Health Care Trajectories for Children With ADHD in France: Results From the QUEST Survey

Impact of online health education on attention-deficit/hyperactivity disorder screening results and parenting stress among school-aged children

Aims

To investigate the effects of an online health education lecture on the positive screening rate of attention-deficit/hyperactivity disorder (ADHD) and parenting stress among parents of children diagnosed with or screened positive for ADHD.

Methods

Using stratified proportional random cluster sampling, 14 primary schools in Chongqing were selected to conduct an online lecture about ADHD for parents and teachers. A total of 2,611 questionnaires were collected (1,508 intervention group, 1,103 control group).

Results

The lecture did not significantly affect the positive screening rate of ADHD (parents: β=-0.37, p=0.208; teachers: β=0.53, p=0.338); however, the positive screening rate increased post-intervention. Inattention scores were higher in the intervention group (β=0.42, p=0.040). Parents as primary caregivers were associated with lower ADHD symptom scores (β=-0.61, p=0.022). Lower parental education levels were associated with higher ADHD screening rates (β=0.49, p=0.039) and symptom scores (β=0.60, p=0.022). Teachers with 10-19 years of experience had higher positive screening rates (β=1.26, p=0.005) and symptom scores (β=2.60, p<0.001). The intervention did not affect parenting stress (Z=-1.413, p=0.158).

Conclusions

The lecture's effects were relatively weak, using questionnaires may have facilitated health communication. Individual characteristics of parents and teachers should be considered in assessments (ClinicalTrial.gov ID: NCT05231902).

Digital Homework Support Program for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Protocol for a Randomized Controlled Trial

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) affects 4% to 5% of the general population. Homework sessions are frequent conflictual moments characterized by increased anxiety in children and stress in their parents, contributing to a lower family quality of life. Children with ADHD experience more severe homework problems than typically developing peers. Poor academic performance in individuals with ADHD is partly attributed to challenging homework. Psychoeducational and school-based approaches are time-consuming and not fully accessible to professionals. Digital tools, such as smartphone and tablet apps, might offer an interesting alternative. We present our digital homework support program for children and adolescents, known as "Programme d'Aide Numérique aux Devoirs pour Enfant avec TDA-H" (PANDAH), along with the study protocol of our ongoing randomized controlled trial.

OBJECTIVE

This study aims to test PANDAH's efficacy in improving homework performance and family quality of life.

METHODS

Individuals aged 9-16 years with an ADHD diagnosis and no comorbid psychiatric disorders are included. This is a multicenter study involving 9 reference centers for ADHD in France. The study comprises (1) a 3-month period with a randomized controlled trial design, where participants are divided into 2 parallel groups (group 1: care as usual or waiting list; group 2: PANDAH app), followed by (2) an extension period of 3 months (months 3-6), during which all participants will have access to the app. This second phase serves as a crucial incentive for patients initially randomly assigned to group 1. Assessments will be conducted at baseline, month 3, and month 6 for each patient by trained psychologists. The primary end point will be the global Homework Performance Questionnaire (HPQ), Parent version score at 6 months. The main analysis will adhere to the "intent-to-treat principle" (all patient data will be analyzed according to their initial group determined by randomization). We expect (1) HPQ score improvement in individuals using the app during the first 3-month period compared to individuals not using the app; (2) greater HPQ score improvement for individuals using the app for 6 months compared to those using the app for 3 months only; and (3) adherence to the PANDAH program, measured with in-app metrics.

RESULTS

Recruitment began in January 2024, and the trial is ongoing.

CONCLUSIONS

This study contributes to the digital transformation of health care. The use of smartphone apps in self-care and self-management is a societal phenomenon, and its implementation in the field of psychiatry is of particular interest. The app might serve as both valuable support for patients and an opportunity for parents to distance themselves from conflict-laden homework sessions. Since the market for smartphone apps in the health care and well-being sector is primarily industry driven, it is crucial to have an academic conception and evaluation of such digital tools.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04857788; https://clinicaltrials.gov/ct2/show/NCT04857788.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44553.

Trends in Pediatric Attention-Deficit Hyperactive Disorder Diagnoses and Prescription Utilization: 2016 to 2019

OBJECTIVE

Attention-deficit hyperactive disorder (ADHD) is one of the most common psychiatric disorders among children, with estimated prevalence of 7% to 15% worldwide. The aim of this analysis was to update and summarize trends in diagnosis, demographics, and drug utilization of pediatric patients with ADHD.

METHODS

We used the Agency for Health care Research and Quality Medical Expenditure Panel Survey (MEPS), a survey of US individuals, families, their medical providers, and employers, using datasets from 2016 to 2019. The data sources from the MEPS database included the full-year consolidated files, medical conditions files, prescribed-medicines files, and condition-event link files for each year. We summarized trends in the proportion of children, ages 17 years and younger, with a diagnosis of ADHD, demographic information and a prescription for medication known to treat ADHD. In addition, we further stratified ADHD medication use by stimulant/nonstimulant categories.

RESULTS

There was a 1.6% and 4.7% absolute increase in children with an ADHD diagnosis and those prescribed ADHD medications, respectively, from 2016 to 2019. Most of these children were male, non-Hispanic, and on public insurance. Of the children prescribed an ADHD medication and concomitant behavioral medications, stimulants-only use was the highest (60%-67%), followed by stimulants/nonstimulants (13%-15%), stimulant/antidepressants (6%-9%), and nonstimulants only (5%-9%). The proportion of patients with ADHD in the high-income and near-poor categories increased by 4% from 2016 to 2019.

CONCLUSION

Diagnosis of ADHD among children is trending upward in the United States. Central nervous system stimulants, especially methylphenidate formulations, are the most prescribed ADHD medications for children 17 years and younger.

Age at diagnosis and diagnostic delay across attention-deficit hyperactivity and autism spectrums

BACKGROUND

Despite the known benefits of accurate and timely diagnosis for children with attention-deficit hyperactivity disorder and autism spectrum disorders (autism), for some children this goal is not always achieved. Existing research has explored diagnostic delay for autism and attention-deficit hyperactivity disorder only, and when attention-deficit hyperactivity disorder and autism co-occur, autism has been the focus. No study has directly compared age at diagnosis and diagnostic delay for males and females across attention-deficit hyperactivity disorder, autism and specifically, attention-deficit hyperactivity disorder + autism.

METHODS

Australian caregivers (N = 677) of children with attention-deficit hyperactivity disorder, autism or attention-deficit hyperactivity disorder + autism were recruited via social media (n = 594) and the Monash Autism and ADHD Genetics and Neurodevelopment Project (n = 83). Caregivers reported on their child's diagnostic process. Diagnostic delay was the mean difference between general initial developmental concerns and the child's attention-deficit hyperactivity disorder and autism diagnosis.

RESULTS

Children with autism were significantly younger at autism diagnosis than the attention-deficit hyperactivity disorder + autism group (ηp2 = 0.06), whereas children with attention-deficit hyperactivity disorder were significantly older at attention-deficit hyperactivity disorder diagnosis than the attention-deficit hyperactivity disorder + autism group (ηp2 = 0.01). Delay to attention-deficit hyperactivity disorder and autism diagnosis was significantly longer in the attention-deficit hyperactivity disorder + autism group compared to attention-deficit hyperactivity disorder (ηp2 = 0.02) and autism (η2 = 0.04) only. Delay to autism diagnosis for females with autism (η2 = 0.06) and attention-deficit hyperactivity disorder + autism (η2 = 0.04) was longer compared to males.

CONCLUSIONS

Having attention-deficit hyperactivity disorder + autism and being female were associated with longer delays to diagnosis. The reasons for these delays and possible adverse effects on outcomes require further study.

Bibliometric analysis of publications on attention deficit hyperactivity disorder (ADHD) in France since 1974

BACKGROUND

The predominance of the psychodynamic approach is often put forward to explain the delay in diagnosis and treatment of attention-deficit disorder with hyperactivity (ADHD) reported in France.

OBJECTIVE

A bibliometric study of abstracts, articles, or letters authored by French researchers may provide objective insight into this issue.

METHODS

Online electronic databases were searched without any date limits for documents related to ADHD, and allocated to the AllFR group when all authors had an affiliation in France or to the notAllFR group when at least one author had an affiliation in France. Publications expressing any psychodynamic point of view on the causes and/or treatment of ADHD were identified.

RESULTS

A total of 747 documents were analyzed: 417 were exclusively indexed in SCOPUS, and 418 were allocated to the AllFR group. Compared with documents in the notAllFR group, documents in the AllFR group were written by a smaller number of authors (median 3 vs. 6, p<0.002), more frequently evoked psychodynamic concepts (10.45% vs. 1.67%, p<0.001), and less frequently acknowledged the persistence of ADHD in adulthood (29.10% vs. 42.14%). The psychodynamic approach was likely to rely on case reports of fewer than three children.

CONCLUSIONS

Any serious review of the literature should pool documents from several online databases, especially SCOPUS. In publications by only French authors, the psychodynamic approach seems predominant and the persistence of ADHD in adulthood is overlooked. This may concur with the excessive delay observed in the diagnosis and treatment of children and adults in France compared to other European countries.

Time of onset and/or diagnosis of ADHD in European children: a systematic review

BACKGROUND

Attention-Deficit/ Hyperactivity Disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Symptoms related to this disorder cause a significant impairment in school tasks and in the activities of children's daily lives; an early diagnosis and appropriate treatment could almost certainly help improve their outcomes. The current study, part of the Models Of Child Health Appraised (MOCHA) project, aims to explore the age at which children experience the onset or diagnosis of ADHD in European countries.

METHODS

A systematic review was done examining the studies reporting the age of onset/diagnosis (AO/AD) of ADHD in European countries (28 European Member States plus 2 European Economic Area countries), published between January 1, 2010 and December 31, 2019. Of the 2276 identified studies, 44 met all the predefined criteria and were included in the review.

RESULTS

The lowest mean AO in the children diagnosed with ADHD alone was 2.25 years and the highest was 7.5 years. It was 15.3 years in the children with ADHD and disruptive behaviour disorder. The mean AD ranges between 6.2 and 18.1 years.

CONCLUSIONS

Our findings indicate that there is a wide variability in both the AO and AD of ADHD, and a too large distance between AO and AD. Since studies in the literature suggest that an early identification of ADHD symptoms may facilitate early referral and treatment, it would be important to understand the underlying reasons behind the wide variability found.

TRIAL REGISTRATION

PROSPERO registration: CRD42017070631 .

Does level of attention deficit-hyperactivity disorder symptoms predicts poor transition into adulthood?

OBJECTIVES

Transition into adulthood is a risky period for young people with attention deficit-hyperactivity disorder (ADHD), but empirical studies on this topic are scarce. This study investigated the association between the level of ADHD symptoms and transition into adulthood.

METHODS

Data were collected in the Cohort Study of Substance Use and Risk Factors among a representative sample of young Swiss men (n = 4681) over three waves. Measures included the level of ADHD symptoms and emerging adulthood assessed with the Inventory of the Dimensions of Emerging Adulthood and indicators of successful transition into adulthood.

RESULTS

The level of ADHD symptoms was associated with a lower success in the transition into adulthood. Young people with high level of ADHD symptoms had a reduced increase in indicators of successful transition over time. Inattention symptoms were more strongly associated with emerging adulthood measures in comparison with hyperactive symptoms.

CONCLUSIONS

The level of ADHD symptoms may delay the transition into adulthood, especially inattentive symptoms. Providing tailored interventions to emerging adults with ADHD symptoms may decrease the substantial impairments adults with ADHD experience in life.

Pathway to care and clinical profile of children with attention-deficit hyperactivity disorder in New Delhi, India

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is a common childhood neurobehavioral disorder, which may cause impairment in multiple domains. Understanding the pathway to care helps in planning effective early interventions. The study aims to provide a quantitative description of the factors affecting the help-seeking pathway.

MATERIALS AND METHODS

The study was conducted at an outpatients department of a tertiary care multispecialty hospital. Fifty consecutive consenting children aged 5-15 years were screened and diagnosed for ADHD using Conners' Parent Rating Scale-Revised: Short Form, Diagnostic and Statistical Manual of Mental Disorders fourth edition text revision criteria, and Kiddie Schedule for affective disorders and schizophrenia. A semi-structured questionnaire was used to study the pathway of care, using the WHO template. The data were analyzed using appropriate parametric and nonparametric tests in SPSS software.

RESULTS

The average delay from the onset of the illness to first consultation with a qualified health professional was 2.32 ± 1.9 years. Children with an urban background, from a nuclear family, with literate mothers, with a family income of more than Rs. 30,000/month, having hyperactive and combined type of ADHD, and who were referred by school teachers presented significantly earlier. The main source of referrals were school teachers and general medical practitioners. The most common parental beliefs for delay were the views that the "child is naughty" and that "hyperactivity is part of normal growth."

CONCLUSION

Parents' help-seeking behavior is affected by different sociocultural beliefs. Such factors as the lack of recognition and awareness of ADHD, resulting in the delay in seeking treatment should be addressed through health promotion programs.

Access to diagnosis, treatment, and supportive services among pharmacotherapy-treated children/adolescents with ADHD in Europe: data from the Caregiver Perspective on Pediatric ADHD survey

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders and negatively impacts caregivers' lives. Factors including barriers to accessing care, dissatisfaction with support services, and lack of caregiver resources may contribute to this.

OBJECTIVES

To report caregivers' experiences of ADHD diagnosis, behavioral therapy (BT), and supportive care for children/adolescents with ADHD.

METHODS

The Caregiver Perspective on Pediatric ADHD (CAPPA) survey included caregivers of children/adolescents (6-17 years) from ten European countries who were currently receiving/had received ADHD pharmacotherapy in the previous 6 months. Caregivers reported experiences of obtaining an ADHD diagnosis, access to BT, availability of caregiver resources, and level of health care/school support. Pan-EU and country-specific descriptive statistics are reported; responses were compared across countries.

RESULTS

Of 3,616 caregivers, 66% were female. Mean age of children/adolescents was 11.5 years; 80% were male. Mean time from the first doctor visit to diagnosis was 10.8 (95% confidence interval 10.2, 11.3) months; 31% of caregivers reported the greatest degrees of difficulty in obtaining an ADHD diagnosis; 44% of children/adolescents did not receive BT. Forty-seven percent of caregivers reported that sufficient resources were available, 44% were "very satisfied"/"satisfied" with medical care, and 50% found health care providers "very supportive"/"somewhat supportive". Mainstream schools were attended by 82% of children/adolescents. Of those, 67% of caregivers thought schools could help more with the child/adolescent's ADHD and 48% received extra help/special arrangement. Results varied significantly between countries (P<0.001, all parameters).

CONCLUSION

Almost a third of caregivers reported a high degree of difficulty in obtaining an ADHD diagnosis for their child/adolescent, less than half felt that sufficient resources were available, and gaps in support from health care providers/schools were identified. Findings underscore the need to improve access to diagnosis and provision of supportive services to enable better standards of care, and potentially reduce the impact of child/adolescent ADHD on caregivers' lives.