and at 3, 6, and 12 months. Baseline ratings were used to group children, as no comorbid mental health condition, internalizing, or externalizing comorbid condition. Multilevel analyses compared community physician care behaviors and ADHD symptom trajectories across groups. RESULTS Approximately, 50 percent of the sample met screening criteria for a comorbid mental health condition. For children diagnosed with ADHD and treated with medication, community physician care largely did not differ across groups, but children with internalizing comorbidities made significantly smaller improvements in inattentive and hyperactive/impulsive symptoms compared with children with no comorbidities. CONCLUSION Children with ADHD and mental health comorbidities, particularly internalizing disorders, exhibit less robust response to ADHD medication and may require additional testing before starting medication and/or alternative treatment approaches. Potential barriers to conducting comprehensive assessments and to providing multi-modal treatment are discussed.
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Racial/Ethnic Differences in the Prevalence of Anxiety Using the Vanderbilt ADHD Scale in a Diverse Community Outpatient Setting. J Dev Behav Pediatr 2016; 37:610-8. [PMID: 27541582 PMCID: PMC5039053 DOI: 10.1097/dbp.0000000000000330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pediatric anxiety is prevalent but frequently underdiagnosed compared with other behavioral conditions in primary care practice. Pediatricians routinely screen for attention-deficit hyperactivity disorder using the Vanderbilt Rating Scale, which includes a short screen for anxiety. We sought to examine the prevalence of potential anxiety among patients whose parents originally had concerns of disruptive behavior in a diverse setting and examine differences in anxiety across ethnic groups using the Vanderbilt ADHD Diagnostic Rating Scale (VADRS). METHOD This was a cross-sectional analysis of medical records data of children between the ages of 5 to 12 years whose parents had concerns of disruptive behavior and received primary care from May 25, 2010, to January 31, 2014 at 2 pediatric community health clinics in Indianapolis. RESULTS Sixteen percent of children whose parents had concerns for disruptive behavior screened positive for anxiety based on the VADRS screen. Hispanic parents were less likely to report symptoms of anxiety (Spanish speaking: adjusted odds ratio (AOR) 0.4, 95% confidence interval (CI), 0.2-0.8; English speaking: AOR 0.3, 95% CI, 0.1-0.9) compared with white and black families. CONCLUSION Anxiety is detected at a lower rate among Hispanic pediatric patients using the VADRS. This may suggest differences in the performance of the VADRS among Spanish-speaking families.
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Tung I, Li JJ, Meza JI, Jezior KL, Kianmahd JS, Hentschel PG, O’Neil PM, Lee SS. Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis. Pediatrics 2016; 138:peds.2016-0430. [PMID: 27694280 PMCID: PMC9923580 DOI: 10.1542/peds.2016-0430] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for comorbid psychopathology, the clinical correlates of ADHD in girls are far less understood relative to boys, despite ADHD being one of the most common childhood disorders in girls. OBJECTIVE To meta-analytically summarize rates of comorbid internalizing (anxiety, depression) and externalizing (oppositional defiant disorder [ODD], conduct disorder [CD]) psychopathology among girls with and without ADHD. DATA SOURCES Literature searches (PubMed, Google Scholar) identified published studies examining comorbid psychopathology in girls with and without ADHD. STUDY SELECTION Eighteen studies (1997 participants) met inclusion criteria and had sufficient data for the meta-analysis. DATA EXTRACTION Odds ratios for each comorbid disorder were calculated from available data. Demographic (eg, age, race/ethnicity) and study characteristics (eg, referral source, diagnostic method) were also coded. RESULTS Compared with girls without ADHD, girls with ADHD were significantly more likely to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for each comorbid disorder assessed. Relative odds were higher for externalizing (ODD: 5.6×; CD: 9.4×) relative to internalizing disorders (anxiety: 3.2×; depression: 4.2×). Meta-regression revealed larger effect sizes of ADHD on anxiety for studies using multiple diagnostic methods, featuring younger children, and including clinic-referred (versus community-referred) girls; the effect of ADHD on ODD varied based on diagnostic informant. LIMITATIONS Findings were derived from cross-sectional studies, precluding causal inferences. CONCLUSIONS Girls with ADHD frequently exhibit comorbid externalizing and internalizing disorders. We discuss future research priorities and consider intervention implications for ADHD and comorbid psychopathology in girls.
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Affiliation(s)
- Irene Tung
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - James J. Li
- Department of Psychology, University of Wisconsin, Madison, Wisconsin; and
| | - Jocelyn I. Meza
- Department of Psychology, University of California, Berkeley, Berkeley, California
| | - Kristen L. Jezior
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Jessica S.V. Kianmahd
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Patrick G. Hentschel
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Paul M. O’Neil
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Steve S. Lee
- Department of Psychology, University of California, Los Angeles, Los Angeles, California;,Address correspondence to Steve S. Lee, PhD, Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095. E-mail:
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Andrus CF. Attention-Deficit/Hyperactivity Disorder. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
OBJECTIVE To examine the effects of stimulant medication on the sleep functioning of children with attention-deficit/hyperactivity disorder (ADHD) and identify predictors of sleep problems as a side effect of taking stimulant medication. METHOD One hundred sixty-three stimulant-naïve children (72% boys) aged 7 to 11 years diagnosed with ADHD (120 with ADHD predominantly inattentive type, 43 with ADHD combined type) participated in a 4-week, randomized, double-blind, placebo-controlled trial of once-daily (long-acting) methylphenidate (MPH). Parents completed weekly side-effect ratings including an item related to sleep problems. RESULTS Ten percent of patients had parent-rated sleep problems before the initiation of medication. Rates of parent-rated sleep problems during MPH titration generally increased with increasing MPH dose (placebo: 8%; low dose: 18%; medium dose: 15%; high dose: 25%). Differences emerged between children with (n = 16) or without (n = 147) preexisting sleep problems. Although 23% of children without preexisting sleep problems went on to have sleep problems at the highest MPH dose, only 37.5% of children with preexisting sleep problems still had sleep problems at the highest MPH dose. Lower weight and lower body mass index (BMI) were associated with increased sleep problems during MPH titration. CONCLUSION This study demonstrated a general association between increased MPH dose and increased sleep problems in children with ADHD, particularly for children of lower weight/BMI. However, a substantial proportion of children with preexisting sleep difficulties no longer had sleep problems on the highest MPH dose, which may help explain mixed findings reported to date in studies examining the impact of MPH on sleep functioning in children with ADHD and suggests that MPH dose titration should not be avoided solely on the basis of a child's premorbid sleep problems. Future research is needed to replicate and extend these findings to more specific domains of sleep functioning and to identify differences between children with persistent or improved sleep functioning as a result of MPH use.
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Yuki K, Bhagia J, Mrazek D, Jensen PS. How does a real-world child psychiatric clinic diagnose and treat attention deficit hyperactivity disorder? World J Psychiatry 2016; 6:118-127. [PMID: 27014602 PMCID: PMC4804260 DOI: 10.5498/wjp.v6.i1.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 11/10/2015] [Accepted: 12/21/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate child and adolescent psychiatrists’ (CAPs) attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) diagnoses and treatments in real-world clinical practice.
METHODS: The medical records of 69 ADHD children (mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales (VADRSs), CAPs’ diagnoses of ADHD and ODD, and CAPs’ treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs’ ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs’ treatment recommendations against established ADHD and ODD guidelines.
RESULTS: Among 63 ADHD subjects, the majority of the subjects (92%) met full ADHD diagnostic criteria at least in one setting (parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings (parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found (95%CI: -0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these case-positives, which is considered as a fair agreement between CAPs and VADRSs (95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.
CONCLUSION: CAPs’ ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD’s most common comorbid condition - ODD - may be under-recognized.
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Dvorsky MR, Langberg JM, Molitor SJ, Bourchtein E. Clinical Utility and Predictive Validity of Parent and College Student Symptom Ratings in Predicting an ADHD Diagnosis. J Clin Psychol 2016; 72:401-18. [DOI: 10.1002/jclp.22268] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Becker SP, Langberg JM, Evans SW. Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2015; 24:897-907. [PMID: 25359419 PMCID: PMC6526027 DOI: 10.1007/s00787-014-0636-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/18/2014] [Indexed: 11/25/2022]
Abstract
Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience high rates of sleep problems and are also at increased risk for experiencing comorbid mental health problems. This study provides an initial examination of the 1-year prospective association between sleep problems and comorbid symptoms in youth diagnosed with ADHD. Participants were 81 young adolescents (75 % male) carefully diagnosed with ADHD and their parents. Parents completed measures of their child's sleep problems and ADHD symptoms, oppositional defiant disorder (ODD) symptoms, and general externalizing behavior problems at baseline (M age = 12.2) and externalizing behaviors were assessed again 1 year later. Adolescents completed measures of anxiety and depression at both time-points. Medication use was not associated with sleep problems or comorbid psychopathology symptoms. Regression analyses indicated that, above and beyond demographic characteristics, ADHD symptom severity, and initial levels of comorbidity, sleep problems significantly predicted greater ODD symptoms, general externalizing behavior problems, and depressive symptoms 1 year later. Sleep problems were not concurrently or prospectively associated with anxiety. Although this study precludes making causal inferences, it does nonetheless provide initial evidence of sleep problems predicting later comorbid externalizing behaviors and depression symptoms in youth with ADHD. Additional research is needed with larger samples and multiple time-points to further examine the interrelations of sleep problems and comorbidity.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, 45229-3039, USA,
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Sluggish cognitive tempo and peer functioning in school-aged children: a six-month longitudinal study. Psychiatry Res 2014; 217:72-8. [PMID: 24656899 DOI: 10.1016/j.psychres.2014.02.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 01/31/2014] [Accepted: 02/05/2014] [Indexed: 11/21/2022]
Abstract
Although research demonstrates sluggish cognitive tempo (SCT) symptoms to be statistically distinct from other child psychopathologies (including attention-deficit/hyperactivity disorder [ADHD], anxiety, depression, and oppositionality) and associated with social impairment, all studies conducted to date have been cross-sectional. Thus, while extant research demonstrates an association between SCT and social functioning, it is entirely unknown whether or not SCT longitudinally predicts increases in social impairment. This study provides an initial examination of the prospective association between SCT symptoms and children׳s peer functioning. Teachers of 176 children in 1st-6th grades (ages 6-13; 47% boys) provided ratings of children׳s psychopathology (i.e., SCT, ADHD, anxious/depressive, and oppositional/conduct problems) and peer functioning (i.e., popularity, negative social preference, peer impairment), and peer functioning was assessed again 6 months later. Multilevel modeling analyses indicated that, above and beyond child demographics, other psychopathologies, and baseline peer functioning, SCT symptoms were significantly associated with poorer peer functioning at the 6-month follow-up. In addition, 75% of children with high levels of SCT were rated as functionally impaired in the peer domain, in contrast to only 8% of children with low SCT. Further research is needed with larger samples to examine SCT over a longer developmental period and with other domains of adjustment.
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Tarren-Sweeney M. An investigation of complex attachment- and trauma-related symptomatology among children in foster and kinship care. Child Psychiatry Hum Dev 2013; 44:727-41. [PMID: 23385520 DOI: 10.1007/s10578-013-0366-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The paper reports an investigation into the nature, patterns and complexity of mental health symptomatology reported for a large (N = 347) population sample of children in foster and kinship care. Cluster analyses were performed on caregiver-reported Child Behavior Checklist (CBCL) and Assessment Checklist for Children (ACC) scores. The derived profile types are characterized more by symptom complexity than specificity, and are delineated more by elevation than shape. The analyses indicate that social and interpersonal relationship difficulties are hallmark features of clinical presentations of children in care; that anxiety is more often observed as a component of felt insecurity than as generalized or trauma-specific anxiety; and that attention-deficit hyperactivity is rarely manifested in isolation from other difficulties. Whereas 35 % of children had clinical difficulties that could plausibly be construed as discrete mental disorders or comorbidity, another 20 % displayed complex attachment- and trauma-related symptomatology that is not adequately conceptualized within DSM or ICD classifications.
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Affiliation(s)
- Michael Tarren-Sweeney
- Health Sciences Centre, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand,
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Becker SP, Langberg JM. Sluggish cognitive tempo among young adolescents with ADHD: relations to mental health, academic, and social functioning. J Atten Disord 2013; 17:681-9. [PMID: 22441891 DOI: 10.1177/1087054711435411] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study investigated the role of sluggish cognitive tempo (SCT) in relation to externalizing and internalizing mental health problems, academic functioning, and social functioning among young adolescents with attention-deficit/hyperactivity disorder (ADHD). METHOD In all, 57 youth ages 10 to 14 participated in the study. Parents rated SCT, internalizing, and externalizing symptoms, as well as social and academic impairment. Teachers rated academic and peer impairment, and intelligence and academic achievement also were assessed. RESULTS Above and beyond ADHD and conduct problem symptoms, SCT was associated with internalizing mental health symptoms and social problems. The association between SCT and externalizing problems or academic functioning was not significant when accounting for ADHD symptomatology and intelligence. CONCLUSION SCT is consistently associated with internalizing symptoms and is also associated with young adolescents' general social difficulties. When controlling for important related constructs, SCT is not associated with externalizing symptoms or academic impairment among young adolescents with ADHD.
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Becker SP, Fite PJ, Vitulano ML, Rubens SL, Evans SC, Cooley JL. Examining Anxiety and Depression as Moderators of the Associations Between ADHD Symptoms and Academic and Social Problems in Hispanic Adolescents. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9394-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Becker SP, McBurnett K, Hinshaw SP, Pfiffner LJ. Negative social preference in relation to internalizing symptoms among children with ADHD predominantly inattentive type: girls fare worse than boys. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 42:784-95. [PMID: 23978167 DOI: 10.1080/15374416.2013.828298] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite distinct peer difficulties, less is known about the peer functioning of children with attention-deficit/hyperactivity disorder (ADHD) predominantly inattentive type (ADHD-I) in comparison to the peer functioning of children with ADHD combined type. Our purpose was to examine whether child sex moderated the relations between negative social preference and internalizing/externalizing problems in children with ADHD-I. Participants included 188 children diagnosed with ADHD-I (110 boys; ages 7-11; 54% Caucasian). Teacher ratings of the proportion of classmates who "like/accept" and "dislike/reject" the participating child were used to calculate negative social preference scores. Children, parents, and teachers provided ratings of anxious and depressive symptoms, and parents and teachers provided ratings of externalizing problems. Boys and girls did not differ on teachers' negative social preference scores. As hypothesized, however, the relation between negative social preference and internalizing symptoms was moderated by sex such that negative social preference was consistently and more strongly associated with internalizing symptoms among girls than in boys. In terms of externalizing problems, negative social preference was associated with teacher (but not parent) ratings, yet no moderation by child sex was found. Negative social preference is associated with teacher-report of externalizing problems for both boys and girls with ADHD-I, whereas negative social preference is consistently associated with girls' internalizing symptoms across child, parent, and teacher ratings. Implications for future research and interventions are discussed.
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Abstract
Nearly 20% of children and adolescents in the US have at least one mental health condition yet less than half of these youth are engaged in treatment. Violent acts such as school shootings, suicide and even bullying have been attributed in part to inadequate mental health awareness, screening and follow-up care in youth. Children and adolescents with persistent behavioral problems, low academic functioning and high rates of psychosocial adversity are ideal candidates for mental health screening in schools and the community. School-based screening offers easier access and less stigma while community care offers the opportunity for more specialized psychiatric evaluation and treatment. There are simple validated screening tools for the most common mental health problems in youth such as anxiety, depression, substance abuse, autistic spectrum disorder, attention-deficit hyperactivity disorder and suicidality. This paper provides an overview of the prevalence of psychiatric disorders in children and adolescents and recommends screening tools to facilitate recognition and referral for additional evaluation and therapeutic intervention.
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Affiliation(s)
- Julie A. Dopheide
- 1Associate Professor of Clinical Pharmacy Psychiatry and the Behavioral Sciences, University of Southern California, School of Pharmacy and Keck School of Medicine Director, PGY2 Psychiatric Pharmacy Residency
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Becker SP, Luebbe AM, Fite PJ, Stoppelbein L, Greening L. Sluggish Cognitive Tempo in Psychiatrically Hospitalized Children: Factor Structure and Relations to Internalizing Symptoms, Social Problems, and Observed Behavioral Dysregulation. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 42:49-62. [DOI: 10.1007/s10802-013-9719-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Yüce M, Zoroglu SS, Ceylan MF, Kandemir H, Karabekiroglu K. Psychiatric comorbidity distribution and diversities in children and adolescents with attention deficit/hyperactivity disorder: a study from Turkey. Neuropsychiatr Dis Treat 2013; 9:1791-9. [PMID: 24265552 PMCID: PMC3833407 DOI: 10.2147/ndt.s54283] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE We aimed to determine distribution and diversities of psychiatric comorbidities in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in terms of age groups, sex, and ADHD subtype. MATERIALS AND METHODS The sample included 6-18 year old children and adolescents from Turkey (N=108; 83 boys, 25 girls) diagnosed with ADHD. All comorbid diagnoses were determined based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version assessment. RESULTS 96.3% of the cases were found to have at least one psychiatric comorbid diagnosis. The most frequent psychiatric comorbid disorder was oppositional defiant disorder (69.4%) followed by anxiety disorders (49%) and elimination disorders (27.8%). Disruptive behavior disorders were more common in ADHD-combined type. Depression and anxiety disorders were more common in girls. Separation anxiety disorder and elimination disorder were more common in children, whereas depression, bipolar disorder, obsessive-compulsive disorder, and social phobia were more common in the adolescents. CONCLUSION According to our results, when a diagnostic tool was used to assess the presence of comorbid psychiatric disorders in children and adolescents diagnosed with ADHD, almost all cases had at least one comorbid diagnosis. Therefore, especially in the clinical sample, ADHD cases should not be solely interpreted with ADHD symptom domains, instead they should be investigated properly in terms of accompanying psychiatric disorders.
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Affiliation(s)
- Murat Yüce
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Friendship Intimacy Exchange Buffers the Relation between ADHD Symptoms and Later Social Problems among Children Attending an After-School Care Program. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2012. [DOI: 10.1007/s10862-012-9334-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Becker SP, Luebbe AM, Langberg JM. Co-occurring Mental Health Problems and Peer Functioning Among Youth with Attention-Deficit/Hyperactivity Disorder: A Review and Recommendations for Future Research. Clin Child Fam Psychol Rev 2012; 15:279-302. [PMID: 22965872 DOI: 10.1007/s10567-012-0122-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stephen P Becker
- Department of Psychology, Miami University, Oxford, OH 45056, USA.
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