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Background: Neuroinflammation seems to be involved in ADHD pathogenesis. Recently, in this regard, some evidence suggests the possibility of an autoimmune mechanism related to anti-Purkinje cell antibodies. The aim of this paper is to confirm this evidence searching for a possible specificity for some subtype of ADHD., Methods: We studied 112 consecutive drug-naïve Caucasian ADHD outpatients, who were attending their first psychiatric examination (91 males and 21 females; median age =108.14 months; sd=34.58 months). K-SADS interview and ADHD rating scale were used for a DSM 5 diagnosis of ADHD and subtype. WISCIII and a validated list of words were used to assess a possible dyslexia. Antibodies to Yo (Purkinje cell cytoplasmic antibody type 1 [PCA-1]) were detected by indirect immunofluorescence assay., Results: Forty-nine point one percent (55) of ADHD children were positive to Anti-Yo antibodies. A lower percentage than in previous studies. We found that in the Anti-Yo positive children, the subtype most represented was significantly the combined subtype. No significant relation was found with ADHD plus Dyslexia children., Conclusions: The number of ADHD subjects positive to Anti-Yo antibodies is less than in previous studies, but it remains interesting and it is more likely to find a positive child in the combined ADHD than in the other subtypes.

Background: Recent literature highlighted the relevance of parenting strategies and emotions in dealing with children with ADHD and showed that these dimensions were highly affected by the COVID-19 lockdowns. Thus, our research investigated the impact that the COVID-19 pandemic had on caregivers of children with attention deficit hyperactivity disorder (ADHD). We focused on the role of medications, children's age, and distance learning on changes in caregivers' emotions and parenting strategies., Methods: Nine hundred ninety-two caregivers completed an anonymous online questionnaire. The survey enquired caregivers about children's pharmacological therapy, difficulties in distance learning, and caregivers' parenting strategies and emotions before and during the lockdown., Results: Our results showed that caregivers experienced relevant difficulties in distance learning and that they felt more frustration emotions and employed more negative parenting strategies than before the pandemic. While pharmacological therapy was not a significant predictor of changes in neither positive nor negative parenting strategies, children's age and learning burden proved to predict caregivers' changes in positive parenting strategies. Moreover, our mediation analysis showed that the learning burden (e.g., homework increasing and children's reliance on caregivers) partially mediates the effect of age on changes in positive strategies. The older the children, the less the burden, and the less the change in positive strategies., Conclusions: These results describe lockdown's impact on caregivers' experience in dealing with children with ADHD and explain how they adapted to it by changing their parenting strategies.

Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Study Objectives: The aim was to describe sleep habits and epidemiology of the most common sleep disorders in Italian children and adolescents., Methods: This was a cross-sectional study in which parents of typically developing children and adolescents (1-18 years) completed an online survey available in Italy, gathering retrospective information focusing on sleep habits and disorders., Results: Respondents were 4,321 typically developing individuals (48.6% females). Most of our sample did not meet the age-specific National Sleep Foundation recommendations for total sleep duration (31.9% of toddlers, 71.5% of preschoolers, 61.6% of school-age children, and 41.3% of adolescents). Napping was described in 92.6% of toddlers and in 35.2% of preschoolers. Regarding geographical differences, children and adolescents of northern Italy showed more frequent earlier bedtimes and rise times than their peers of central and southern Italy. The most frequently reported sleep disorder in our sample was restless sleep (35.6%), followed by difficulties falling asleep (16.8%), > 2 night awakenings (9.9%), and bruxism (9.6%). Data also suggest that longer screen time is associated with later bedtimes on weekdays in all age groups., Conclusions: The current study shows that Italian children are at risk of sleep disorders, particularly insufficient sleep, restless sleep, and difficulty falling asleep. The study also provides normative sleep data by age group in a large cohort of typically developing Italian children, emphasizing the importance of the developmentally, ecologically, and culturally based evaluation of sleep habits and disorders., Citation: Breda M, Belli A, Esposito D, et al. Sleep habits and sleep disorders in Italian children and adolescents: a cross-sectional survey. J Clin Sleep Med . 2023;19(4):659-672., (© 2023 American Academy of Sleep Medicine.)

Objective: To examine how changes in sleep patterns and sleep problems occurring between the pre-pandemic and the Covid-19 lockdown period influenced mood-behavioral functioning of children with Attention Deficit Hyperactivity Disorder (ADHD)., Methods: Parents of 992 children with ADHD (85.4% boys, mean age: 11.52 years, SD = 3.17), recruited from the Italian ADHD family association, completed a modified version of the Sleep Disturbance Scale for Children and filled out 11 emotional behavioral items selected from the Child Behavior Checklist (CBCL) 6-18 questionnaire. Subgroups identified based on sleep duration changes ("maintained", "increased", "reduced") and of sleep problems during lockdown ("onset", "remission", "maintained", "no sleep problem") were analyzed to evaluate the association with internalizing and externalizing scores., Results: Sleep duration showed no or low influence on internalizing and externalizing behaviors after control for age, sex, and socioeconomic status. Patients with ADHD with "no sleep problem" showed significant lower scores in internalizing and externalizing behaviors than those who "maintained" or had "onset" of different sleep problems. The effect sizes were higher for internalizing than externalizing behaviors. Lower internalizing scores were found in those who remitted difficulty in falling asleep, daytime sleepiness, nightmares, vs. the "maintained" or "onset" groups and those who remitted hypnic jerks vs. the "onset" group. Children with ADHD who "maintained" sleep terrors reported higher internalizing and mainly externalizing scores than the other groups., Conclusion: Sleep problems negatively influence daytime functioning of patients with ADHD. but mood and behavioral domains show different susceptibility to the changes of sleep problems, and different vulnerability to specific sleep problems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Children with Attention-Deficit/Hyperactivity (ADHD) and/or Developmental Coordination Disorder (DCD) show high rates of motor difficulties in daily activities. This study aimed to examine the validity and reliability of the Developmental Coordination Disorder Questionnaire (DCDQ) in identifying motor characteristics in daily activities, differentiating children with ADHD-only, with DCD-only and with ADHD and DCD comorbidity., Methods: Thirty-three children with ADHD-only, 30 with DCD-only, 33 with ADHD/DCD, and 35 controls participated to the study. Diagnosis satisfied DSM-5 criteria for ADHD and DCD. The DCDQ was administered to all children; moreover, the association between DCDQ scores and ADHD symptoms, measured by SNAP-IV, and motor coordination severity, measured by M-ABC subscales, was examined., Results: The DCDQ subscale scores were significantly lower in all clinical groups than in controls, but only minimal differences were found between the clinical groups. Principal Component Analysis (PCA) of DCDQ identified five components showing the best adaptability and accounting for 71% of the variance. Both ADHD-only and ADHD/DCD achieved a better performance than DCD-only in the "Motor control in running/jumping". Conversely, children with DCD-only performed better in "General coordination". ADHD-only reached better mean scores than ADHD/DCD in "Motor control with the ball" and, than DCD, in "Planning". Inattention, hyperactivity-impulsivity at SNAP-IV, and balance at M-ABC, represented the main predictors for ADHD-only, ADHD/DCD and DCD-only, respectively., Conclusions: DCDQ may represent a useful measure to detect the different areas of difficulties in children with neurodevelopmental disorders and provides suggestions for identifying distinct altered processes underlying ADHD and DCD, alone or in comorbidity.

Lockdown experience for COVID-19 pandemic significantly affected children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) exacerbating or promoting the onset of externalizing and internalizing symptoms. However, few studies have considered how externalizing and internalizing behaviors changed in relation to parental emotions and parenting strategies. In the present study, 992 caregivers of children and adolescents with ADHD from 5 to 18 years were presented with an online survey evaluating youths' externalizing and internalizing behaviors, their non-compliance with lockdown rules, and parental factors related to parental emotions and parenting strategies. Two hierarchical linear regression models were performed to examine the contribution of children's non-compliance with lockdown rules, parental emotions, and parenting strategies on children's externalizing and internalizing behaviors. Results revealed that externalizing behaviors were higher in children and adolescents with ADHD non-compliant with lockdown rules. Moreover, positive parenting strategies moderated the relationship between non-compliance with lockdown rules and externalizing behaviors. Differently, higher internalizing behaviors were observed in children with ADHD who had parents reporting more negative emotions and positive parenting strategies. In this case, parents' negative emotions had a moderator effect in the association between internalizing behaviors and non-compliance to lockdown measures. The clinical implications of these two different patterns of relations are discussed.

Background: A possible definition of body image is the picture that an individual has of her/his own body, irrespective of how her/his body actually is. Body image is a competence that develops in children similar to many other skills. The aim of this study was to validate a new rapid 20-items questionnaire to study the body image distortion in children and adolescents: the Strange Sensations Questionnaire (SSQ). A secondary aim was to improve the knowledge about body image distortion and about depersonalization symptoms,and their correlation with possible hallucinations, in children and adolescents, as it can be investigated using a scale., Methods: 1557 children and adolescents, balanced for sex and age filled out a new 20-items questionnaire (SSQ) about body image, and a second validated questionnaire about fantasy with a Reality/Unreality distinction subscale to study the relationship with hallucinations (Free Fantasy Questionnaire-FFQ)., Results: Results showed a good validation of SSQ with three subscales: depersonalization, fragility and other shapes. We found a relative high frequency of proneness to out-of-body experiences. Children of primary school age have a higher mean score than pre-adolescents and adolescents in the total score of all the three subscales of SSG. Adolescents seem to have a significantly higher mean score in Fragility subscale. The mean total score and the mean scores of all the three subscales have a significant correlation with the Reality/Unreality subscale of FFQ., Conclusions: SSQ was validated. The research could confirm also the high frequency of body image distortion in developmental age, suggesting the possibility of a specific retardation as a possible origin of some body image distortion disorders. Data also confirm the proneness for hallucination of adolescents with body image distortion.

Objective: To examine the impact of home confinement during the COVID-19 pandemic on the sleep patterns and sleep disturbances in Italian children and adolescents., Methods: Participants completed an anonymous online survey, shared via social media and targeting children and adolescents aged 1-18 years, subdivided into age groups: 1-3, 4-5, 6-12, and 13-18 years. Caregivers completed a modified version of the Sleep Disturbance Scale for Children (SDSC), along with demographic information., Results: The final sample consisted of 4314 subjects: 2217 males (50.4%) and 2097 females (49.6%). Age group distribution was: 1-3 years 1263 (29.3%), 4-5 years 893 (20.7%), 6-12 years 1848 (42.8%) and 13-18 years 310 (7.2%). We found a significant delay in bedtime and risetime in all age groups. School-age children and adolescents experienced the most significant delay: weekday bedtime ≥23 was reported by 28.4% of 6- to 12-year-old children during lockdown vs. 0.9% before and by 63.5% vs. 12.3% of 13- to 18-year-old adolescents. Risetime was also delayed with most subjects waking up after 8 in all age groups and sleep duration increased in all groups but not in the younger group. The screen time (excluding online lessons) boosted during the lockdown, mainly in older children but also in younger children. Sleep disorders increased in all groups but not in adolescents. Younger groups had an increased prevalence of difficulty falling asleep, anxiety at bedtime, night awakenings, nightmares and sleep terrors., Conclusion: Our study demonstrates that confinement due to COVID-19 determined a big delay in sleep/wake schedule of children in all age groups as well as an increase of sleep disturbances in all groups but adolescents., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Study Objectives: The impact of the COVID-19 outbreak on sleep of participants with autism spectrum disorder (ASD) was assessed., Methods: Parents of 111 children and adolescents with ASD filled out an anonymous online survey shared via social media, investigating the sleep patterns and disturbances before and during the lockdown., Results: The lockdown changed significantly the bedtime on weekdays in 57.8% of participants with ASD (56.9% delayed; 0.9% advanced) and the rise time in 69.2% (61.7% delayed and 7.5% advanced). Sleep duration varied on weekdays in 49.1% (24.1% increased; 25% decreased). During the lockdown, participants with ASD showed a significant increase of sleep disturbances, compared to the preceding period, especially falling asleep (35.1% vs 22.5%), anxiety at bedtime (22.5% vs 10.8%), sleep terrors (5.4% vs 0%), and daytime sleepiness (14.4% vs 3.6%)., Conclusions: Lockdown affected sleep of patients with ASD, showing an increase of difficulty in falling asleep, anxiety at bedtime, sleep terrors, and daytime sleepiness. The outbreak of COVID-19 significantly worsened sleep disturbances of children with ASD., Citation: Bruni O, Melegari MG, Breda M, et al. Impact of COVID-19 lockdown on sleep in children with autism spectrum disorders. J Clin Sleep Med . 2022;18(1):137-143., (© 2022 American Academy of Sleep Medicine.)