Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial.

INTRODUCTION: Cognitive behavioral therapy and dialectical behavior therapy (DBT) can be effective in treating adults with ADHD, and patients generally consider these interventions useful. While adherence, as measured by attendance at sessions, is mostly sufficient, adherence to therapy skills has not been assessed. Furthermore, the relationship between patient evaluation of therapy effectiveness, treatment adherence, and clinical outcomes is understudied. OBJECTIVE: This study aimed to examine treatment acceptability and adherence in relation to treatment outcomes in a large randomized controlled trial comparing a DBT-based intervention with a nonspecific active comparison, combined with methylphenidate or placebo. METHOD: A total of 433 adult patients with ADHD were randomized. Participants reported how effective they found the therapy, and adherence was measured by attendance at therapy sessions and by self-reports. Descriptive, between-groups, and linear mixed model analyses were conducted. RESULTS: Participants rated psychotherapy as moderately effective, attended 78.40-94.37% of sessions, and used skills regularly. The best-accepted skills were sports and mindfulness. Groups receiving placebo and/or nonspecific clinical management rated their health condition and the medication effectiveness significantly worse than the psychotherapy and methylphenidate groups. Improvements in clinical outcomes were significantly associated with treatment acceptability. Subjective (self-reported) adherence to psychotherapy was significantly associated with improvements in ADHD symptoms, clinical global efficacy and response to treatment. DISCUSSION: These results further support the acceptability of DBT for adult ADHD and suggest the need to address adherence to treatment to maximize clinical improvements. Results may be limited by the retrospective assessment of treatment acceptability and adherence using an ad hoc instrument.

Efficacy of Nonpharmacological Treatments on Comorbid Internalizing Symptoms of Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

Background: Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid in adulthood. This meta-analysis was aimed at ascertaining the efficacy of different psychotherapies in improving comorbid internalizing symptoms in adults with ADHD. Method: Twenty randomized controlled trials and 12 uncontrolled pretest-posttest studies were included and combined using the inverse variance method. Risk of bias and heterogeneity assessment and moderator analyses were performed. Results: Cognitive-behavioral therapy (CBT) improved quality of life (QoL), emotional dysregulation (ED), depression, and anxiety symptoms, particularly at follow-up, which was predicted by core symptoms reduction. A significant between-group effect was obtained only on QoL, ED, and self-esteem for dialectical behavior therapy (DBT), mindfulness-based therapies (MBTs), and neurofeedback, respectively. Conclusion: Results support CBT efficacy for treating comorbid internalizing symptoms. More research is needed to determine the effectiveness of DBT, MBT, and neurofeedback. The small number of studies evaluating some therapies and the high risk of bias observed might limit these results.

Long-Term Efficacy of Psychosocial Treatments for Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

Background: Recent evidence suggests that psychosocial treatments, particularly cognitive-behavioral therapy (CBT), are effective interventions for adult attention deficit hyperactivity disorder (ADHD). The objective of this review was to determine the long-term efficacy of psychosocial interventions in improving clinically relevant variables, including ADHD core symptoms, clinical global impression (CGI), and global functioning. Methods: In total, nine randomized controlled trials and three uncontrolled single-group pretest-posttest studies were included. The data from these studies were combined using the inverse variance method. Heterogeneity and risk of bias were assessed. Subgroup analyses and meta-regressions were performed, to determine the influence of different potential moderator variables (risk of bias, medication status, follow-up length, therapy type and setting, and control group type) on effect size (ES) estimates. Results: Up to 680 of a total of 1,073 participants assessed pre-treatment were retained at follow-up. Treatment groups showed greater improvement than control groups in self-reported total ADHD symptoms, inattention, and hyperactivity/impulsivity, in addition to CGI and global functioning. Blind assessors also reported a large ES in within-subject outcomes. Studies using dialectical behavioral therapy (DBT) in a group setting, with active control matching, and that were rated as having an unclear risk of bias, achieved significantly lower ES estimates for most outcomes. Treatment effectiveness, according to the CGI measure, and global functioning were significantly increased when the percentage of medicated participants was greater. Conclusions: Our results indicate that the post-treatment gains reported in previous reviews are sustained for at least 12 months. Nevertheless, these results must be interpreted with caution, because of a high level of heterogeneity among studies and the risk of bias observed in the majority of outcomes. Thus, these findings indicate that psychological interventions are a highly valuable and stable clinical tool for the treatment of core symptoms and global functioning in adults with ADHD.

Quality of life and stressors in patients with chronic kidney disease depending on treatment.

This study evaluated health-related quality of life (HRQOL) in a Spanish sample of chronic kidney disease patients (n = 90) undergoing different renal replacement therapies, considering the influence of treatment stressors, mood, anxiety and quality of sleep. While all patients had worse physical functioning than controls (p < .01), only those undergoing haemodialysis (HD) showed worse physical well-being, occupational functioning, spiritual fulfillment and more health interference with work (p < .05). They also obtained higher depression scores than renal transplant patients (TX) (p = .005). Those TX receiving the immunosuppressor sirolimus exhibited more cardiac/renal, cognitive and physical limitations than the rest (p < .05). Dialysis vintage correlated positively with sleep disturbances and depression scores and negatively with total Quality of Life (QLI) (p < .05). HD patients experienced more psychological distress than peritoneal dialysis patients (PD) (p = .036). Regression models including sleep, anxiety and depression were estimated for subscales of HRQOL. In TX patients, low depressive scores related to an optimal QLI in almost all subscales, while in HD patients they explained part of the variability in psychological well-being, interpersonal functioning and personal fulfillment. HD condition results in a QLI more distant to the standards of controls.

[The role of the prefrontal cortex in the sensory problems of children with autism spectrum disorder and its involvement in social aspects]. / Papel de la corteza prefrontal en los problemas sensoriales de los niños con trastornos del espectro autista y su implicación en los aspectos sociales.

INTRODUCTION: In persons with autism spectrum disorders (ASD), aberrant sensory perceptions could be as characteristic and disruptive as the presence of anomalies in social communication and interaction or restricted and repetitive interests. Most of them present sensory modulation disorders (hyper- or hypo-responsiveness) in several sensory channels. Furthermore, there is a deficit in the integration of the information from a number of sensory systems (for example, auditory and visual). All this would worsen the core symptoms related with communication and increase the appearance of behavioural problems. AIMS: This study aims to review the experimental evidence that addresses the role played by the prefrontal cortex in unusual sensory experiences in ASD and its involvement in social aspects. There is evidence of hypoactivation and dysfunction of the neural networks, which include the prefrontal cortex and participate in social cognition, such as the default mode and the mirror neuron system in children with ASD. CONCLUSIONS: Sensory-motor problems at an early age correspond to a disruption in the organisation and regulation not only of perception and action but also language, thought, emotion and even memory.

TITLE: Papel de la corteza prefrontal en los problemas sensoriales de los niños con trastornos del espectro autista y su implicacion en los aspectos sociales.Introduccion. En las personas con trastornos del espectro autista (TEA), las percepciones sensoriales aberrantes podrian ser tan caracteristicas y disruptivas como la presencia de anomalias en la comunicacion e interaccion social, asi como de intereses restringidos y repetitivos. La mayoria presenta trastornos de la modulacion sensorial (hiper o hiporresponsividad) en varios canales sensoriales. Ademas, muestra un deficit en la integracion de la informacion procedente de varios sistemas sensoriales (por ejemplo, auditivo y visual). Todo ello agravaria los sintomas nucleares relacionados con la comunicacion y aumentaria la aparicion de problemas conductuales. Objetivo. Revisar la evidencia experimental que aborda el papel de la corteza prefrontal en las experiencias sensoriales inusuales en los TEA y su implicacion en los aspectos sociales. Hay evidencia de hipoactivacion y disfuncion en redes neurales, que incluyen la corteza prefrontal y participan en la cognicion social, como la red por defecto y el sistema de neuronas espejo en niños con TEA. Conclusiones. Los problemas sensoriomotores a edad temprana suponen una disrupcion de la organizacion y regulacion no solo de la percepcion y la accion, sino tambien del lenguaje, el pensamiento, la emocion e incluso la memoria.

Neurobiological foundations of multisensory integration in people with autism spectrum disorders: the role of the medial prefrontal cortex.

This review aims to relate the sensory processing problems in people with autism spectrum disorders (ASD), especially multisensory integration (MSI), to the role of the medial prefrontal cortex (mPFC) by exploring neuroanatomical findings; brain connectivity and Default Network (DN); global or locally directed attention; and temporal multisensory binding. The mPFC is part of the brain's DN, which is deactivated when attention is focused on a particular task and activated on rest when spontaneous cognition emerges. In those with ASD, it is hypoactive and the higher the social impairment the greater the atypical activity. With an immature DN, cross-modal integration is impaired, resulting in a collection of disconnected fragments instead of a coherent global perception. The deficit in MSI may lie in the temporal synchronization of neural networks. The time interval in which the stimulation of one sensory channel could influence another would be higher, preventing integration in the typical shorter time range. Thus, the underconnectivity between distant brain areas would be involved in top-down information processes (relying on global integration of data from different sources) and would enhance low level perception processes such as over focused attention to sensory details.

Language laterality, handedness and empathy in a sample of parents of children with autism spectrum disorder.

BACKGROUND: First-order relatives of persons with Autism Spectrum Disorder (ASD) exhibit a cognitive pattern which is part of a broader autism phenotype. METHOD: The purpose of the present study was to evaluate whether some neuropsychological features related to the autism phenotype are present in parents of ASD children. To this end, the exploration included a dichotic listening task, handedness and the Empathy Quotient (EQ-60). RESULTS: The scores obtained by the total sample (fathers plus mothers) were similar to those of the general population, although there were differences in some parameters of the dichotic listening task depending on the gender. Contrary to expectations, only in fathers, the negative correlation between data from both ears was not statistically significant, which could be evidence of a lack of hemispheric interdependence. CONCLUSIONS: These results support the possible existence of a genetic susceptibility to an aberrant language asymmetry pattern. Moreover, possible unknown epigenetic factors could act on a vulnerable genotype in some ASD subjects. Nevertheless, due to the small sample size, the present research must be considered a pilot study.

Training adults and children with an autism spectrum disorder to be compliant with a clinical dental assessment using a TEACCH-based approach.

The specific neuropsychological and sensory profile found in persons with autism spectrum disorders complicate dental procedures and as a result of this, most are treated under general anesthesia or unnecessary sedation. The main goal of the present study was to evaluate the effectiveness of a short treatment and education of autistic and related communication-handicapped children-based intervention program (five sessions) to facilitate a 10-component oral assessment in children (n = 38, aged 4-9 years) and adults (n = 34, aged 19-41) with autism spectrum disorder (with or without associated intellectual disability). The assessment ranges from entering into the examination room to the evaluation of the dental occlusion. There were statistically significant differences in the number of components reached and in compliance before and after the training program.

Oral manifestations in a group of adults with autism spectrum disorder.

OBJECTIVE: A number of studies have evaluated the buccodental health of patients with autism spectrum disorder (ASD), though most have involved children, and no specific oral manifestations have been described. The present study describes the buccodental disorders and hygiene habits in a group of adults with ASD. STUDY DESIGN: A prospective case-control study was made of a group of patients with ASD (n=30), with a mean age of 27.7±5.69 years, and of a healthy age- and gender-matched control group (n=30). An evaluation was made of the medical history, medication, oral hygiene habits and oral diseases, with determination of the CAOD, CAOS and OHI-S oral hygiene scores. RESULTS: Most of the patients in the ASD group used two or more drugs and were assisted in brushing 2-3 times a day. The most frequent manifestations were bruxism, self-inflicted oral lesions and certain malocclusions. The CAOD and CAOS scores were significantly lower than in the controls. CONCLUSIONS: Adults with ASD and assisted dental hygiene presented fewer caries than the non-disabled population. However, bruxism, ogival palate and anterior open bite were frequent in the patients with ASD.

Effects of immunosuppressive drugs on the cognitive functioning of renal transplant recipients: a pilot study.

Some renal transplant patients show cognitive, emotional, and behavioral changes as part of possible neurotoxic effects associated with immunosuppressive medication, especially tacrolimus. This study evaluated effects of immunosuppressive drugs on some cognitive tasks. Patients treated with sirolimus and cyclosporine reported some of the noncognitive side effects related to immunosuppressive treatment. We observed attention and working memory impairment in patients treated with sirolimus or tacrolimus. Performance of cyclosporine-treated subjects was similar to that of healthy volunteer controls. Since the mood, anxiety, and sleep patterns measured were unaffected, it could be concluded that the cognitive deficit found was partly related to treatment.

Activation of serotonergic neurotransmission during the performance of aggressive behavior in rats.

High aggression is often linked to lowered serotonin (5-HT) neurotransmission. Although this may hold for high aggression as a trait characteristic of an individual, serotonergic activity is probably increased during performance of aggressive behavior. To test this hypothesis, first, the 5-HT1A agonist alnespirone and gamma aminobutyric acid-A agonist muscimol were administered into the dorsal raphe nucleus. These treatments, which inhibit 5-HT neuronal activity, were shown to decrease performance of aggressive behavior. Second, after a resident-intruder test, the activation of 5-HT neurons (measured by c-fos expression) was increased in high-aggressive rats, compared with low-aggressive rats or control rats that were not subjected to a social confrontation. Results show that performance of aggressive behavior increases 5-HT neuronal activity and that preventing this activation inhibits expression of aggressive behavior.

Similar rewarding effects of testosterone in mice rated as short and long attack latency individuals.

An attempt was made to confirm and extend the findings of an earlier study on the rewarding properties of testosterone in male mice using conditioned place preference (CPP). Previous results had only partially demonstrated such an effect because the reinforcement depended on environmental cues such as the colour of the compartment. High individual variability was evident, suggesting that basal levels of aggressiveness may modulate such effects. Animals were pre-screened for aggressive behaviour and allocated to short and long attack latency (SAL and LAL) categories. Five days later the CPP procedure started. This involved pre-conditioning tests, conditioning and post-conditioning tests. SAL and LAL animals were treated with vehicle, 1 or 2 mg/kg of testosterone. During conditioning (on alternate days), a distinctive floor was paired four times with testosterone. On the intervening days animals were paired with a different floor with vehicle. CPP was clearly observed after testosterone treatment when the colour of the compartment was controlled in both SAL and LAL animals. These results provide additional support for the idea that testosterone and its derivatives have rewarding properties, which could explain processes of dependence.