Search

BACKGROUND: Methylphenidate (MPH) is an efficacious treatment for ADHD but concerns have been raised about potential adverse effects of extended treatment on growth.OBJECTIVES: To systematically review the literature, up to December 2018, conducting a meta-analysis of association of long-term (> six months) MPH exposure with height, weight and timing of puberty.RESULTS: Eighteen studies (ADHD n = 4868) were included in the meta-analysis. MPH was associated with consistent statistically significant pre-post difference for both height (SMD = 0.27, 95% CI 0.16-0.38, p CONCLUSIONS: Long-term treatment with MPH can result in reduction in height and weight. However, effect sizes are small with possible minimal clinical impact. Long-term prospective studies may help to clarify the underlying biological drivers and specific mediators and moderators.

The current COVID-19 virus crisis is creating unprecedented challenges at every level of society. Individuals with neurodevelopmental disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD) are particularly vulnerable and may display increased behavioural problems. The current crisis also poses several important questions for their clinicians on how best to deliver care within the new restrictions. This document provides a summary of the guidance on the assessment and management of ADHD during the COVID-19 virus pandemic, developed by the European ADHD Guidelines Group (EAGG). The full guidance is reported in the Appendix.

Hashimoto encephalopathy (he) is a rare disorder with a great diversity in clinical presentation of neurological and/or psychiatric symptoms. We describe a case of Hashimoto thyroiditis with hypothyroidism and Hashimoto encephalopathy in a fifteen-year-old boy who was referred to a child and adolescent psychiatrist due to a suspicion of a psychotic episode. Patient recovered after treatment with levothyroxine and corticosteroids. ispartof: Tijdschrift voor Psychiatrie vol:60 issue:2 pages:120-123 ispartof: location:Netherlands status: published

The need for engaging treatment approaches within mental health care has led to the application of gaming approaches to existing behavioral training programs (i.e., gamification). Because children with attention deficit/hyperactivity disorder (ADHD) tend to have fewer problems with concentration and engagement when playing digital games, applying game technologies and design approaches to complement treatment may be a useful means to engage this population in their treatment. Unfortunately, gamified training programs currently available for ADHD have been limited in their ability to demonstrate in-game behavior skills that generalize to daily life situations. Therefore, we developed a new serious game (called "Plan-It Commander") that was specifically designed to promote behavioral learning and promotes strategy use in domains of daily life functioning such as time management, planning/organizing, and prosocial skills that are known to be problematic for children with ADHD. An interdisciplinary team contributed to the development of the game. The game's content and approach are based on psychological principles from the Self-Regulation Model, Social Cognitive Theory, and Learning Theory. In this article, game development and the scientific background of the behavioral approach are described, as well as results of a survey (n = 42) to gather user feedback on the first prototype of the game. The findings suggest that participants were satisfied with this game and provided the basis for further development and research to the game. Implications for developing serious games and applying user feedback in game development are discussed.

Background: Behavioural interventions, including parent training, have been recommended for use with children and adolescents with attention- deficit/hyperactivity disorder (ADHD), however specific guidance for their implementation based on the best available evidence is currently lacking. Here a group of specialist clinicians and researchers provide practitioners and policy-makers with evidence-based, expert guidance on the use of behavioural interventions for ADHD. Methods: The review used a question and answer format organized around four themes: treatment benefits, therapeutic content and delivery, treatment indications and contraindications and relationship to other non-pharmacological treatments. Specific questions were designed to address key issues of clinical concern based on expert interpretation of the evidence with precedence given to meta-analyses of trials although when necessary other evidence was also considered. Results: Parent training reduces ADHD symptoms according to reports of parents engaged in the delivery of the intervention and who were not blind to treatment allocation. These reports have not to date been corroborated by blinded raters There is however evidence from probably blinded measures that these interventions benefit parenting practices and improve conduct problems (a common comorbidity and source of impairment) in the context of ADHD. Positive results have also been found in relation to parental knowledge, children’s emotional, social and academic functioning. Generic as well as specialised ADHD parent training approaches - delivered either individually or in groups - have value. High quality training and supervision of therapists and practice with the child may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence that behavioural treatment should be limited to parents with parenting difficulties or children with conduct problems. Adjunctive treatment for parental depression may be valuable. Conclusion: Behavioural interventions have an important role to play in the comprehensive treatment of ADHD but their role in the management of core ADHD symptoms is much less clear and requires further study using trials with well-blinded outcomes. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and their barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use it seems important to acknowledge and respond to parental treatment preferences.

Antipsychotics are frequently prescribed for a wide range of psychiatric and non-psychiatric indications. Over the last few years there has been a marked increase in the use of antipsychotics, in European and non-European countries. The use has also increased in children. AIM: To assess trends in the sales of antipsychotics for Belgian children and adolescents (7 to 17 years old) between 2005 and 2014. METHOD: We used data supplied by Farmanet, the official Belgian organisation responsible for collecting information about the prescription behaviour of doctors in Belgium. RESULTS: Between 2005 and 2014 there was a 53% increase in the number of prescriptions for antipsychotics issued by doctors in Belgium. This period also saw a 75.5% increase in the number of prescriptions for antipsychotics issued for the treatment of children and adolescents. There was a particularly large increase in the number of prescriptions for aripiprazole, the increase being only very slightly compensated by a simultaneous decrease in the number of prescriptions issued for other antipsychotics. In 2014, 21 different antipsychotics were prescribed for children, the majority of these prescriptions being for risperidone and aripiprazole. A large proportion of antipsychotics are used off-label. In exceptional cases, antipsychotics were prescribed for children under the age of six, and even for children younger than two. CONCLUSION: Between 2005 and 2014 there was an increase in the number of prescriptions for antipsychotics issued for children and adolescents in Belgium. During that period of time there was a similar increase in the use of antipsychotics by children and adolescents in other European and non-European countries. It is not clear whether these increases are justified. ispartof: Tijdschrift voor Psychiatrie vol:59 issue:6 pages:329-338 ispartof: location:Netherlands status: published

ispartof: Tijdschrift voor Psychiatrie vol:59 issue:6 pages:329-338 status: published

BACKGROUND: The need for accessible and motivating treatment approaches within mental health has led to the development of an Internet-based serious game intervention (called "Plan-It Commander") as an adjunct to treatment as usual for children with attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE: The aim was to determine the effects of Plan-It Commander on daily life skills of children with ADHD in a multisite randomized controlled crossover open-label trial. METHODS: Participants (N=170) in this 20-week trial had a diagnosis of ADHD and ranged in age from 8 to 12 years (male: 80.6%, 137/170; female: 19.4%, 33/170). They were randomized to a serious game intervention group (group 1; n=88) or a treatment-as-usual crossover group (group 2; n=82). Participants randomized to group 1 received a serious game intervention in addition to treatment as usual for the first 10 weeks and then received treatment as usual for the next 10 weeks. Participants randomized to group 2 received treatment as usual for the first 10 weeks and crossed over to the serious game intervention in addition to treatment as usual for the subsequent 10 weeks. Primary (parent report) and secondary (parent, teacher, and child self-report) outcome measures were administered at baseline, 10 weeks, and 10-week follow-up. RESULTS: After 10 weeks, participants in group 1 compared to group 2 achieved significantly greater improvements on the primary outcome of time management skills (parent-reported; P=.004) and on secondary outcomes of the social skill of responsibility (parent-reported; P=.04), and working memory (parent-reported; P=.02). Parents and teachers reported that total social skills improved over time within groups, whereas effects on total social skills and teacher-reported planning/organizing skills were nonsignificant between groups. Within group 1, positive effects were maintained or further improved in the last 10 weeks of the study. Participants in group 2, who played the serious game during the second period of the study (weeks 10 to 20), improved on comparable domains of daily life functioning over time. CONCLUSIONS: Plan-It Commander offers an effective therapeutic approach as an adjunct intervention to traditional therapeutic ADHD approaches that improve functional outcomes in daily life. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV). ispartof: Journal of Medical Internet Research vol:18 issue:2 ispartof: location:Canada status: published

OBJECTIVE: Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD symptoms when raters were probably blind to treatment allocation. The present analysis is extended to a broader range of child and parent outcomes.METHOD: A systematic search in PubMed, Ovid, Web of Knowledge, ERIC, and CINAHAL databases (up to February 5, 2013) identified published randomized controlled trials measuring a range of patient and parent outcomes for children and adolescents diagnosed with ADHD (or who met validated cutoffs on rating scales).RESULTS: Thirty-two of 2,057 nonduplicate screened records were analyzed. For assessments made by individuals closest to the treatment setting (usually unblinded), there were significant improvements in parenting quality (standardized mean difference [SMD] for positive parenting 0.68; SMD for negative parenting 0.57), parenting self-concept (SMD 0.37), and child ADHD (SMD 0.35), conduct problems (SMD 0.26), social skills (SMD 0.47), and academic performance (SMD 0.28). With probably blinded assessments, significant effects persisted for parenting (SMD for positive parenting 0.63; SMD for negative parenting 0.43) and conduct problems (SMD 0.31).CONCLUSION: In contrast to the lack of blinded evidence of ADHD symptom decrease, behavioral interventions have positive effects on a range of other outcomes when used with patients with ADHD. There is blinded evidence that they improve parenting and decrease childhood conduct problems. These effects also may feed through into a more positive parenting self-concept but not improved parent mental well-being.

ispartof: Tijdschrift voor Psychiatrie vol:56 issue:6 pages:365-374 status: published