Expected changes in parenting after an online parent training for ADHD

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Treatments for this population should be multidisciplinary and must be initiated as early as possible. Non-pharmacological interventions for ADHD include psychoeducation, parent behavioural training programs and school interventions and accommodations. In response to the COVID-19 pandemic, we developed an online version of a combined psychoeducation and behavioural training program to facilitate access to mental health treatment and ensure continuity of care.

OBJECTIVE

The study assessed the acceptability of this online parent training program, among parents and caretakers of children and adolescents with ADHD.

METHODS

The program consisted of ten online sessions over the course of two consecutive days (five sessions a day). Satisfaction, usefulness and general comments about the program were assessed with open-ended questions and visual-analogous scales. Parents/caretakers' use of strategies to manage behavioural problems was assessed using the Parenting and Family Adjustment Scales.

RESULTS

A total of 206 parents participated in the online program 175 of whom completed the evaluation. Participants were satisfied with the content of the program. More than half of participants had already started using strategies included in the program. The engagement was high and no major obstacles were identified other than some internet connection issues.

DISCUSSION

In our survey, online delivery was described as more convenient, and participants were satisfied with the content of the program finding it beneficial for their child. Despite this, some difficulties in implementing new strategies were observed. Online BTP increased access to the BTP programs while being effective on ADHD symptoms and behavioural disturbances.

CONCLUSIONS

With these measures, we hope to improve engagement in online psychoeducation and behavioural therapy programs. Future research evaluating online behavioural training programs should focus on ways to make them more accessible and adaptable to families' obstacles.

Adaptation of the working alliance inventory to therapeutic interventions for early-age regulatory and behavioral symptoms: French versions of the infant-toddler WAI for parents and therapists

OBJECTIVES

The therapeutic alliance, an essential component of the therapeutic process, has been investigated in adult and child therapy, but studies in the context of parent-infant or parent-toddler therapeutic interventions are scarce. This monocentric study aims to produce a French cross-cultural adaptation of a therapeutic alliance scale for the context of early consultations in a child and psychiatry department.

METHOD

Fifty-five young children aged 3 to 30 months consulting for regulation or behavioral disorders and their mothers were included in the study. The working alliance inventory (WAI) was translated into French by two bilingual translators and adapted to early-age consultations in parent and therapist versions. Assessments of the child's symptoms and the parents' anxiety and depression were carried out at the start and end of therapy. We studied the association of the alliance with the initial clinical characteristics and with the outcome of the child and the mother. An exploratory factor analysis was performed considering the items most associated with expected outcomes.

RESULTS

The alliance coded by the mother was lower in case of child behavioral problems and was associated with the mother and child outcome. Short versions of the infant-toddler WAI were developed based on factor analysis, highlighting four factors: positive goals and tasks, bond with the mother, alliance with the child, negative experience of care relationship.

DISCUSSION

Results were similar to those found in therapy with adults or older children. The alliance issue in mother-baby therapies was as essential as in other therapy contexts. The short Infant-Toddler WAI resulting from this work must be validated in future studies.

Social representations of intellectual disability; a comparison between cultures

OBJECTIVES

People with Intellectual disability consistently appear to be one of the most looked-down upon and repressed subgroups of society in many cultures. The main aim of this study was to compare social representations of intellectual disability in its various aspects between different cultures.

MATERIALS AND METHODS

The study was conducted in four different sites: Beirut-Lebanon, Algiers-Algeria, Tours-France and Namur-Belgium. Participants were asked to complete a questionnaire evaluating social representations of intellectual disability.

RESULTS

A total of 755 participants consented to take part in the study. Gender only affected social representations in the Lebanese population. Overall, Algerians appeared to have the least positive social representations and Lebanon to have more positive attitudes, while France and Belgium tended to have the most favourable representations.

DISCUSSION AND CONCLUSIONS

Findings highlight the imbalance between a European and a non-European country showing the importance of developing tailored interventions to improve general attitudes towards intellectual disability.

Validation of the French version of the Emotion and Regulation Beliefs Scale (ERBS) and Dissociation Belief Scale (DBS)

INTRODUCTION

Dissociation is a recurrent symptom of post-traumatic stress disorder (PTSD) and is associated with emotional dysregulation. Beliefs about emotions seem to be involved in emotional dysregulation but have not been studied in relation to dissociation. Likewise, there is currently little empirical evidence of beliefs about dissociation. The aims of the study were to validate psychometric tools assessing these beliefs, to assess their role in dissociation, and to explore the mediating role of emotional dysregulation and beliefs about dissociation in the relationship between beliefs about emotion and dissociation.

METHOD

We recruited a sample from the general population (n=1009) and a sample of patients with PTSD (n=90). All participants completed self-report questionnaires to evaluate symptoms of PTSD (PTSD Checklist/Impact of Event Scale, PCL-5/IES-6), dissociation (Dissociative Experiences Scale, DES), difficulties in emotion regulation (Difficulties in Emotion Regulation Scale, DERS), beliefs about dissociation (Dissociation Beliefs Scale, DBS), and beliefs about emotion (Emotion and Regulation Beliefs Scale, ERBS).

RESULTS

The questionnaires used to assess the beliefs about emotion (ERBS) and dissociation (DBS) had good psychometric properties. Dissociation was positively associated with positive and negative beliefs about dissociation and with negative beliefs about emotions in both the clinical and non-clinical groups. The relationship between beliefs about emotions and dissociation was mediated by emotional dysregulation and positive beliefs about dissociation in both groups.

CONCLUSION

The ERBS and DBS are effective tools to assess beliefs. Beliefs about emotion and dissociation seem to be involved in dissociative manifestations in both clinical and non-clinical individuals.

Anxiety and sleep quality in a sample of Lebanese healthcare workers during the COVID-19 outbreak

A cross-sectional, survey based study was conducted in order to assess mental health outcomes among healthcare workers in a private university hospital involved in the COVID-19 response in Lebanon. The main objective was to quantify symptoms of anxiety and sleep quality using self-rating scales (the State-Trait Anxiety Inventory (STAI) and Pittsburgh Sleep Quality Index (PSQI) respectively), while identifying factors that might affect those symptoms. A total of 628 healthcare workers completed the survey; 409 (66.2%) were younger than 40 years, and 441 (71.4%) were women. Of all participants, 503 (81.4%) were nurses, 52 (8.4%) were physicians and 63 (10.2%) were residents. Registered nurses, residents, women, and younger participants presented higher scores on both scales than other categories of participants. Among factors related with COVID-19, those associated with higher scores were having relatives affected by the virus (22.2%), being excessively exposed to media (12.9%), and increasing the consumption of substances/alcohol (31.2%) during this period. Factors associated with higher risk of anxiety symptoms after multivariable logistic regression analysis were: female sex, young age, poor sleep quality, and living with elderly. Our findings contribute to the understanding of the psychological wellbeing of health care workers involved in the acute COVID-19 outbreak in Lebanon.

[Effect of SSRIs on bone metabolism]

INTRODUCTION

SSRIs have been shown to affect bone health in adults, but this has been poorly studied in children. Given the frequency of SSRI prescription in children and adolescents, it is crucial to evaluate the impact of SSRIs on bone growth because the bone mass attained early in life is the most important predictor of a normal bone constitution. Experimental studies have demonstrated a direct functional role of serotonin in bone metabolism, independently of hyperprolactinemia or growth hormone levels. We have reviewed the literature on serotonin and bone metabolism, including experimental studies, clinical studies in adults as well as in the pediatric population.

EXPERIMENTAL STUDIES

Experimental studies have shown that 5-HT transporter (5-HTT) is expressed in all kind of bone cells and is highly specific of the 5-HT recapture. 5-HTT inhibition by the SSRIs in these cells affects their function in vitro. Even though a few studies have suggested exposure to SSRIs could be beneficial by an anabolic effect on the trabecular bone, more concluding studies have demonstrated that SSRIs negatively affect bone growth, resulting in a specific bone phenotype including a reduction in bone mass, an altered bone architecture, and decreased mechanical properties. This phenotype is most probably the consequence of a decrease in bone formation, rather than an increase in bone resorption and is a direct and dose-dependent effect. However, many aspects of this bone effect of 5-HTT inhibition need to be further clarified, including the signal ways for 5-HTT and 5-HT receptors, origins of 5-HT in bone, and methods to isolate the inhibitory effect of 5-HTT specifically on bone.

CLINICAL STUDIES

Metabolic and neuroendocrine side effects have been documented in children and adolescents taking SSRIs but the specific and direct effect of these molecules on bone metabolism has been poorly studied in this population. In adults, clinical studies have shown an association between the use of SSRIs and bone demineralization as well as reduction in bone mass, especially in the elderly and post-menopausal women. However, depression itself has been associated with a lower bone mass and increased risk of osteoporosis. In children, case reports show a decrease in growth due to a decreased secretion of growth hormone, but not by a direct effect. One cross-sectional study suggests a decrease in bone mass following SSRI treatment that is independent of variation in prolactin levels, but without elevation of fracture risk. These results, however, need to be replicated in further studies.

CONCLUSION

Our review shows that experimental studies have demonstrated the implication of the serotonin system in bone metabolism. Mice with genetic disruption of 5-HTT have a bone phenotype of decreased bone mass, altered architecture, and decreased mechanical properties. Clinical studies exploring the effect of SSRIs on bone metabolism are scarce in children. However, results in adults tend to show a deleterious effect in the elderly. Regarding the frequency of SSRI prescription in the pediatric population, it is becoming urgent to better explore the effect of SSRIs on bone growth of children, as it can have major implications on the ulterior follow-up and on the precautions to take.

[Review of cases of prolonged QTC and wave burst arrhythmia in patients treated with methadone]

INTRODUCTION

For the past 40 years, methadone has been known to be an efficient treatment of substitution. Its use allowed a significant reduction in the mortality related to opioid addiction. Since 2001, many articles have reported some cases of syncope, wave burst arrhythmia, ventricular tachycardia due to prolonged QT interval and sudden death secondary to cardiac arrest, with a risk of prolongation of the QT interval above 440 ms (men) and 460 ms (women). Many explorations have helped in understanding the physiopathology by showing that opioids, including methadone, cause a blockage of the potassium channels of the gene HERG K+P. This event could slow the repolarisation and the atrioventricular cardiac synchronization and could induce ventricular arrhythmia.

LITERATURE FINDINGS

Nearly 20 studies showed a prolonged QT interval secondary to methadone in patients exhibiting the following features: (1) patients with cardiac pathologies, notably bradycardia, congenital long QT interval, myocardial pathologies related to AIDS and electrolyte disturbances; (2) patients receiving concomitant treatment with substances known to prolong QT interval, such as psychoactive stimulants, narcoleptics, tricyclic antidepressants, antiarrhythmic agents, macrolids, quinolones, non diuretic hypokalemiants and certain corticoids; (3) patients receiving treatments that inhibit methadone's metabolism, particularly those that act on the cytochrome P450 3A4 such as SSRI, antifungal agents, some macrolids and some retroviral agents. Many recent studies, while evaluating the dose-dependent effect of methadone on the QT prolongation, showed a tendency to a prolonged QT when using higher doses of methadone.

CONCLUSION

Screening for these risk factors should be carried out before prescribing methadone. EKG should not be systematically performed unless the conditions described above are present or if a higher dose of methadone is needed.