Do we over-diagnose ADHD in North America? A critical review and clinical recommendations

There has been a marked increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD) in the last 25 years in North America. Some see this trend as positive and believe that it reflects a better identification of ADHD and even think that the disorder is still under-diagnosed. Others, however, contend that ADHD is over-diagnosed. To help mental health clinicians to maintain an informed and nuanced perspective on this debate, this critical review aims to (1) summarize empirical results on factors that might contribute to increase the number of ADHD diagnoses and (2) propose clinical recommendations coherent with these findings to improve clinical practices for ADHD assessment and treatment. We conclude that artifactual factors such as current formulation of diagnostic criteria, clinical practices, and inordinate focus on performance, which is rampant in North America, likely contribute to inflated prevalence rates.

Virtual reality as a screening tool for sports concussion in adolescents

PRIMARY OBJECTIVE

There is controversy surrounding the cognitive effects of sports concussion. This study aimed to verify whether the technique of virtual reality could aid in the identification of attention and inhibition deficits in adolescents.

STUDY DESIGN

A prospective design was used to assess 25 sports-concussed and 25 non-sports-concussed adolescents enrolled in a sport and education programme.

METHODS AND PROCEDURES

Participants were evaluated in immersive virtual reality via ClinicaVR: Classroom-CPT and in real life via the traditional VIGIL-CPT.

MAIN OUTCOMES AND RESULTS

The neuropsychological assessment using virtual reality showed greater sensitivity to the subtle effects of sports concussion compared to the traditional test, which showed no difference between groups. The results also demonstrated that the sports concussion group reported more symptoms of cybersickness and more intense cybersickness than the control group.

CONCLUSIONS

Sports concussion was associated with subtle deficits in attention and inhibition. However, further studies are needed to support these results.

Comparative study of the cognitive sequelae of school-aged victims of Shaken Baby Syndrome

OBJECTIVE

Shaken Baby Syndrome (SBS) is now recognized as being the main cause of severe traumatic brain injury in infancy. However, our understanding of the impact of this type of abuse on child development remains sketchy. The main objective of the current study was therefore to shed light on the cognitive dysfunctions that are particular to SBS victims once they are school-aged.

METHOD

A clinical group was formed of 11 children diagnosed with SBS who had been admitted between 1988 and 1999 to a tertiary pediatric hospital in Quebec, Canada. The children were matched for age, gender, socio-economic status, and family composition to 11 healthy Quebec children, who made up the control group. A battery of composite tests was developed to assess the children's main cognitive functions and was administered individually to the 22 children. A univariate t-test was used to compare the performances of the two groups.

RESULTS

The mean age of the children in the clinical and control groups at the time of the assessment was 87.64 months and 90.18 months, respectively. Pairing and birth data were equivalent for both groups. Significant weaknesses were noted in the clinical group for intelligence quotient (IQ), working memory, mental organization, alternation, and inhibition. These deficits seemed to have a greater impact on the verbal sphere of the children's mental functioning.

CONCLUSION

Primary results point to the anterior cerebral regions of the brain as the principal site of dysfunctions that persist years post-trauma. It is important to consider these results longitudinally, even in children apparently less extensively affected, since the frontal regions only reach maturity at the end of adolescence.