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Dentz A, Soelch CM, Fahim C, Torsello A, Parent V, Ponsioen A, Guay MC, Bioulac-Rogier S, Clément C, Bader M, Romo L. Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD. L'ENCEPHALE 2024; 50:309-328. [PMID: 38326137 DOI: 10.1016/j.encep.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 02/09/2024]
Abstract
Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.
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Affiliation(s)
- Amélie Dentz
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland.
| | - Chantal Martin Soelch
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Cherine Fahim
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Alexandra Torsello
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | | | | | | | | | - Céline Clément
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication (EA 2310), Université de Strasbourg, Strasbourg, France
| | - Michel Bader
- Unité de Recherche, Service de Psychiatrie de l'Enfant et de l'adolescent (SUPEA - DP CHUV), Lausanne, Switzerland
| | - Lucia Romo
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre Université, Nanterre, France
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Nahidi M, Soleimanpour S, Emadzadeh M. Probiotics as a Promising Therapy in Improvement of Symptoms in Children With ADHD: A Systematic Review. J Atten Disord 2024; 28:1163-1172. [PMID: 38369739 DOI: 10.1177/10870547241228828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND ADHD is widely recognized as the most prevalent neurodevelopmental disorder in children. Recently, the potential role of gut microbiota as an etiological factor in ADHD has gained attention. This systematic review aims to investigate the potential impact of probiotic supplements on alleviating ADHD symptoms and influencing behavior. METHODS PubMed, Web of Science, Cochrane Library, and SCOPUS were searched from inception to May 2023. Only randomized controlled trials that have suitable data of the effects of probiotics/synbiotics on children with ADHD were enrolled. The risk of bias of the included studies was assessed by Cochrane Collaboration risk of bias tool. RESULTS Five related randomized controlled trial were evaluated in the current review. Types of interventions ranged from single/multi strain probiotics to synbiotic. The duration of intervention in all of the studies were 2 to 3 months. The assessed outcomes were very diverse and different tools were used to report the symptoms in children. Among those which used Conners' Parent Rating Scale, a decrease in the total score occurred in the probiotic group, compared to the placebo group. An improvement in both intervention and control groups was seen in one study which used ADHD-Rating Scale. CONCLUSION In summary, the combined findings from the reviewed studies suggest that probiotic supplements might potentially serve as a complementary intervention for ADHD. However, given the small number of studies, limited sample sizes, and the diversity of probiotic strains, further research is needed to clarify the effects of probiotics in children with ADHD. The observed tolerability of probiotics is noteworthy as none of the studies report adverse effects.
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Affiliation(s)
- Mahsa Nahidi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saman Soleimanpour
- Antimicrobial Resistance Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Tost G, Srikanth P, Bruton A, Hatsu IE, Leung BM, Ast HK, Eiterman LP, Robinette LM, Williams C, Gracious B, Eugene Arnold L, Johnstone JM. Problems most concerning to parents of children with ADHD and emotional dysregulation in a randomized controlled trial of multinutrients: MADDY secondary analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02463-1. [PMID: 38819662 DOI: 10.1007/s00787-024-02463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE With dual focus on structured, objective quantification of parent observations of child's behavior and identifying behaviors most amenable to change, this report examines Parent Target Problems (PTP) as a secondary outcome in a randomized clinical trial (RCT) of children with attention-deficit/ hyperactivity disorder (ADHD) in which one primary outcome, Clinical Global Impression-Improvement, showed a significant advantage of multinutrients over placebo and the other, Likert-type parent ratings, showed significant improvement in both groups, without significant difference between them. METHOD In a multisite 8-week RCT of broad-spectrum micronutrients ("multinutrients"), parents of children ages 6-12 (N = 126, 73% male, 88% white) with ADHD and emotional dysregulation nominated their child's most concerning problem(s) at baseline and quantified them by frequency, duration, impairment, and consequences. At subsequent visits, parents re-quantified the problem(s). Blinded child psychiatrists independently reviewed the PTPs and rated change at two timepoints compared to baseline. PTPs were grouped into 9 categories. Mean ratings were compared between active and placebo groups and explored by category. RESULTS By week 8, a significant separation favored multinutrients: 38% of the multinutrient group were "definitely improved" or better, compared to 25% of the placebo group, and ratings of "no change" or "worse" occurred in 35% with placebo versus 23% with multinutrients (p = 0.04). Inattention (72.2%) and emotional dysregulation (69.1%) were the most frequently reported PTP categories. Inattention and internalizing symptoms improved more with multinutrients than placebo (p = 0.01, d = 0.55; p = 0.03, d = 0.80, respectively). The multinutrient advantage was not significant for 7 other symptoms, including hyperactivity/impulsivity, aggression, autistic symptoms, or emotional dysregulation/irritable oppositionality. CONCLUSIONS This secondary analysis found that the multinutrients, compared to placebo, were associated with improvements in parental concerns overall, and in two domains specifically: inattention and internalizing symptoms (anxiety/depression), but not in seven domains: hyperactivity/impulsivity, aggression, autistic symptoms or physiological symptoms, peer relationships or emotional dysregulation/irritable oppositionality.
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Affiliation(s)
- Gabriella Tost
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | - Priya Srikanth
- OHSU-Portland State University School of Public Health, Portland, Oregon, United States
| | - Alisha Bruton
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | - Irene E Hatsu
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
- The Ohio State University, Columbus, Ohio, United States
| | | | - Hayleigh K Ast
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | | | | | - Craig Williams
- The Ohio State University, Columbus, Ohio, United States
| | - Barbara Gracious
- The Ohio State University, Columbus, Ohio, United States
- Orange Park Medical Center, Florida, Florida, United States
- Edward Via College of Osteopathic Medicine, Auburn, Alabama, United States
| | | | - Jeanette M Johnstone
- National University of Natural Medicine, Helfgott Research Institute, Portland, Oregon, United States.
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Brewerton TD, Dennis K, Wiss DA. Dismantling the myth of "all foods fit" in eating disorder treatment. J Eat Disord 2024; 12:60. [PMID: 38760858 PMCID: PMC11102136 DOI: 10.1186/s40337-024-01017-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Kim Dennis
- SunCloud Health, Chicago, IL, USA
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago, IL, USA
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Wider W, Mutang JA, Chua BS, Pang NTP, Jiang L, Fauzi MA, Udang LN. Mapping the evolution of neurofeedback research: a bibliometric analysis of trends and future directions. Front Hum Neurosci 2024; 18:1339444. [PMID: 38799297 PMCID: PMC11116792 DOI: 10.3389/fnhum.2024.1339444] [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: 11/22/2023] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction This study conducts a bibliometric analysis on neurofeedback research to assess its current state and potential future developments. Methods It examined 3,626 journal articles from the Web of Science (WoS) using co-citation and co-word methods. Results The co-citation analysis identified three major clusters: "Real-Time fMRI Neurofeedback and Self-Regulation of Brain Activity," "EEG Neurofeedback and Cognitive Performance Enhancement," and "Treatment of ADHD Using Neurofeedback." The co-word analysis highlighted four key clusters: "Neurofeedback in Mental Health Research," "Brain-Computer Interfaces for Stroke Rehabilitation," "Neurofeedback for ADHD in Youth," and "Neural Mechanisms of Emotion and Self-Regulation with Advanced Neuroimaging. Discussion This in-depth bibliometric study significantly enhances our understanding of the dynamic field of neurofeedback, indicating its potential in treating ADHD and improving performance. It offers non-invasive, ethical alternatives to conventional psychopharmacology and aligns with the trend toward personalized medicine, suggesting specialized solutions for mental health and rehabilitation as a growing focus in medical practice.
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Affiliation(s)
- Walton Wider
- Faculty of Business and Communications, INTI International University, Nilai, Negeri Sembilan, Malaysia
| | - Jasmine Adela Mutang
- Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Bee Seok Chua
- Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Nicholas Tze Ping Pang
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Leilei Jiang
- Faculty of Education and Liberal Arts, INTI International University, Nilai, Negeri Sembilan, Malaysia
| | - Muhammad Ashraf Fauzi
- Faculty of Industrial Management, Universiti Malaysia Pahang Al-Sultan Abdullah, Pekan, Pahang, Malaysia
| | - Lester Naces Udang
- Faculty of Liberal Arts, Shinawatra University, Pathumthani, Thailand
- College of Education, University of the Philippines, Diliman, Philippines
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Huberts-Bosch A, Bierens M, Ly V, van der Velde J, de Boer H, van Beek G, Appelman D, Visser S, Bos LHP, Reijmers L, van der Meer J, Kamphuis N, Draaisma JMT, Donders R, van de Loo-Neus GHH, Hoekstra PJ, Bottelier M, Arias-Vasquez A, Klip H, Buitelaar JK, van den Berg SW, Rommelse NN. Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder: a randomized-controlled trial. Eur Child Adolesc Psychiatry 2024; 33:1503-1516. [PMID: 37430148 PMCID: PMC11098970 DOI: 10.1007/s00787-023-02256-y] [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] [Received: 11/22/2022] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5-12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED-but not HD-participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably 'easier to treat' than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 ( https://www.onderzoekmetmensen.nl/en/trial/25997 ).
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Affiliation(s)
- Annick Huberts-Bosch
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.
| | - Margreet Bierens
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Verena Ly
- Institute of Psychology, Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Jessica van der Velde
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Heleen de Boer
- Accare, Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Gerry van Beek
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Danielle Appelman
- Triversum-GGZ-NHN, Child and Adolescent Psychiatry, Alkmaar, The Netherlands
| | | | - Lisa H P Bos
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Lisa Reijmers
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | | | - Niki Kamphuis
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gigi H H van de Loo-Neus
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry and Accare Child Study Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco Bottelier
- Accare, Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Alejandro Arias-Vasquez
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen Klip
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia W van den Berg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Utrecht, The Netherlands
| | - Nanda N Rommelse
- Karakter, Child and Adolescent Psychiatry, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
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Talib M, Rachdi M, Papazova A, Nicolis H. The Role of Dietary Patterns and Nutritional Supplements in the Management of Mental Disorders in Children and Adolescents: An Umbrella Review of Meta-Analyses: Le rôle des habitudes alimentaires et des suppléments nutritionnels dans la prise en charge des troubles mentaux chez les enfants et les adolescents : une méta-revue de méta-analyses. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241248070. [PMID: 38689430 DOI: 10.1177/07067437241248070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE In recent years, the relationship between nutrition and mental health has gained considerable interest. We identified, synthesized, and appraised all meta--analyses of randomized controlled trials (RCTs) and observational studies reporting on the efficacy of dietary patterns and nutrient supplements in the prevention and treatment of mental disorders in children and adolescents. METHODS Systematic research in MEDLINE, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews was completed on 8 January 2024. RESULTS Our research found 24 meta-analyses: 14 on RCTs, 8 on observational studies, and 2 combining both. Emerging evidence suggests that omega-3, in particular eicosapentaenoic acid, and Vitamin D may have adjunctive benefits in the treatment of attention deficit hyperactivity disorder (ADHD), while no evidence was found for autism spectrum disorder (ASD). Observational data also indicated that prenatal folic acid supplementation (>400 μg daily) was associated with a reduced risk of ASD in offspring. In terms of dietary habits, several meta-analyses of observational data revealed that healthy dietary patterns (rich in fruits, vegetables, and fibre, low in saturated fats) during the prenatal period, childhood, and adolescence were linked to a significantly reduced risk of internalizing disorders and externalizing disorders. Conversely, unhealthy dietary habits (high in sugars, saturated animal fats, and industrial foods, low in fruits, vegetables, and fibre) are associated with an elevated risk of these mental health issues. However, the number of available studies on dietary interventions for the treatment of depression, ASD, and ADHD was limited, and the results obtained were either nonsignificant or contradictory. CONCLUSION Our findings emphasize the need to establish clear causal relationships between dietary habits and the risk of mental illness in children and adolescents. Moreover, further investigation of the benefits observed with some nutrient supplements (such as omega-3 and vitamin D for ADHD) through larger-scale RCTs is imperative to establish more robust conclusions.
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Affiliation(s)
- Maria Talib
- Child and Adolescent Psychiatry Department, Erasme Hospital, Brussels, Belgium
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Majda Rachdi
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anna Papazova
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hélène Nicolis
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Mental Health Service, Université Libre de Bruxelles, Brussels, Belgium
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Bedawi RM, Al-Farsi Y, Mirza H, Al-Huseini S, Al-Mahrouqi T, Al-Kiyumi O, Al-Azri M, Al-Adawi S. Prevalence and Clinical Profile of Adults with ADHD Attending a Tertiary Care Hospital for Five Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:566. [PMID: 38791781 PMCID: PMC11121453 DOI: 10.3390/ijerph21050566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
(1) Objectives: This study aimed to assess the 5-year prevalence and clinical profile of attention deficit hyperactive disorder (ADHD) among adult patients seeking care in a tertiary care hospital in Oman. (2) Methods: The data were analysed using descriptive and inferential statistics and standardised prevalence estimates were calculated. (3) Results: Of the 39,881 hospital visits, 1.77% were made by adults with ADHD. This is equivalent to 17.8 visits per 1000 outpatients. The year 2021 saw the highest prevalence among the five years considered, while 2020 had the lowest prevalence. Although the age distribution indicated that the age group 'under 20' had the highest prevalence, the gender distribution showed that ADHD was more common among adult men. Among the various subtypes of ADHD, inattention was the most common. (4) Conclusions: This study specifically compared the prevalence and associated factors between an adult cohort with ADHD and those other psychiatric clinic attendees during the same period. The study offers important information on the prevalence and clinical profile of adults with ADHD in the population under consideration.
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Affiliation(s)
- Rabab Mohammed Bedawi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (R.M.B.); (Y.A.-F.); (M.A.-A.)
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (R.M.B.); (Y.A.-F.); (M.A.-A.)
| | - Hassan Mirza
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Salim Al-Huseini
- Department of Psychiatry, Al Masarra Hospital, Ministry of Health, Muscat 113, Oman;
| | - Tamadhir Al-Mahrouqi
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat 130, Oman (O.A.-K.)
| | - Omaima Al-Kiyumi
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat 130, Oman (O.A.-K.)
| | - Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (R.M.B.); (Y.A.-F.); (M.A.-A.)
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
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Schmidt KL, Kowalski A, Schweda A, Dörrie N, Skoda EM, Bäuerle A, Teufel M. Evaluation of a manualised neurofeedback training in psychosomatic-psychotherapeutic outpatient treatment (Neuro-pp-out): study protocol for a clinical mixed-methods pilot study. BMJ Open 2024; 14:e079098. [PMID: 38631828 PMCID: PMC11029405 DOI: 10.1136/bmjopen-2023-079098] [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: 08/21/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Electroencephalographic neurofeedback (NFB), as a non-invasive form of brainwave training, has been shown to be effective in the treatment of various mental health disorders. However, only few results regarding manualised and standardised NFB trainings exist. This makes comparison as well as replication of studies difficult. Therefore, we developed a standard manual for NFB training in patients with mental health disorders attending a psychosomatic outpatient clinic. The current study aims at investigating the conduction of a standardised manual for NFB training in patients with mental health disorders. If successful, the study provides new opportunities to investigate NFB in a more controlled and comparable manner in clinical practice. METHODS AND ANALYSIS 30 patients diagnosed with a mental health disorder will be included. After the educational interview, patients will undergo baseline diagnostics (T0). The subsequent intervention consists of 10 sessions of NFB training aiming at increasing sensorimotor rhythm and alpha-frequency amplitudes and decreasing theta-frequency and high beta-frequency amplitudes to induce relaxation and decrease subjective stress. All patients will undergo a post-treatment diagnostic assessment (T1) and a follow-up assessment 8 weeks following the closing session (T2). Changes in amplitude bands (primary outcome) will be recorded with electroencephalography during pre-assessments, post-assessments and follow-up assessments and during NFB sessions. Physiological (respiratory rate, blood volume pulse, muscle tension) and psychometric parameters (distress, perceived stress, relaxation ability, depressive and anxiety symptoms, insomnia, self-efficacy and quality of life) will be assessed at T0, T1 and T2. Moreover, satisfaction, acceptance and usability will be assessed at T1 after NFB training. Further, qualitative interviews about the experiences with the intervention will be conducted with NFB practitioners 6 months after the study starts. Quantitative data will be analysed using repeated measures analysis of variance as well as mediation analyses on mixed linear models. Qualitative data will be analysed using Mayring's content analysis. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the Medical Faculty of the University of Duisburg-Essen (23-11140-BO) and patient enrolment began in April 2023. Before participation, written informed consent by each participant will be required. Results will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Prospectively registered on 28 March 2023 in the German clinical trials register, DRKS00031497.
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Affiliation(s)
- Kira Leandra Schmidt
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | | | - Adam Schweda
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Nora Dörrie
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva Maria Skoda
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Department for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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10
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Peterson BS, Trampush J, Maglione M, Bolshakova M, Rozelle M, Miles J, Pakdaman S, Brown M, Yagyu S, Motala A, Hempel S. Treatments for ADHD in Children and Adolescents: A Systematic Review. Pediatrics 2024; 153:e2024065787. [PMID: 38523592 DOI: 10.1542/peds.2024-065787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 03/26/2024] Open
Abstract
CONTEXT Effective treatment of attention-deficit/hyperactivity disorder (ADHD) is essential to improving youth outcomes. OBJECTIVES This systematic review provides an overview of the available treatment options. DATA SOURCES We identified controlled treatment evaluations in 12 databases published from 1980 to June 2023; treatments were not restricted by intervention content. STUDY SELECTION Studies in children and adolescents with clinically diagnosed ADHD, reporting patient health and psychosocial outcomes, were eligible. Publications were screened by trained reviewers, supported by machine learning. DATA EXTRACTION Data were abstracted and critically appraised by 1 reviewer and checked by a methodologist. Data were pooled using random-effects models. Strength of evidence and applicability assessments followed Evidence-based Practice Center standards. RESULTS In total, 312 studies reported in 540 publications were included. We grouped evidence for medication, psychosocial interventions, parent support, nutrition and supplements, neurofeedback, neurostimulation, physical exercise, complementary medicine, school interventions, and provider approaches. Several treatments improved ADHD symptoms. Medications had the strongest evidence base for improving outcomes, including disruptive behaviors and broadband measures, but were associated with adverse events. LIMITATIONS We found limited evidence of studies comparing alternative treatments directly and indirect analyses identified few systematic differences across stimulants and nonstimulants. Identified combination of medication with youth-directed psychosocial interventions did not systematically produce better results than monotherapy, though few combinations have been evaluated. CONCLUSIONS A growing number of treatments are available that improve ADHD symptoms and other outcomes, in particular for school-aged youth. Medication therapies remain important treatment options but are associated with adverse events.
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Affiliation(s)
- Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, California
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Joey Trampush
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | | | - Maria Bolshakova
- Southern California Evidence Review Center, Los Angeles, California
| | - Mary Rozelle
- Southern California Evidence Review Center, Los Angeles, California
| | - Jeremy Miles
- Southern California Evidence Review Center, Los Angeles, California
| | - Sheila Pakdaman
- Southern California Evidence Review Center, Los Angeles, California
| | - Morah Brown
- Southern California Evidence Review Center, Los Angeles, California
| | - Sachi Yagyu
- Southern California Evidence Review Center, Los Angeles, California
| | - Aneesa Motala
- Southern California Evidence Review Center, Los Angeles, California
| | - Susanne Hempel
- Southern California Evidence Review Center, Los Angeles, California
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11
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Byrne MK, Cook R, Murta JCD, Bressington D, Meyer BJ. Dietary Intakes of Long-Chain Polyunsaturated Fatty Acids and Impulsivity: Comparing Non-Restricted, Vegetarian, and Vegan Diets. Nutrients 2024; 16:875. [PMID: 38542786 PMCID: PMC10975088 DOI: 10.3390/nu16060875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Research suggests a link between deficiencies in omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) and impulsivity among psychiatric populations. However, this association is less evident in non-clinical populations. As omega-3 LCPUFAs are predominantly sourced through fish consumption, non-fish dieters may be more vulnerable to higher impulsivity. METHODS This cross-sectional observational study explored the association between lower intakes of omega-3 LCPUFA food sources and higher self-reported measures of impulsivity among healthy adults consuming non-restricted, vegetarian, and vegan diets. RESULTS The results from the validated Food Frequency Questionnaire showed significantly lower estimated omega-3 LCPUFA intakes among vegans and vegetarians when compared with people consuming non-restricted diets. Furthermore, although all groups scored within the normal range of impulsivity measures, vegans scored comparatively higher. Vegans also scored significantly higher in impulsivity control relating to attention than those consuming non-restricted diets. CONCLUSIONS The significantly lower omega-3 LCPUFA dietary intakes in the vegan diets were associated with higher scores in the second-order attentional aspect of self-reported impulsiveness.
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Affiliation(s)
- Mitchell K. Byrne
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Rebecca Cook
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Janina C. D. Murta
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
| | - Daniel Bressington
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, NT 0810, Australia; (M.K.B.); (R.C.); (J.C.D.M.); (D.B.)
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Sri Phum District, Chiang Mai 50200, Thailand
| | - Barbara J. Meyer
- School of Medical, Indigenous and Health Sciences, Lipid Research Centre, Molecular Horizons, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
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12
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Faraone SV, Bellgrove MA, Brikell I, Cortese S, Hartman CA, Hollis C, Newcorn JH, Philipsen A, Polanczyk GV, Rubia K, Sibley MH, Buitelaar JK. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2024; 10:11. [PMID: 38388701 DOI: 10.1038/s41572-024-00495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD; also known as hyperkinetic disorder) is a common neurodevelopmental condition that affects children and adults worldwide. ADHD has a predominantly genetic aetiology that involves common and rare genetic variants. Some environmental correlates of the disorder have been discovered but causation has been difficult to establish. The heterogeneity of the condition is evident in the diverse presentation of symptoms and levels of impairment, the numerous co-occurring mental and physical conditions, the various domains of neurocognitive impairment, and extensive minor structural and functional brain differences. The diagnosis of ADHD is reliable and valid when evaluated with standard diagnostic criteria. Curative treatments for ADHD do not exist but evidence-based treatments substantially reduce symptoms and/or functional impairment. Medications are effective for core symptoms and are usually well tolerated. Some non-pharmacological treatments are valuable, especially for improving adaptive functioning. Clinical and neurobiological research is ongoing and could lead to the creation of personalized diagnostic and therapeutic approaches for this disorder.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, Norton College of Medicine at SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Mark A Bellgrove
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
- DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Chris Hollis
- National Institute for Health and Care Research (NIHR) MindTech MedTech Co-operative and NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Katya Rubia
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, UK
- Department of Child & Adolescent Psychiatry, Transcampus Professor KCL-Dresden, Technical University, Dresden, Germany
| | | | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
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13
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Cheng F, Shi L, Xie H, Wang B, Hu C, Zhang W, Hu Z, Yu H, Wang Y. A study of the interactive mediating effect of ADHD and NSSI caused by co-disease mechanisms in males and females. PeerJ 2024; 12:e16895. [PMID: 38348102 PMCID: PMC10860553 DOI: 10.7717/peerj.16895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
Background Non-suicidal self-injury (NSSI), of which the predisposing factors are complex and diverse, profoundly affects the physical and mental health of young people. Therefore, this work established an NSSI intermediary network model considering the interaction of multiple factors. A mediating effect between attention-deficit/hyperactivity disorder (ADHD) and NSSI, considering the influence of comorbidities, such as depression, anxiety, and impulsive personality, was proposed based on sex differences. Methods A total of 2,689 middle school students in Ningbo City, Zhejiang Province, China, were randomly sampled and participated in this study. Data regarding their demographic characteristics, attention deficit, hyperactivity/impulsivity, NSSI, anxiety, depression, internet addiction, and other comorbid symptoms were collected and analyzed. After initially screening the data, variables were assessed for significance using a single-factor inter-group difference analytic method, and a binary logistic regression analysis was performed. The intermediary effect of factors influencing NSSI in males and females was also analyzed. Results The overall NSSI rate was 15.16%. The results showed that the impact of individual impulsivity characteristics (impulsiveness, the ADHD with hyperactivity/impulsivity subtype) on NSSI behavior was not significant (regression results, P > 0.05). The degree of association between ADHD with attention deficit and ADHD with comprehension deficit subtypes, and other comorbid symptoms (depression, anxiety, and internet addiction disorder) and NSSI, with odds ratios (ORs) of 7.6/6.42/436.68/3.82/1.86, and 95% bootstrap confidence intervals (CIs) of 4.64, 12.87/3.46, 12.67/137.42, 2659.13/2.32, 6.37/1.31, 2.82, respectively. The results also showed significant effects of ADHD subtypes on comorbid symptoms and the path effects of NSSI (P < 0.01). Among them, the mediating effect was the strongest when anxiety was the mediating variable, and the mediating effect of girls was higher than that of boys. Conclusion The results of this work demonstrated the influence of ADHD symptoms on NSSI behavior. Among patients with ADHD, patients with subtypes with obvious attention deficit characteristics were more likely to exhibit NSSI behavior, whereas the hyperactive impulse subtype had no direct impact on NSSI. We conclude that adolescent impulsivity may not be directly related to NSSI behavior and that impulsive characteristics jointly affect NSSI behavior through a series of NSSI comorbid symptoms. Notably, the probability of symptom onset and the degree of comorbidity was significantly higher in girls than in boys of the same age, and girls were more prone to NSSI behavior. These findings provide effective theoretical support for the prevention and treatment of adolescent NSSI behavior.
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Affiliation(s)
- Fang Cheng
- The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | | | - Huabing Xie
- People’s Hospital of Wuhan University, Wuhan, China
| | - Beini Wang
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Changzhou Hu
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Wenwu Zhang
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Zhenyu Hu
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Haihang Yu
- Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo, China
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Yiming Wang
- The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Psychiatry, Affiliated Hospital to Guizhou Medical University, Guizhou, China
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14
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Badia-Aguarón T, Royuela-Colomer E, Pera-Guardiola V, Vergés-Balasch P, Cebolla A, Luciano JV, Soler J, Feliu-Soler A, Huguet Miguel A. Combining mindfulness and cognitive training in children with attention deficit hyperactivity disorder: study protocol of a pilot randomized controlled trial (the NeuroMind study). Front Psychol 2024; 15:1291198. [PMID: 38384348 PMCID: PMC10879620 DOI: 10.3389/fpsyg.2024.1291198] [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: 09/08/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Attention Deficit Hyperactivity Disorder (ADHD) has a global mean prevalence of 5%. Cognitive Training (CT) and Mindfulness-Based Interventions (MBIs) have shown promising results in managing ADHD symptoms, but they are not its Treatment-As-Usual (TAU). The NeuroMind Study aims to evaluate the preliminary effectiveness and feasibility of three interventions: Mindfulness for Health (M4H), CT using the NeuronUP® platform (CT), and a combination of both, Mindfulness Cognitive Training (MCT). There is empirical evidence supporting the effectiveness of the M4H and NeuronUP® platform; however, this study explores for the first time the effectiveness of MCT and CT, as well as the integration of M4H into TAU. The objectives of this 5-month Randomized Controlled Trial (RCT) are: (1) To analyze the preliminary effectiveness and feasibility of M4H, CT or a combination of both (MCT) added to TAU for children with ADHD; (2) To evaluate the role of psychological process variables (mindfulness and emotional regulation) as mediators of 5-month follow-up clinical outcomes; (3) To preliminarily explore whether specific sociodemographic and clinical characteristics can predict the short-and medium-term clinical response to the specific treatments. Methods and analysis Participants will be 120 children (7 to 12 years) with ADHD recruited at Child and Adolescent Mental Health Service (CAMHS) Sant Joan de Déu Terres de Lleida (Spain) randomly allocated to one of the four study arms: TAU vs. TAU + CT vs. TAU + M4H vs. TAU + MCT. An assessment to collect ADHD symptoms, Executive Functions (EF), comorbid symptoms and global functioning will be conducted pre-intervention, post-intervention (2 months after baseline) and at the 5-month follow-up. Linear mixed models and mediational models will be computed. Discussion If the preliminary effectiveness and feasibility of the MCT are demonstrated, this study could be a preliminary basis to do a full RCT with a larger sample to definitively validate the intervention. The MCT could be applied in clinical practice if it is definitively validated.Clinical trial registration:ClinicalTrials.gov, identifier, NCT05937347. https://clinicaltrials.gov/study/NCT05937347?locStr=Spain&country=Spain&cond=ADHD&intr=Mindfulness&rank=1.
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Affiliation(s)
- Tania Badia-Aguarón
- Department of Basic, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Estíbaliz Royuela-Colomer
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Vanessa Pera-Guardiola
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
- Department of Psychology, University of Lleida, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Pere Vergés-Balasch
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
| | - Ausiàs Cebolla
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBER of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Juan V. Luciano
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquim Soler
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
- CIBER of Mental Health (CIBERSAM), Madrid, Spain
| | - Albert Feliu-Soler
- Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Huguet Miguel
- Child and Adolescent Mental Health Service Sant Joan de Déu Terres de Lleida, Lleida, Spain
- Department of Medicine, University of Lleida, Lleida, Spain
- Sant Joan de Déu Research Institute (IRSJD), Esplugues de Llobregat, Spain
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15
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Marquet-Doléac J, Biotteau M, Chaix Y. Behavioral Parent Training for School-Aged Children With ADHD: A Systematic Review of Randomized Control Trials. J Atten Disord 2024; 28:377-393. [PMID: 38083879 DOI: 10.1177/10870547231211595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND All guidelines for the treatment of ADHD in children include behavioral parent training in combination with other strategies. In the past, several systematic reviews have been carried out that were either outdated or not sufficiently specific to ADHD. We wanted to conduct a new review focusing on a specific ADHD population of school age (4-12 years) and on behavioral and cognitive programs. We aimed to test our hypothesis that behavioral parent training would improve parents' difficulties, children's symptomatology, and the quality of life of families with ADHD. METHODS PUBMED, PsychInfo, Web of Science, ERIC, and Cochrane databases were searched for original articles on randomized control trials on behavioral parent training group for children with ADHD aged from 4 to 12 years until July 2023. RESULTS A total of 20 studies were included in the systematic review. The results were divided into four categories: parent data, child data collected by parents, teachers, or researchers. A qualitative analysis revealed for parents, effects on parental stress, feelings of parental efficacy, and negative parental educational behavior. As regard children, only effects are noted for parental assessment, on ADHD symptomatology, externalized disorders, and social skills. CONCLUSION Despite the heterogeneity or small number of studies in some categories, BPTs have positive effects on both parents and children. There are no convincing results to support the generalization of progress. This would seem to indicate that it remains essential to consider actions specific to each problematic environment for the child.
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Affiliation(s)
- Jerome Marquet-Doléac
- University of Toulouse, INSERM, UPS, France
- University of Toulouse 3 Paul Sabatier, France
| | - Maëlle Biotteau
- University of Toulouse, INSERM, UPS, France
- Purpan University Hospital, Toulouse, France
| | - Yves Chaix
- University of Toulouse, INSERM, UPS, France
- Purpan University Hospital, Toulouse, France
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16
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Kaiser A, Aggensteiner PM, Blasco Fontecilla H, Ros T, Acquaviva E, Attal Y, Banaschewski T, Baumeister S, Bousquet E, Bussalb A, Delhaye M, Delorme R, Drechsler R, Goujon A, Häge A, Mayaud L, Mechler K, Menache C, Revol O, Tagwerker F, Walitza S, Werling AM, Bioulac S, Purper-Ouakil D, Brandeis D. Limited usefulness of neurocognitive functioning indices as predictive markers for treatment response to methylphenidate or neurofeedback@home in children and adolescents with ADHD. Front Psychiatry 2024; 14:1331004. [PMID: 38312916 PMCID: PMC10836215 DOI: 10.3389/fpsyt.2023.1331004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Earlier studies exploring the value of executive functioning (EF) indices for assessing treatment effectiveness and predicting treatment response in attention-deficit/hyperactivity disorder (ADHD) mainly focused on pharmacological treatment options and revealed rather heterogeneous results. Envisioning the long-term goal of personalized treatment selection and intervention planning, this study comparing methylphenidate treatment (MPH) and a home-based neurofeedback intervention (NF@Home) aimed to expand previous findings by assessing objective as well as subjectively reported EF indices and by analyzing their value as treatment and predictive markers. Methods Children and adolescents (n = 146 in the per protocol sample) aged 7-13 years with a formal diagnosis of an inattentive or combined presentation of ADHD were examined. We explored the EF performance profile using the Conners Continuous Performance Task (CPT) and the BRIEF self-report questionnaire within our prospective, multicenter, randomized, reference drug-controlled NEWROFEED study with sites in five European countries (France, Spain, Switzerland, Germany, and Belgium). As primary outcome for treatment response, the clinician-rated ADHD Rating Scale-IV was used. Patients participating in this non-inferiority trial were randomized to either NF@home (34-40 sessions of TBR or SMR NF depending on the pre-assessed individual alpha peak frequency) or MPH treatment (ratio: 3:2). Within a mixed-effects model framework, analyses of change were calculated to explore the predictive value of neurocognitive indices for ADHD symptom-related treatment response. Results For a variety of neurocognitive indices, we found a significant pre-post change during treatment, mainly in the MPH group. However, the results of the current study reveal a rather limited prognostic value of neurocognitive indices for treatment response to either NF@Home or MPH treatment. Some significant effects emerged for parent-ratings only. Discussion Current findings indicate a potential value of self-report (BRIEF global score) and some objectively measured neurocognitive indices (CPT commission errors and hit reaction time variability) as treatment markers (of change) for MPH. However, we found a rather limited prognostic value with regard to predicting treatment response not (yet) allowing recommendation for clinical use. Baseline symptom severity was revealed as the most relevant predictor, replicating robust findings from previous studies.
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Affiliation(s)
- Anna Kaiser
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Pascal M Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | - Tomas Ros
- Department of Neuroscience, Campus Biotech CISA-Université de Genève, Genève, Switzerland
| | - Eric Acquaviva
- Child and Adolescent Psychiatry Department and Child Brain Institute, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris and Universite Paris Cite, Paris, France
| | | | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Elisa Bousquet
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | | | - Marie Delhaye
- Child and Adolescent Psychiatry, Erasme Academic Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Richard Delorme
- Child and Adolescent Psychiatry Department and Child Brain Institute, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris and Universite Paris Cite, Paris, France
| | - Renate Drechsler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Allison Goujon
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Alexander Häge
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | - Konstantin Mechler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | - Olivier Revol
- Unit of Child and Adolescent Psychiatry, Hospices civils de Lyon, Hôpital Femme Mère Enfant, Bron Cedex, France
| | - Friederike Tagwerker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Maria Werling
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Stéphanie Bioulac
- SANPSY, USR 3413, CNRS, Bordeaux, France
- Clinique du Sommeil, CHU Pellegrin, Bordeaux Cedex, France
| | - Diane Purper-Ouakil
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Montpellier, France
- Development and Trajectories, INSERM CESP U 1018 Psychiatry, Montpellier, France
- CESP, INSERM U 1018, Paul Brousse Hospital, Villejuif, France
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Bikic A, Dalsgaard S, Pittman B, Leckman JF, Wexler B. Cognitive training for children with ADHD: composite cognitive score outcome in a randomized controlled trial. Nord J Psychiatry 2024; 78:87-91. [PMID: 37905332 DOI: 10.1080/08039488.2023.2270954] [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: 10/25/2022] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE OF THE ARTICLE Cognitive training for Attention Deficit/Hyperactivity Disorder (ADHD) has shown promising, although mixed results. In post-hoc analyses, we evaluate effects of cognitive training using a novel composite cognition score as the outcome for children attending at least 16 sessions of training, dose-response of training and associations between symptoms and cognitive functioning. MATERIALS AND METHODS Children (age 6-13) with ADHD were randomized to intervention (n = 26) or control (n = 34). For the current analysis, we restricted the intervention group to children, who completed at least 16 sessions of cognitive training (n = 26) and examined a dose response within that group. RESULTS Cognition improved significantly in the intervention, but not control group. Amount of the completed training sessions correlated significantly with the amount of cognitive improvement. CONCLUSION Variations in dose and frequency of training may be an important source of the variance in previous studies.
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Affiliation(s)
- Aida Bikic
- Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
- Child and Adolescent Psychiatric Services Southern Jutland, Aabenraa, Denmark
| | - Søren Dalsgaard
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
- Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Bruce Wexler
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Zhang DW, Johnstone SJ, Sauce B, Arns M, Sun L, Jiang H. Remote neurocognitive interventions for attention-deficit/hyperactivity disorder - Opportunities and challenges. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110802. [PMID: 37257770 DOI: 10.1016/j.pnpbp.2023.110802] [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: 11/04/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
Improving neurocognitive functions through remote interventions has been a promising approach to developing new treatments for attention-deficit/hyperactivity disorder (AD/HD). Remote neurocognitive interventions may address the shortcomings of the current prevailing pharmacological therapies for AD/HD, e.g., side effects and access barriers. Here we review the current options for remote neurocognitive interventions to reduce AD/HD symptoms, including cognitive training, EEG neurofeedback training, transcranial electrical stimulation, and external cranial nerve stimulation. We begin with an overview of the neurocognitive deficits in AD/HD to identify the targets for developing interventions. The role of neuroplasticity in each intervention is then highlighted due to its essential role in facilitating neuropsychological adaptations. Following this, each intervention type is discussed in terms of the critical details of the intervention protocols, the role of neuroplasticity, and the available evidence. Finally, we offer suggestions for future directions in terms of optimizing the existing intervention protocols and developing novel protocols.
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Affiliation(s)
- Da-Wei Zhang
- Department of Psychology/Center for Place-Based Education, Yangzhou University, Yangzhou, China; Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia.
| | - Stuart J Johnstone
- School of Psychology, University of Wollongong, Wollongong, Australia; Brain & Behaviour Research Institute, University of Wollongong, Australia
| | - Bruno Sauce
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, Netherlands; Department of Experimental Psychology, Utrecht University, Utrecht, Netherlands; NeuroCare Group, Nijmegen, Netherlands
| | - Li Sun
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Han Jiang
- College of Special Education, Zhejiang Normal University, Hangzhou, China
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Lawrence K, Fibert P, Hobbs J, Myrissa K, Toribio-Mateas MA, Quadt F, Cotter PD, Gregory AM. Randomised controlled trial of the effects of kefir on behaviour, sleep and the microbiome in children with ADHD: a study protocol. BMJ Open 2023; 13:e071063. [PMID: 38149413 PMCID: PMC10711914 DOI: 10.1136/bmjopen-2022-071063] [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] [Received: 12/16/2022] [Accepted: 11/07/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Current interventions for children with attention-deficit/hyperactivity disorder (ADHD) are primarily medication, behavioural therapy and parent training. However, research suggests dietary manipulations may provide therapeutic benefit for some. There is accumulating evidence that the gut microbiome may be atypical in ADHD, and therefore, manipulating gut bacteria in such individuals may help alleviate some of the symptoms of this condition. The aim of this study is to explore the effects of supplementation with kefir (a fermented dairy drink) on ADHD symptomatology, sleep, attention and the gut microbiome in children diagnosed with ADHD. METHODS AND ANALYSIS A 6-week randomised, double-blind, placebo-controlled trial in 70 children aged 8-13 years diagnosed with ADHD. Participants will be recruited throughout the UK, through support groups, community groups, schools, social media and word of mouth. Children will be randomised to consume daily either dairy kefir or a placebo dairy drink for 6 weeks. The primary outcome, ADHD symptomatology, will be measured by The Strengths and Weakness of ADHD-symptoms and Normal-behaviour scale. Secondary outcomes will include gut microbiota composition (using shotgun metagenomic microbiome sequencing), gut symptomatology (The Gastrointestinal Severity Index questionnaire), sleep (using 7-day actigraphy recordings, The Child's Sleep Habits Questionnaire and Sleep Self Report questionnaire), inattention and impulsivity (with a computerised Go/NoGo test). Assessments will be conducted prior to the intervention and at the end of the intervention. Interaction between time (preintervention/postintervention) and group (probiotic/placebo) is to be analysed using a Mixed Model Analysis of Variances. ETHICS AND DISSEMINATION Ethical approval for the study was granted by St Mary's University Ethics Committee. Results will be disseminated through peer-reviewed publications, presentations to the scientific community and support groups. TRIAL REGISTRATION NUMBER NCT05155696.
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Affiliation(s)
- Kate Lawrence
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Philippa Fibert
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Jemima Hobbs
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | - Kyriaki Myrissa
- School of Allied Health & Life Sciences, St Mary's University, Twickenham, UK
| | | | - Frits Quadt
- Quadt Consultancy B.V, Oostvoorne, The Netherlands
| | - Paul D Cotter
- SeqBiome Ltd, Cork, Ireland
- University College Cork APC Microbiome Institute, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
| | - Alice M Gregory
- Department of Psychology, Goldsmiths University of London, London, UK
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20
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Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [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: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
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Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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Öztürk FÖ, Ekinci M. The effect of psycho-education given to mothers of children with attention deficit hyperactivity disorder on mother-child interaction and family functionality. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023; 36:299-306. [PMID: 37357505 DOI: 10.1111/jcap.12432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
PROBLEM One of the most prevalent psychiatric conditions in children is attention deficit hyperactivity disorder (ADHD). Regular psycho-education for people with chronic illnesses and their families is beneficial for prevention, treatment, and rehabilitation. This study aimed to determine the effect of psycho-education given to mothers of children with ADHD on mother-child interaction and family functionality. METHODS The sample of the study consisted of 98 mothers and children (50 participants for the intervention group and 48 participants for the control group). Mothers in the intervention group were given psycho-education. Pre and post-tests were completed by mothers. FINDINGS Post-test mean scores in terms of warmth/affection, hostility/aggression, indifference/neglect, and control subscales of the Parental Acceptance-Red/Control Scale were statistically significantly lower among the intervention group. Post-test mean scores in terms of communication, showing interest, and the behavior control subscales of the family assessment device were statistically significantly lower in the intervention group. CONCLUSIONS For families dealing with a child with ADHD, psychoeducation increased mother-child interaction and family functioning Therefore, psychoeducation should be widespread in the treatment of ADHD. When ADHD causes problems with mother-child contact, maternal psychoeducation may be helpful.
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Affiliation(s)
- Fatma Özgün Öztürk
- Department of Psychiatric Nursing, Faculty of Health Science, University of Pamukkale, Denizli, Turkey
| | - Mine Ekinci
- Department of Psychiatric Nursing, Faculty of Health Science, University of Atatürk, Erzurum, Turkey
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22
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Caselles‐Pina L, Sújar A, Quesada‐López A, Delgado‐Gómez D. Adherence, frequency, and long-term follow-up of video game-based treatments in patients with attention-deficit/hyperactivity disorder: A systematic review. Brain Behav 2023; 13:e3265. [PMID: 37743605 PMCID: PMC10636395 DOI: 10.1002/brb3.3265] [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] [Received: 04/11/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adolescents. Recent studies show that video games have great potential for the treatment and rehabilitation of ADHD patients. The aim of the present review is to systematically review the scientific literature on the relationship between video games and ADHD, focusing on adherence to treatment, frequency of the intervention, and the long-term follow-up of video games in children and adolescents with ADHD. METHODS The preferred reporting items for systematic reviews and meta-analyses guidelines were adopted. The review protocol was registered in PROSPERO database. We searched in three databases, PubMed, Medline, and Web of Science to identify studies examining the association between video game interventions in ADHD patients. RESULTS A total of 18 empirical studies met the established inclusion criteria. The results showed that video games-based interventions can be used to improve ADHD symptoms and display high adherence to treatment. In addition, in the studies reviewed, the most common intervention frequency is 30 min three to five times per week. However, there is little evidence from studies with video games showing long-term effects in patients with ADHD. CONCLUSION Video games are useful and effective interventions that can complement traditional treatments in patients with ADHD.
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Affiliation(s)
- Lucía Caselles‐Pina
- Department of StatisticsUniversidad Carlos III de MadridGetafeSpain
- Department of PsychologyUniversidad Autónoma de MadridMadridSpain
| | - Aaron Sújar
- School of Computer EngineeringUniversidad Rey Juan CarlosMóstolesSpain
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Huang YF, Chang SC, Purborini N, Lin YK, Chang HJ. The Efficacy of Health Promotion Program Among Parents Who Had Children With Attention-Deficit/Hyperactivity-Disorder. J Atten Disord 2023; 27:1488-1503. [PMID: 37515356 DOI: 10.1177/10870547231187165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
OBJECTIVES To explore the effect of health promotion program (HPP) on stress, quality of life, health-promoting lifestyles, and children's attention-deficit/hyperactivity disorder (ADHD) symptoms in parents of children with ADHD. METHODS Sixty parents of children with ADHD were equally randomized into the intervention (health promotion program) and control (usual care) groups. Outcomes included parents' stress, quality of life, health-promoting lifestyles, and children's ADHD symptoms before, immediately after, and 1, 3, and 6 months after the intervention. The GEE was used to evaluate the effectiveness. RESULTS The intervention group reported significant improvement in the children's hyperactivity/impulse and opposition at the 6- and 3-month, respectively. Parental overall stress significantly improved at 3 and 6 months. Parents' quality of life had significant effects at the immediate, 3-month, and 6-month. Self-actualization behavior for health-promoting lifestyles had significant effects at the immediate follow-up. CONCLUSION HPP can promote the mental well-being of parents of children with ADHD.
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de Jong SRC, van den Hoofdakker BJ, van der Veen-Mulders L, Veenman B, Twisk JWR, Oosterlaan J, Luman M. The efficacy of a self-help parenting program for parents of children with externalizing behavior: a randomized controlled trial. Eur Child Adolesc Psychiatry 2023; 32:2031-2042. [PMID: 35794395 PMCID: PMC9261243 DOI: 10.1007/s00787-022-02028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/11/2022] [Indexed: 12/03/2022]
Abstract
Parenting programs are effective for children with externalizing problems, but not always easily accessible for parents. In order to facilitate accessibility, we developed a self-help parenting program, consisting of a manual and online part. The efficacy of the program in reducing children's externalizing problems was compared to waitlist in a randomized controlled trial. In addition, two versions of the program were exploratively compared, one with and one without biweekly telephonic support. Candidate moderators (child and parent factors) and parental satisfaction were also examined. We randomly assigned 110 families to one of the following three conditions: the support condition, the no support condition, or the waitlist condition. Intervention duration was 15 weeks. Outcomes were collected at baseline (T0), 8 weeks (T1), 15 weeks (T2), and 28 weeks (T3) and included daily telephonic measurements of parent-rated externalizing behavior and the Intensity scale of the parent-rated Eyberg Child Behavior Inventory (ECBI). Main analyses compared outcomes at T2, using longitudinal regressions with T0 as fixed factor. Results showed that children improved significantly more on both outcomes in the intervention condition compared to waitlist, with small to medium effect sizes. Parental satisfaction was high. Neither differences in efficacy nor in parental satisfaction were found between the support and no support condition. No moderators were detected. The newly developed self-help parenting program is effective in reducing children's externalizing behavior problems and may help improve access to evidence-based care.
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Affiliation(s)
- Suzanne R C de Jong
- Department of Clinical-, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Lianne van der Veen-Mulders
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
| | - Betty Veenman
- Accare Child Study Center, Groningen, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jaap Oosterlaan
- Department of Clinical-, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, , Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Marjolein Luman
- Department of Clinical-, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Levvel, Specialists in Youth and Family Care, Amsterdam, The Netherlands
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Perrotte G, Moreira MMG, de Vargas Junior A, Teixeira Filho A, Castaldelli-Maia JM. Effects of Caffeine on Main Symptoms in Children with ADHD: A Systematic Review and Meta-Analysis of Randomized Trials. Brain Sci 2023; 13:1304. [PMID: 37759905 PMCID: PMC10526204 DOI: 10.3390/brainsci13091304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Attention-deficit/hyperactivity disorder (ADHD) is typically treated with stimulant medications, which may lead to several adverse effects. Recent animal studies have shown that caffeine can improve the symptoms of ADHD. This systematic review and meta-analysis sought to evaluate the effect of caffeine on ADHD symptoms in children. (2) Methods: PubMed, Embase, and Cochrane databases were searched for randomized controlled trials comparing caffeine with placebo in children, comparing overall symptoms of ADHD, inattention, hyperactivity, and impulsivity. (3) Results: We included seven RCTs in the systematic review for qualitative assessment, with 104 patients aged 5 to 15 years. Four of these studies (n = 76) were included in the meta-analysis. After qualitative analysis, four studies indicated no improvement in any of the ADHD symptoms compared with placebo. One study showed improvement in ADHD symptoms based on 1 of 5 scales applied. One study indicated significant improvement in general symptoms, inattention, and hyperactivity. One study indicated improvement in sustained attention but a worsening of impulsivity. In contrast, when using a quantitative analysis of the general symptoms of ADHD, the data showed no significant difference when comparing placebo with caffeine (standardized mean difference -0.12; 95% CI -0.44 to 0.20; p = 0.45; I2 = 0%). (4) Conclusion: overall, the totality of the evidence suggests no significant benefit of caffeine over placebo in the treatment of children with ADHD.
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Affiliation(s)
- Giuliana Perrotte
- Department of Neuroscience, Medical School, FMABC University Center, Santo André 09060-870, Brazil;
| | | | - Amauri de Vargas Junior
- Department of Medicine, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 82590-300, Brazil;
| | - Alvaro Teixeira Filho
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, FMABC University Center, Santo André 09060-870, Brazil;
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05403-903, Brazil
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Roording-Ragetlie SL, Pieters S, Wennekers E, Klip H, Buitelaar J, Slaats-Willemse D. Working memory training in children with neurodevelopmental disorders and intellectual disabilities, the role of coaching: A double-blind randomised controlled trial. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:842-859. [PMID: 37313626 DOI: 10.1111/jir.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Working memory training (WMT) can offer therapeutic benefits to patients with neurodevelopmental disorders (NDD) and mild to borderline intellectual disability (MBID). However, consistent evidence for treatment benefits of WMT over placebo training is missing. So far, participants in double-blind research designs did receive non-specific coaching, whereas active coaching based on individual training results might increase the efficacy of WMT. Furthermore, the intensity and duration of WMT is often too stressful for these children. This study therefore investigated whether a less intensive but more prolonged WMT, with active personalised coaching and feedback, would reduce behavioural symptoms and improve neurocognitive functioning and academic achievements in children with NDD and MBID. METHOD A double-blind randomised controlled trial in children (aged 10;0-13;11) with MBID (60 < IQ < 85) and ADHD and/or ASD evaluated the effects of a less intensive but prolonged version of the original Cogmed WMT (30 min a day, 4 days a week, 8 weeks in total). Eighteen participants received active, personalised coaching and feedback, based on their actual individual performance during training. Twenty-two received general non-personalised coaching for the same amount of time. Executive functioning, academic achievements and several behavioural measurements were administered, before and after training, with a 6-months follow-up. RESULTS We observed a significant effect of time on both primary and secondary outcome measures, indicating that all children improved in working memory performance and other neurocognitive and academic outcomes. The interaction between time and group was not significant. DISCUSSION This study was unable to document superior effects of active personalised coaching and feedback compared with general non-personalised coaching and no feedback in an adaptive WMT in children with MBID and NDD. The objectively documented changes over time suggest that for these vulnerable children, a regular, structured and structural contact with a coach and adapted exercises is enough to develop therapy fidelity, boost motivation and improve neurodevelopmental task performance. Further research is needed to examine which possible subgroups within this heterogenic group of children profit more from WMT compared with other subgroups.
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Affiliation(s)
| | - S Pieters
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
- Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands
| | - E Wennekers
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
| | - H Klip
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
| | - J Buitelaar
- Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - D Slaats-Willemse
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Denkkracht, Center for Neuropsychological Expertise, Nijmegen-Arnhem, The Netherlands
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Sibley MH, Graziano PA, Coxe SJ, Bickman L, Martin P, Flores S. A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity. Behav Ther 2023; 54:839-851. [PMID: 37597961 PMCID: PMC10440417 DOI: 10.1016/j.beth.2023.03.001] [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] [Received: 06/28/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 08/21/2023]
Abstract
Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability but variable implementation fidelity. Primary outcome analyses suggested no significant differences between STAND and usual care (UC) unless the clinician delivering STAND was licensed. The present study reports secondary outcomes for this trial on indices of comorbidity (anxiety, depression, oppositional defiant disorder, conduct disorder) and ADHD outcomes not targeted by the active treatment (social skills, sluggish cognitive tempo). We also examine whether therapist licensure moderated treatment effects (as in primary outcome analyses). Using intent-to-treat and per protocol linear mixed models, patients randomized to STAND were compared to those randomized to UC over approximately 10 months of follow-up. Group × Time effects revealed that, overall, STAND did not outperform usual care when implemented by community clinicians. However, a Group × Time × Licensure interaction revealed a significant effect on conduct problems when STAND was delivered by licensed clinicians (d = .19-.47). When delivered in community settings, behavior therapy for adolescent ADHD can outperform UC with respect to conduct problems reduction. Community mental health clinics should consider: (1) assigning adolescent ADHD cases to licensed professionals to maximize impact and (2) choosing psychosocial approaches when ADHD presents with comorbid conduct problems. There is also a need to reduce implementation barriers for unlicensed clinicians in community settings.
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Affiliation(s)
- Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute.
| | | | | | - Leonard Bickman
- Center for Children & Families, Florida International University
| | | | - Sabrina Flores
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
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Doffer DPA, Dekkers TJ, Hornstra R, van der Oord S, Luman M, Leijten P, Hoekstra PJ, van den Hoofdakker BJ, Groenman AP. Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: A meta-analytic review of longer-term child and parental outcomes. JCPP ADVANCES 2023; 3:e12196. [PMID: 37720584 PMCID: PMC10501699 DOI: 10.1002/jcv2.12196] [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: 08/29/2022] [Accepted: 08/02/2023] [Indexed: 09/19/2023] Open
Abstract
Background Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained. Aims This meta-analytic review investigated longer-term (i.e., more than 2 months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD. Materials & Methods We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change. Results Between pre-intervention and follow-up (M = 5.3 months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up. Discussion & Conclusion We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.
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Affiliation(s)
- Dominique P. A. Doffer
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Tycho J. Dekkers
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- Levvel, Academic Center for Child and Adolescent PsychiatryAmsterdamThe Netherlands
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Child and Adolescent PsychiatryAmsterdam University Medical Centers (AUMC)AmsterdamThe Netherlands
| | - Rianne Hornstra
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Saskia van der Oord
- KU LeuvenClinical PsychologyFaculty of Psychology and Educational SciencesLeuvenBelgium
| | - Marjolein Luman
- Levvel, Academic Center for Child and Adolescent PsychiatryAmsterdamThe Netherlands
- Department of Clinical, Neuro, and Developmental PsychologyVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Patty Leijten
- University of AmsterdamResearch Institute of Child Development and EducationAmsterdamThe Netherlands
| | - Pieter J. Hoekstra
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
| | - Barbara J. van den Hoofdakker
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Annabeth P. Groenman
- Department of Child and Adolescent PsychiatryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Accare Child Study CenterGroningenThe Netherlands
- University of AmsterdamResearch Institute of Child Development and EducationAmsterdamThe Netherlands
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Frolli A, Cerciello F, Esposito C, Ricci MC, Laccone RP, Bisogni F. Universal Design for Learning for Children with ADHD. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1350. [PMID: 37628349 PMCID: PMC10453933 DOI: 10.3390/children10081350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
Attention Deficit-Hyperactivity Disorder (ADHD) is a psychiatric condition that shows developmentally inappropriate levels of inattention, hyperactivity, or impulsivity. Symptoms begin at a young age and usually include a lack of attention, poor concentration, disorganization, difficulty completing tasks, forgetfulness, and losing things. It is important to diagnose and treat the disorder at a young age so that the symptoms do not persist into adulthood and cause other comorbid conditions. Learning difficulties, motor impairment, anxiety, or depressive disorders may occur with this condition. To improve the academic careers of children with ADHD, we focused on a specific innovative educational approach (Universal Design for Learning) that could improve basic learning skills (reading, writing, and arithmetic skills) to prevent or manage any learning difficulty that could occur with ADHD. The Universal Design for Learning is an individualized approach that combines current neuroscientific knowledge, creating personalized teaching based on the strengths and weaknesses of the student. The goal of this study is to analyze the impact that this approach has on basic learning abilities. We found that both interventions led to improvements in test performance, indicating that interventions were necessary to enhance reading, writing, and arithmetic skills. Furthermore, the group that received an educational intervention based on Universal Design for Learning demonstrated a more significant improvement in these areas. Additionally, we propose that the set of techniques implemented by teachers in the classroom helped children to read, write, and perform math tasks correctly and more fluently.
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Affiliation(s)
- Alessandro Frolli
- Disability Research Centre of Rome University of International Studies, 00147 Rome, Italy; (F.C.); (C.E.); (R.P.L.); (F.B.)
| | - Francesco Cerciello
- Disability Research Centre of Rome University of International Studies, 00147 Rome, Italy; (F.C.); (C.E.); (R.P.L.); (F.B.)
| | - Clara Esposito
- Disability Research Centre of Rome University of International Studies, 00147 Rome, Italy; (F.C.); (C.E.); (R.P.L.); (F.B.)
| | - Maria Carla Ricci
- FINDS—Italian Neuroscience and Developmental Disorders Foundation, 81040 Caserta, Italy;
| | - Rossana Pia Laccone
- Disability Research Centre of Rome University of International Studies, 00147 Rome, Italy; (F.C.); (C.E.); (R.P.L.); (F.B.)
| | - Fabio Bisogni
- Disability Research Centre of Rome University of International Studies, 00147 Rome, Italy; (F.C.); (C.E.); (R.P.L.); (F.B.)
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30
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Cirino PT, Farrell AE, Barnes MA, Roberts GJ. An Evaluation of the Structure of Attention in Adolescence. Dev Neuropsychol 2023; 48:162-185. [PMID: 37218215 PMCID: PMC10330620 DOI: 10.1080/87565641.2023.2213789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
This study evaluated the factor structure of attention, considering internal and external attention, and juxtaposed alongside processing speed (PS) and working memory (WM). We expected the hypothesized model to fit better than unitary or method factors. We included 27 measures with 212 Hispanic middle schoolers from Spanish-speaking backgrounds, where a substantial proportion were at risk for learning difficulties. Confirmatory factor analytic models separated factors of PS and WM, but the final model did not align with theoretical predictions; rather only measurement factors emerged. Findings extend and refine our understanding of the structure of attention in adolescents.
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31
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Frisch C, Tirosh E, Rosenblum S. Children with ADHD Symptomatology: Does POET Improve Their Daily Routine Management? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1083. [PMID: 37371314 DOI: 10.3390/children10061083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) struggle with executive delays while managing their daily tasks. This is a secondary analysis of existing data from open-label research examining the efficacy of Parental Occupational Executive Training (POET). It further examines POET's efficacy in increasing young children's (3.83 to 7.08 years) executive control over daily routines, and in decreasing their ADHD symptoms. Additionally, the second analysis investigates which of the children's increased capabilities is better associated with the change in their daily routine management following the intervention. Parents of children with ADHD symptomatology (N = 72, 55 boys) received eight POET sessions. They completed standardised ADHD symptomatology, executive management of daily routines, and executive functions (EF) questionnaires at pretest, post-test, and 3-month follow-up. Children's ADHD symptoms and their management of daily routines significantly improved following the POET intervention. The children's score changes in EF accounted for 37% of the variance in their improved routine management. These findings suggest that interventions aiming to increase children's executive control over their daily routines should improve their broader array of EF besides decreasing core ADHD symptoms.
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Affiliation(s)
- Carmit Frisch
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Emanuel Tirosh
- The Hannah Khoushy Child Development Center, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 69094, Israel
| | - Sara Rosenblum
- The Laboratory of Complex Human Activity and Participation (CHAP), Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
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32
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Türk S, Korfmacher AK, Gerger H, van der Oord S, Christiansen H. Interventions for ADHD in childhood and adolescence: A systematic umbrella review and meta-meta-analysis. Clin Psychol Rev 2023; 102:102271. [PMID: 37030086 DOI: 10.1016/j.cpr.2023.102271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
There are several meta-analyses of treatment effects for children and adolescents with attention deficit hyperactivity disorder (ADHD). The conclusions of these meta-analyses vary considerably. Our aim was to synthesize the latest evidence of the effectiveness of psychological, pharmacological treatment options and their combination in a systematic overview and meta-meta-analyses. A systematic literature search until July 2022 to identify meta-analyses investigating effects of treatments for children and adolescents with ADHD and ADHD symptom severity as primary outcome (parent and teacher rated) yielded 16 meta-analyses for quantitative analyses. Meta-meta-analyses of pre-post data showed significant effects for pharmacological treatment options for parent (SMD = 0.67, 95% CI 0.60 to 0.74) and teacher ADHD symptom ratings (SMD = 0.68, 95% CI 0.54 to 0.82) as well as for psychological interventions for parent (SMD = 0.42, 95% CI 0.33 to 0.51) and teacher rated symptoms (SMD = 0.25, 95% CI 0.12 to 0.38). We were unable to calculate effect sizes for combined treatments due to the lack of meta-analyses. Our analyses revealed that there is a lack of research on combined treatments and for therapy options for adolescents. Finally, future research efforts should adhere to scientific standards as this allows comparison of effects across meta-analyses.
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Affiliation(s)
- Selina Türk
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Ann-Kathrin Korfmacher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Heike Gerger
- Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, Netherlands
| | | | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Sibley MH, Bruton AM, Zhao X, Johnstone JM, Mitchell J, Hatsu I, Arnold LE, Basu HH, Levy L, Vyas P, Macphee F, Gonzalez ES, Kelley M, Jusko ML, Bolden CR, Zulauf-McCurdy C, Manzano M, Torres G. Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:415-428. [PMID: 36907194 PMCID: PMC10370370 DOI: 10.1016/s2352-4642(22)00381-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/26/2022] [Accepted: 12/19/2022] [Indexed: 03/11/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents globally and is associated with negative life outcomes and socioeconomic costs. First-generation ADHD treatments were predominantly pharmacological; however, increased understanding of biological, psychological, and environmental factors contributing to ADHD has expanded non-pharmacological treatment possibilities. This Review provides an updated evaluation of the efficacy and safety of non-pharmacological treatments for paediatric ADHD, discussing the quality and level of evidence for nine intervention categories. Unlike medication, no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms. When considering broad outcomes (eg, impairment, caregiver stress, and behavioural improvement), multicomponent (cognitive) behaviour therapy joined medication as a primary ADHD treatment. With respect to secondary treatments, polyunsaturated fatty acids showed a consistent modest effect on ADHD symptoms when taken for at least 3 months. Additionally, mindfulness and multinutrient supplementation with four or more ingredients showed modest efficacy on non-symptom outcomes. All other non-pharmacological treatments were safe; clinicians might tolerate their use but should educate families of childrenand adolescents with ADHD on the disadvantages, including costs, burden to the service user, absence of proven efficacy relative to other treatments, and delay of proven treatment.
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Alisha M Bruton
- Department of Psychiatry, Oregon Health Sciences University, Portland, OR, USA
| | - Xin Zhao
- Department of Medicine, University of California-Irvine, Irvine, CA, USA
| | | | - John Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Irene Hatsu
- Department of Human Sciences, Ohio State University, Columbus, OH, USA
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | - Hana H Basu
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Laura Levy
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Pooja Vyas
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Fiona Macphee
- Division of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Erin Schoenfelder Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Megan Kelley
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Morgan L Jusko
- Department of Psychology, Florida International University, Miami, FL, USA
| | - China R Bolden
- Division of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Courtney Zulauf-McCurdy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Maychelle Manzano
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Gabriela Torres
- Department of Psychology, Florida International University, Miami, FL, USA
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Wiers RW, Pan T, van Dessel P, Rinck M, Lindenmeyer J. Approach-Bias Retraining and Other Training Interventions as Add-On in the Treatment of AUD Patients. Curr Top Behav Neurosci 2023. [PMID: 37221351 DOI: 10.1007/7854_2023_421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In the past two decades, a variety of cognitive training interventions have been developed to help people overcome their addictive behaviors. Conceptually, it is important to distinguish between programs in which reactions to addiction-relevant cues are trained (varieties of cognitive bias modification, CBM) and programs in which general abilities are trained such as working memory or mindfulness. CBM was first developed to study the hypothesized causal role in mental disorders: by directly manipulating the bias, it was investigated to what extent this influenced disorder-relevant behavior. In these proof-of-principle studies, the bias was temporarily modified in volunteers, either temporarily increased or decreased, with corresponding effects on behavior (e.g., beer consumption), in case the bias was successfully manipulated. In subsequent clinical randomized controlled trials (RCTs), training (away from the substance vs. sham training) was added to clinical treatment. These studies have demonstrated that CBM, as added to treatment, reduces relapse with a small effect of about 10% (similar effect size as for medication, with the strongest evidence for approach-bias modification). This has not been found for general ability training (e.g., working memory training), although effects on other psychological functions have been found (e.g., impulsivity). Mindfulness also has been found to help people overcome addictions, and different from CBM, also as stand-alone intervention. Research on (neuro-)cognitive mechanisms underlying approach-bias modification has pointed to a new perspective in which automatic inferences rather than associations are influenced by training, which has led to the development of a new variety of training: ABC training.
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Affiliation(s)
- Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Ting Pan
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter van Dessel
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Ruhr University Bochum, Bochum, Germany
| | - Johannes Lindenmeyer
- Salus Klinik, Lindow, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Germany
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Lv YB, Cheng W, Wang MH, Wang XM, Hu YL, Lv LQ. Effect of non-pharmacological treatment on the full recovery of social functioning in patients with attention deficit hyperactivity disorder. World J Clin Cases 2023; 11:3238-3247. [PMID: 37274030 PMCID: PMC10237121 DOI: 10.12998/wjcc.v11.i14.3238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/25/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Long-term treatment of attention deficit/hyperactivity disorder (ADHD) is associated with adverse events, such as nausea and vomiting, dizziness, and sleep disturbances, and poor maintenance of late ADHD medication compromises treatment outcomes and prolongs the recovery of patients' social functioning.
AIM To evaluate the effect of non-pharmacological treatment on the full recovery of social functioning in patients with ADHD.
METHODS A total of 90 patients diagnosed with ADHD between May 2019 and August 2020 were included in the study and randomly assigned to either the pharmacological group (methylphenidate hydrochloride and tomoxetine hydrochloride) or the non-pharmacological group (parental training, behavior modification, sensory integration therapy, and sand tray therapy), with 45 cases in each group. Outcome measures included treatment compliance, Swanson, Nolan, and Pelham, Version IV (SNAP-IV) scores, Conners Parent Symptom Questionnaire (PSQ) scores, and Weiss Functional Impairment Rating Scale (WFIRS) scores.
RESULTS The non-pharmacological interventions resulted in significantly higher compliance in patients (95.56%) compared with medication (71.11%) (P < 0.05). However, no significant differences in SNAP-IV and PSQ scores, in addition to the learning/school, social activities, and adventure activities of the WFIRS scores were observed between the two groups (P > 0.05). Patients with non-pharmacological interventions showed higher WFIRS scores for family, daily life skills, and self-concept than those in the pharmacological group (P < 0.05).
CONCLUSION Non-pharmacological interventions, in contrast to the potential risks of adverse events after long-term medication, improve patient treatment compliance, alleviate patients' behavioral symptoms of attention, impulsivity, and hyperactivity, and improve their cognitive ability, thereby improving family relationships and patient self-evaluation.
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Affiliation(s)
- Ying-Bo Lv
- Pediatric Health Care Section, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
| | - Wei Cheng
- Pediatric Health Care Section, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
| | - Meng-Hui Wang
- Pediatric Health Care Section, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
| | - Xiao-Min Wang
- Pediatric Health Care Section, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
| | - Yan-Li Hu
- Pediatric Health Care Section, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
| | - Lan-Qiu Lv
- Pediatric Health Care Section, Ningbo Women and Children’s Hospital, Ningbo 315000, Zhejiang Province, China
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Zulauf-McCurdy CA, LaCount PA, Shelton CR, Morrow AS, Zhao XA, Russell D, Sibley MH, Arnold LE. Systematic Review and Meta-Analyses: Safety and Efficacy of Complementary and Alternative Treatments for Pediatric Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2023; 44:e322-e332. [PMID: 37084312 DOI: 10.1097/dbp.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/07/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE Complementary and alternative treatments (CATs) for ADHD have proliferated over the past decade; however, their safety and efficacy remain uncertain. We completed a systematic review and meta-analyses across CAT domains. METHODS Systematic search and data extraction identified randomized controlled trials for pediatric ADHD (ages 3-19 years) that included probably blind ADHD symptom outcome measures. We evaluated basic (RCT of a CAT compared with sham/placebo, attention/active control, treatment as usual, and waitlist control), complementary (RCTs comparing an evidence-based treatment with a CAT and the same evidence-based treatment), and alternative (evidence-based treatment to CAT) efficacy. Random-effect meta-analyses were conducted when at least 3 blinded studies were identified for a specific CAT domain. RESULTS Eighty-seven of 2253 nonduplicate screened manuscripts met inclusion criteria. No study reported significantly greater adverse effects for CATs than controls; naturopathy reported fewer adverse effects than evidence-based treatments but did not demonstrate basic efficacy. In the systematic review of basic efficacy, evidence of effectiveness was mixed but replicated previous evidence for the possible efficacy of cognitive training, neurofeedback, and essential fatty acid supplementation for certain patients. With respect to alternative and complementary efficacy, no CAT outperformed or enhanced evidence-based treatments (stimulant medications and behavioral therapy) when replication was required. Individual meta-analyses indicated that cognitive training was the only CAT that demonstrated overall basic efficacy ( SMD = 0.216; p = 0.032). CONCLUSION Clinicians may cautiously recommend (but monitor) cognitive training when evidence-based treatments are not feasible or effective for a patient. Additional studies are needed to further understand the potential of CAT domains.
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Affiliation(s)
| | - Patrick A LaCount
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | | | | | - Xin A Zhao
- Department of Medicine, University of California, Irvine
| | - Douglas Russell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Margaret H Sibley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Nisonger Center, Ohio State University College of Medicine
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Gillies D, Leach MJ, Perez Algorta G. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database Syst Rev 2023; 4:CD007986. [PMID: 37058600 PMCID: PMC10103546 DOI: 10.1002/14651858.cd007986.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a major problem in children and adolescents, characterised by age-inappropriate levels of inattention, hyperactivity, and impulsivity, and is associated with long-term social, academic, and mental health problems. The stimulant medications methylphenidate and amphetamine are the most frequently used treatments for ADHD, but these are not always effective and can be associated with side effects. Clinical and biochemical evidence suggests that deficiencies of polyunsaturated fatty acids (PUFA) could be related to ADHD. Research has shown that children and adolescents with ADHD have significantly lower plasma and blood concentrations of PUFA and, in particular, lower levels of omega-3 PUFA. These findings suggest that PUFA supplementation may reduce the attention and behaviour problems associated with ADHD. This review is an update of a previously published Cochrane Review. Overall, there was little evidence that PUFA supplementation improved symptoms of ADHD in children and adolescents. OBJECTIVES To compare the efficacy of PUFA to other forms of treatment or placebo in treating the symptoms of ADHD in children and adolescents. SEARCH METHODS We searched 13 databases and two trials registers up to October 2021. We also checked the reference lists of relevant studies and reviews for additional references. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials that compared PUFA with placebo or PUFA plus alternative therapy (medication, behavioural therapy, or psychotherapy) with the same alternative therapy alone in children and adolescents (aged 18 years and under) diagnosed with ADHD. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was severity or improvement of ADHD symptoms. Our secondary outcomes were severity or incidence of behavioural problems; quality of life; severity or incidence of depressive symptoms; severity or incidence of anxiety symptoms; side effects; loss to follow-up; and cost. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included 37 trials with more than 2374 participants, of which 24 trials were new to this update. Five trials (seven reports) used a cross-over design, while the remaining 32 trials (52 reports) used a parallel design. Seven trials were conducted in Iran, four each in the USA and Israel, and two each in Australia, Canada, New Zealand, Sweden, and the UK. Single studies were conducted in Brazil, France, Germany, India, Italy, Japan, Mexico, the Netherlands, Singapore, Spain, Sri Lanka, and Taiwan. Of the 36 trials that compared a PUFA to placebo, 19 used an omega-3 PUFA, six used a combined omega-3/omega-6 supplement, and two used an omega-6 PUFA. The nine remaining trials were included in the comparison of PUFA to placebo, but also had the same co-intervention in the PUFA and placebo groups. Of these, four trials compared a combination of omega-3 PUFA plus methylphenidate to methylphenidate. One trial each compared omega-3 PUFA plus atomoxetine to atomoxetine; omega-3 PUFA plus physical training to physical training; and an omega-3 or omega-6 supplement plus methylphenidate to methylphenidate; and two trials compared omega-3 PUFA plus dietary supplement to dietary supplement. Supplements were given for a period of between two weeks and six months. Although we found low-certainty evidence that PUFA compared to placebo may improve ADHD symptoms in the medium term (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.47 to 2.60; 3 studies, 191 participants), there was high-certainty evidence that PUFA had no effect on parent-rated total ADHD symptoms compared to placebo in the medium term (standardised mean difference (SMD) -0.08, 95% CI -0.24 to 0.07; 16 studies, 1166 participants). There was also high-certainty evidence that parent-rated inattention (medium-term: SMD -0.01, 95% CI -0.20 to 0.17; 12 studies, 960 participants) and hyperactivity/impulsivity (medium-term: SMD 0.09, 95% CI -0.04 to 0.23; 10 studies, 869 participants) scores were no different compared to placebo. There was moderate-certainty evidence that overall side effects likely did not differ between PUFA and placebo groups (RR 1.02, 95% CI 0.69 to 1.52; 8 studies, 591 participants). There was also moderate-certainty evidence that medium-term loss to follow-up was likely similar between groups (RR 1.03, 95% CI 0.77 to 1.37; 13 studies, 1121 participants). AUTHORS' CONCLUSIONS Although we found low-certainty evidence that children and adolescents receiving PUFA may be more likely to improve compared to those receiving placebo, there was high-certainty evidence that PUFA had no effect on total parent-rated ADHD symptoms. There was also high-certainty evidence that inattention and hyperactivity/impulsivity did not differ between PUFA and placebo groups. We found moderate-certainty evidence that overall side effects likely did not differ between PUFA and placebo groups. There was also moderate-certainty evidence that follow-up was similar between groups. It is important that future research addresses the current weaknesses in this area, which include small sample sizes, variability of selection criteria, variability of the type and dosage of supplementation, and short follow-up times.
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Affiliation(s)
- Donna Gillies
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Matthew J Leach
- School of Nursing & Midwifery, University of South Australia, Adelaide, Australia
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Neurofeedback for Attention-Deficit/Hyperactivity Disorder: 25-Month Follow-up of Double-Blind Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2023; 62:435-446. [PMID: 36521694 PMCID: PMC10065891 DOI: 10.1016/j.jaac.2022.07.862] [Citation(s) in RCA: 1] [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: 02/16/2022] [Revised: 07/11/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine delayed effects of theta-beta ratio (TBR) neurofeedback (NF) for attention-deficit/hyperactivity disorder (ADHD) 25 months after baseline, ∼21 months after end of treatment. METHOD Children aged 7 to 10 years with rigorously diagnosed ADHD had been randomized to 38 sessions of TBR NF (n = 84) or control treatment (n = 58) of identical appearance, intensity/frequency, and duration, differing only in that reinforcement for controls was based on a pre-recorded electroencephalogram (EEG) of another child. Child, parent, and all site staff were blinded until after 25-month assessments, with only one-fourth able to guess the control treatment correctly. Baseline assessments were repeated off medication after 25 months. RESULTS Of the 142 participants, 120 had 25-month follow-up (84.5% retention). Only 12 participants (6 controls) had NF after the study treatment, greatly retaining the randomization. The primary outcome, parent-rated inattention, was not significantly different between treatments despite large pre-post effect sizes (NF recipients, d = 1.63; controls, d = 1.42). Most secondary measures showed the same pattern. Response rates (Clinical Global Impression-Improvement ≤2) were 58.6% of NF recipients and 66% of controls (not significant). Marginally more controls than NF recipients needed medication (57.1% vs 38.6%, p = .059); specifically, 7.1% of NF recipients and 4% of controls had reduced medication need, whereas 34.3% of NF recipients and 50% of controls needed more medication (p = 0.084). CONCLUSION Most of the large within-group improvement from the NF treatment package reported by unblinded studies and replicated in this blinded study reflects nonspecific effects, not specific effects of deliberate down-training of EEG theta-beta power ratio. At 25-month follow-up, it appears comparable to the evidence-based Multimodal Treatment Study of ADHD (MTA) treatments, suggesting a psychotherapeutic/behavioral effect. CLINICAL TRIAL REGISTRATION INFORMATION Double-Blind 2-Site Randomized Clinical Trial of Neurofeedback for ADHD; http://clinicaltrials.gov/; NCT02251743. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group.
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Co-designed Mindful Parenting for Parents of Children with ADHD: A Pilot and Feasibility Study. Child Psychiatry Hum Dev 2023; 54:406-420. [PMID: 34580793 DOI: 10.1007/s10578-021-01260-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
This mixed-methods single arm pilot study examined the feasibility, acceptability, and preliminary outcomes of a co-designed mindful parenting intervention for parents of children with ADHD, Parents that Mind (PTM). The 5-week parent-only intervention comprised two face-to-face group retreats and 5 weeks home practice. Eighteen parents of children with ADHD participated in PTM, completing self-report questionnaires and semi-structured interviews. Indicating high acceptability, 100% of parents interviewed reported PTM was helpful and they would recommend PTM. High feasibility of parents attending one face-to-face retreat was observed, with all parents attending the first retreat, however intervention adherence was challenging, with 55% of parents attending the second retreat. Barriers to intervention adherence included: lack of time, work commitments, illness and exhaustion. Quantitative data indicate promising preliminary effects for parents and children. Addressing the barriers raised by parents in this pilot appear necessary, before examining efficacy in a blinded RCT.
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Russell D, Arnold LE. Complementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:173-192. [PMID: 37147036 DOI: 10.1016/j.chc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
First-line psychopharmacologic and psychosocial treatments for attention-deficit/hyperactivity disorder in children are effective but limited by tolerability and accessibility problems. Many complementary and integrative strategies have been investigated as alternative or adjunctive treatments for the disorder, and the literature has progressed to meta-analyses for several. Although heterogeneity of study methods and risk of bias pervades the literature, we conclude that Omega-3 supplementation, dietary restriction of artificial food colorings, and physical activity can be considered evidence-based. Additionally, meditation, yoga, and sleep hygiene are safe, partially effective, cost effective and sensible adjunctive treatment strategies.
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Affiliation(s)
- Douglas Russell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, c/o Seattle Children's Hospital, OA.5.154 PO Box 5371, Seattle, WA 98145-5005, USA.
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 395E McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA
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Kenworthy L, Childress D, Armour AC, Verbalis A, Zhang A, Troxel M, Handsman R, Kocher K, Myrick Y, Werner M, Alexander KC, Cannon L, Anthony LG. Leveraging technology to make parent training more accessible: Randomized trial of in-person versus online executive function training for parents of autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:616-628. [PMID: 35916246 PMCID: PMC9892365 DOI: 10.1177/13623613221111212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
LAY ABSTRACT This study compared the first online parent training program for executive function intervention for autism to in-person parent training on the same content. Participants were parents of autistic children, who were between 8 and 12 years of age and did not have intellectual disability. Parents were randomized to the in-person (n = 51) or online (n = 46) training conditions. Both trainings were developed with stakeholder (parents and autistic people) guidance. In this trial, most parents reported that they liked both trainings and that they were able to implement what they learned with their children. Parents in both groups spent equivalent amounts of time (about 8 hours) with the training materials, but while 94% of parents in the in-person training attended both parent trainings, only 59% of parents in the online group completed all 10 online modules. Parents reported that it was difficult to stay motivated to complete the online trainings over the 10-week trial. Parent and child outcomes did not differ significantly between the groups. Overall, parents reported that the trainings resulted in a reduction in their own parenting strain and improvements in their child's flexibility, emotional control, and global executive function, but not planning and organization. These findings indicated brief in-person and online training can help parents learn to support and improve their autistic children's executive function abilities, reducing their own experience of parenting strain. The finding that the online training was equivalent to the in-person trainings is important because it is accessible to parents who encounter barriers to in-person care.
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Affiliation(s)
| | | | | | | | | | - Mary Troxel
- University of Colorado School of Medicine, USA
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Robling K, Cosby C, Parent G, Gajjar S, Chesher T, Baxter M, Hartwell M. Person-centered language and pediatric ADHD research: a cross-sectional examination of stigmatizing language within medical literature. J Osteopath Med 2023; 123:215-222. [PMID: 36762442 DOI: 10.1515/jom-2022-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
CONTEXT Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and often goes untreated. A major barrier to treatment is the stigma surrounding the disorder, including from the educational and scientific community. Person-centered language (PCL) is associated with positive health outcomes, and its implementation is recommended by multiple professional groups, but its use has not been quantified for ADHD. OBJECTIVES The goal of this study is to quantify the adherence to PCL among ADHD-related journal publications utilizing a cross-sectional study design. METHODS We conducted a cross-sectional examination including a systematic search of PubMed, which encompasses MEDLINE, for ADHD-related articles from January 2014 to March 2021. All journals with at least 20 ADHD-related search returns, human research, and in the English language were included, totaling 5,308 articles from 88 journals. Articles were randomized, and the first 500 were screened for inclusion of prespecified, non-PCL terminology. After exclusion, 311 articles were retained. RESULTS Of the 311 retained articles, 131 (42.1%) adhered to PCL guidelines. Among articles with non-PCL, stigmatizing language such as "problem(s) with [the/a] child or problem child" and "suffers from" was found most frequently- occurring in 47.6% (148/311) and 5.8% (18/311) of the articles, respectively. We found no significant association between PCL adherence and study characteristics. CONCLUSIONS Our findings revealed that over half of the current ADHD literature did not adhere to PCL guidelines. Adherence to PCL by the scientific and medical community will increase the overall efforts to mitigate stigma and increase support for individuals with ADHD.
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Affiliation(s)
- Kristyn Robling
- Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Caitlin Cosby
- Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Gunner Parent
- Oklahoma State University College of Osteopathic Medicine at the Cherokee Nation, Tahlequah, OK, USA
| | - Swapnil Gajjar
- Department of Industrial Engineering & Management, Oklahoma State University, Stillwater, OK, USA
| | - Tessa Chesher
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Michael Baxter
- Department of Pediatrics, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Micah Hartwell
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Westwood SJ, Parlatini V, Rubia K, Cortese S, Sonuga-Barke EJS. Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): a meta-analysis of randomized controlled trials with blinded and objective outcomes. Mol Psychiatry 2023; 28:1402-1414. [PMID: 36977764 PMCID: PMC10208955 DOI: 10.1038/s41380-023-02000-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 03/30/2023]
Abstract
This meta-analysis investigated the effects of computerized cognitive training (CCT) on clinical, neuropsychological and academic outcomes in individuals with attention-deficit/hyperactivity disorder (ADHD). The authors searched PubMed, Ovid, and Web of Science until 19th January 2022 for parallel-arm randomized controlled trials (RCTs) using CCT in individuals with ADHD. Random-effects meta-analyses pooled standardized mean differences (SMD) between CCT and comparator arms. RCT quality was assessed with the Cochrane Risk of Bias 2.0 tool (PROSPERO: CRD42021229279). Thirty-six RCTs were meta-analysed, 17 of which evaluated working memory training (WMT). Analysis of outcomes measured immediately post-treatment and judged to be "probably blinded" (PBLIND; trial n = 14) showed no effect on ADHD total (SMD = 0.12, 95%CI[-0.01 to -0.25]) or hyperactivity/impulsivity symptoms (SMD = 0.12, 95%[-0.03 to-0.28]). These findings remained when analyses were restricted to trials (n: 5-13) with children/adolescents, low medication exposure, semi-active controls, or WMT or multiple process training. There was a small improvement in inattention symptoms (SMD = 0.17, 95%CI[0.02-0.31]), which remained when trials were restricted to semi-active controls (SMD = 0.20, 95%CI[0.04-0.37]), and doubled in size when assessed in the intervention delivery setting (n = 5, SMD = 0.40, 95%CI[0.09-0.71]), suggesting a setting-specific effect. CCT improved WM (verbal: n = 15, SMD = 0.38, 95%CI[0.24-0.53]; visual-spatial: n = 9, SMD = 0.49, 95%CI[0.31-0.67]), but not other neuropsychological (e.g., attention, inhibition) or academic outcomes (e.g., reading, arithmetic; analysed n: 5-15). Longer-term improvement (at ~6-months) in verbal WM, reading comprehension, and ratings of executive functions were observed but relevant trials were limited in number (n: 5-7). There was no evidence that multi-process training was superior to working memory training. In sum, CCT led to shorter-term improvements in WM, with some evidence that verbal WM effects persisted in the longer-term. Clinical effects were limited to small, setting specific, short-term effects on inattention symptoms.
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Affiliation(s)
- Samuel J Westwood
- Department of Psychology, Institute of Psychiatry, Psychology, Neuroscience, King's College London, London, UK
- School of Social Science, University of Westminster, London, UK
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Edmund J S Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Fan HC, Chiang KL, Chang KH, Chen CM, Tsai JD. Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges. Int J Mol Sci 2023; 24:ijms24065270. [PMID: 36982345 PMCID: PMC10049646 DOI: 10.3390/ijms24065270] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, Hungkuang University, Taichung 433, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
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Eckard ML, Welle K, Sobolewski M, Cory-Slechta DA. A behavioral timing intervention upregulates striatal serotonergic markers and reduces impulsive action in adult male mice. Behav Brain Res 2023; 440:114267. [PMID: 36539165 PMCID: PMC9839656 DOI: 10.1016/j.bbr.2022.114267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/04/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Many studies support the hypothesis that time-based interventions reduce impulsive behavior in rodents. However, few studies have directly assessed 1) how such interventions affect impulsive action rather than impulsive choice, 2) if intervention effects differ by sex, and 3) how time-based interventions affect neurochemistry in regions mediating decision-making and reward. Thus, we assessed how a fixed-interval (FI) intervention initiated during late adolescence and extending into adulthood affected dopaminergic and serotonergic analytes in the frontal cortex and striatum and subsequent impulsive action in adult male and female mice. Beginning on postnatal day (PND) 45, mice were either trained on a progressive series of FI schedules (FI 20, 40, & 60 s) or remained in the home cage. Following the intervention, increases in striatal serotonergic analytes were found in FI-exposed males and females (n = 8/sex/group) with few changes found in the frontal cortex. Impulsive action was assessed in the remaining mice (n = 10/sex/group) using a fixed-ratio waiting-for-reward (FR-wait) task in which completion of an FR-25 component initiated a "free" pellet component in which pellets were delivered at increasing intervals according to a fixed delay increment that varied across sessions. Responses reset the additive delay and initiated a new FR-25 component. FI-exposed males, but not females, showed fewer delay resets and no-wait resets relative to control mice. Importantly, FI-exposure did not affect discrimination reversal performance in either sex. These data suggest that time-based interventions may reduce impulsive action in addition to impulsive choice perhaps with increased male sensitivity. Additionally, time-based interventions appear to operate through striatal serotonergic augmentation.
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Affiliation(s)
- M L Eckard
- Department of Psychology, Radford University, Radford, VA, USA; Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | - K Welle
- Mass Spectrometry Resource Laboratory, University of Rochester Medical Center, Rochester, NY, USA
| | - M Sobolewski
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - D A Cory-Slechta
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
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Stern P, Kolodny T, Tsafrir S, Cohen G, Shalev L. Near and Far Transfer Effects of Computerized Progressive Attention Training (CPAT) Versus Mindfulness Based Stress Reduction (MBSR) Practice Among Adults With ADHD. J Atten Disord 2023; 27:757-776. [PMID: 36794845 PMCID: PMC10173353 DOI: 10.1177/10870547231155877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE The present study evaluated the near (attention) and far (reading, ADHD symptoms, learning, and quality of life) transfer effects of a Computerized Progressive Attention Training (CPAT) versus Mindfulness Based Stress Reduction (MBSR) practice among adults with ADHD compared to a passive group. METHOD Fifty-four adults participated in a non-fully randomized controlled trial. Participants in the intervention groups completed eight 2-hr weekly training sessions. Outcomes were assessed before, immediately after, and 4 months post-intervention, using objective tools: attention tests, eye-tracker, and subjective questionnaires. RESULTS Both interventions showed near-transfer to various attention functions. The CPAT produced far-transfer effects to reading, ADHD symptoms, and learning while the MBSR improved the self-perceived quality of life. At follow-up, all improvements except for ADHD symptoms were preserved in the CPAT group. The MBSR group showed mixed preservations. CONCLUSION Both interventions have beneficial effects, however only the CPAT group exhibited improvements compared to the passive group.
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Gut Microbiome and Neurodevelopmental Disorders: A Link Yet to Be Disclosed. Microorganisms 2023; 11:microorganisms11020487. [PMID: 36838452 PMCID: PMC9964594 DOI: 10.3390/microorganisms11020487] [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: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Τhe importance of the gut microbiome and its functions has only recently been recognized and researched in greater depth. The establishment of the human gut microbiome begins in utero, forming its adult-like phenotype in the first 2-3 years of life. Several factors affect and alter the gut microbiome composition and its metabolic functions, such as early onset of breastfeeding, mode of delivery, antibiotic administration, or exposure to chemical substances, among others. Existing data support the important connection between health status and gut microbiome homeostasis. In cases when this balance is disturbed, several disorders may arise, such as inflammatory reactions that lead to atopy, eczema, or allergic asthma. The so-called gut-brain axis refers to the complex biochemical pathways between the central nervous system and the gastrointestinal system. One of the most fascinating areas of ongoing research is the broad spectrum of neurodevelopmental disorders (NDDs) and how gut health may be associated with such disorders. The prevalence of NDDs, such as autism spectrum disorder or attention deficit hyperactivity disorder, has increased over recent years. Whether gut microbiota homeostasis plays a role in these disorders is not yet fully understood. The aim of this narrative review is to provide an account of current knowledge on how gut health is linked with these disorders. We performed a literature review in order to identify and synthesize available data that highlights the potential association between NDDs and a balanced gut microbiome in terms of composition and proper function. The connection between the gut microbiome and NDDs offers promising new opportunities for future research.
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Lim CG, Soh CP, Lim SSY, Fung DSS, Guan C, Lee TS. Home-based brain-computer interface attention training program for attention deficit hyperactivity disorder: a feasibility trial. Child Adolesc Psychiatry Ment Health 2023; 17:15. [PMID: 36698168 PMCID: PMC9878772 DOI: 10.1186/s13034-022-00539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/29/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a prevalent child neurodevelopmental disorder that is treated in clinics and in schools. Previous trials suggested that our brain-computer interface (BCI)-based attention training program could improve ADHD symptoms. We have since developed a tablet version of the training program which can be paired with wireless EEG headsets. In this trial, we investigated the feasibility of delivering this tablet-based BCI intervention at home. METHODS Twenty children diagnosed with ADHD, who did not receive any medication for the preceding month, were randomised to receive the 8-week tablet-based BCI intervention either in the clinic or at home. Those in the home intervention group received instructions before commencing the program and got reminders if they were lagging on the training sessions. The ADHD Rating Scale was completed by a blinded clinician at baseline and at week 8. Adverse events were monitored during any contact with the child throughout the trial and at week 8. RESULTS Children in both groups could complete the tablet-based intervention easily on their own with minimal support from the clinic therapist or their parents (at home). The intervention was safe with few reported adverse effects. Clinician-rated inattentive symptoms on the ADHD-Rating Scale reduced by 3.2 (SD 6.20) and 3.9 (SD 5.08) for the home-based and clinic-based groups respectively, suggesting that home-based intervention was comparable to clinic-based intervention. CONCLUSIONS This trial demonstrated that the tablet version of our BCI-based attention training program can be safely delivered to children in the comfort of their own home. Trial registration This trial is registered at clinicaltrials.gov as NCT01344044.
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Affiliation(s)
- Choon Guan Lim
- Department of Developmental Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore, 539747, Singapore.
| | - Chui Pin Soh
- grid.414752.10000 0004 0469 9592Department of Developmental Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore, 539747 Singapore
| | - Shernice Shi Yun Lim
- grid.414752.10000 0004 0469 9592Department of Developmental Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore, 539747 Singapore
| | - Daniel Shuen Sheng Fung
- grid.414752.10000 0004 0469 9592Department of Developmental Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore, 539747 Singapore
| | - Cuntai Guan
- grid.59025.3b0000 0001 2224 0361School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Tih-Shih Lee
- grid.428397.30000 0004 0385 0924Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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Custodio RJP, Kim HJ, Kim J, Ortiz DM, Kim M, Buctot D, Sayson LV, Lee HJ, Kim BN, Yi EC, Cheong JH. Hippocampal dentate gyri proteomics reveals Wnt signaling involvement in the behavioral impairment in the THRSP-overexpressing ADHD mouse model. Commun Biol 2023; 6:55. [PMID: 36646879 PMCID: PMC9842619 DOI: 10.1038/s42003-022-04387-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) often struggle with impaired executive function, temporal processing, and visuospatial memory, hallmarks of the predominantly inattentive presentation (ADHD-PI), subserved by the hippocampus. However, the specific genes/proteins involved and how they shape hippocampal structures to influence ADHD behavior remain poorly understood. As an exploratory tool, hippocampal dentate gyri tissues from thyroid hormone-responsive protein overexpressing (THRSP OE) mice with defining characteristics of ADHD-PI were utilized in proteomics. Integrated proteomics and network analysis revealed an altered protein network involved in Wnt signaling. Compared with THRSP knockout (KO) mice, THRSP OE mice showed impaired attention and memory, accompanied by dysregulated Wnt signaling affecting hippocampal dentate gyrus cell proliferation and expression of markers for neural stem cell (NSC) activity. Also, combined exposure to an enriched environment and treadmill exercise could improve behavioral deficits in THRSP OE mice and Wnt signaling and NSC activity. These findings show new markers specific to the ADHD-PI presentation, converging with the ancient and evolutionary Wnt signaling pathways crucial for cell fate determination, migration, polarity, and neural patterning during neurodevelopment. These findings from THRSP OE mice support the role of Wnt signaling in neurological disorders, particularly ADHD-PI presentation.
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Affiliation(s)
- Raly James Perez Custodio
- grid.419241.b0000 0001 2285 956XDepartment of Ergonomics, Leibniz Research Centre for Working Environment and Human Factors - IfADo, Ardeystr. 67, 44139 Dortmund, Germany ,grid.412357.60000 0004 0533 2063Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu Seoul, 01795 Republic of Korea ,grid.411545.00000 0004 0470 4320Institute for New Drug Development, College of Pharmacy, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si Jeollabuk-do, 54896 Republic of Korea
| | - Hee Jin Kim
- grid.412357.60000 0004 0533 2063Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu Seoul, 01795 Republic of Korea
| | - Jiyeon Kim
- grid.31501.360000 0004 0470 5905Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Seoul National University, Seoul, 03080 Republic of Korea
| | - Darlene Mae Ortiz
- grid.412357.60000 0004 0533 2063Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu Seoul, 01795 Republic of Korea
| | - Mikyung Kim
- grid.412357.60000 0004 0533 2063Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu Seoul, 01795 Republic of Korea ,grid.412357.60000 0004 0533 2063Department of Chemistry & Life Science, Sahmyook University, 815 Hwarangro, Nowon-gu Seoul, 01795 Republic of Korea
| | - Danilo Buctot
- grid.412357.60000 0004 0533 2063Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu Seoul, 01795 Republic of Korea
| | - Leandro Val Sayson
- grid.412357.60000 0004 0533 2063Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu Seoul, 01795 Republic of Korea
| | - Hyun Jun Lee
- grid.412357.60000 0004 0533 2063Uimyung Research Institute for Neuroscience, Department of Pharmacy, Sahmyook University, 815 Hwarangro, Nowon-gu Seoul, 01795 Republic of Korea
| | - Bung-Nyun Kim
- grid.31501.360000 0004 0470 5905Department of Psychiatry and Behavioral Science, College of Medicine, Seoul National University, 101 Daehakro, Jongno-gu Seoul, 03080 Republic of Korea
| | - Eugene C. Yi
- grid.31501.360000 0004 0470 5905Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Seoul National University, Seoul, 03080 Republic of Korea
| | - Jae Hoon Cheong
- grid.411545.00000 0004 0470 4320Institute for New Drug Development, College of Pharmacy, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju-si Jeollabuk-do, 54896 Republic of Korea
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Klöbl M, Prillinger K, Diehm R, Doganay K, Lanzenberger R, Poustka L, Plener P, Konicar L. Individual brain regulation as learned via neurofeedback is related to affective changes in adolescents with autism spectrum disorder. Child Adolesc Psychiatry Ment Health 2023; 17:6. [PMID: 36635760 PMCID: PMC9837918 DOI: 10.1186/s13034-022-00549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/18/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Emotions often play a role in neurofeedback (NF) regulation strategies. However, investigations of the relationship between the induced neuronal changes and improvements in affective domains are scarce in electroencephalography-based studies. Thus, we extended the findings of the first study on slow cortical potential (SCP) NF in autism spectrum disorder (ASD) by linking affective changes to whole-brain activity during rest and regulation. METHODS Forty-one male adolescents with ASD were scanned twice at rest using functional magnetic resonance imaging. Between scans, half underwent NF training, whereas the other half received treatment as usual. Furthermore, parents reported on their child's affective characteristics at each measurement. The NF group had to alternatingly produce negative and positive SCP shifts during training and was additionally scanned using functional magnetic resonance imaging while applying their developed regulation strategies. RESULTS No significant treatment group-by-time interactions in affective or resting-state measures were found. However, we found increases of resting activity in the anterior cingulate cortex and right inferior temporal gyrus as well as improvements in affective characteristics over both groups. Activation corresponding to SCP differentiation in these regions correlated with the affective improvements. A further correlation was found for Rolandic operculum activation corresponding to positive SCP shifts. There were no significant correlations with the respective achieved SCP regulation during NF training. CONCLUSION SCP NF in ASD did not lead to superior improvements in neuronal or affective functioning compared to treatment as usual. However, the affective changes might be related to the individual strategies and their corresponding activation patterns as indicated by significant correlations on the whole-brain level. Trial registration This clinical trial was registered at drks.de (DRKS00012339) on 20th April, 2017.
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Affiliation(s)
- Manfred Klöbl
- Department of Psychiatry & Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Robert Diehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Kamer Doganay
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry & Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, Medical University of Göttingen, Göttingen, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Lilian Konicar
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
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