ADHDCoach-a virtual clinic for parents of children with ADHD: Development and usability study.

Attention-deficit/ hyperactivity disorder (ADHD) is one of the most common mental health problems in childhood. Despite the fact that evidence-based treatments exist, behavioral parent training programs are the gold standard in the care of children with ADHD, a significant percentage of parents of children with ADHD do not access such interventions. Internet-delivered interventions are effective for a range of mental health problems, however, there is limited research conducted on the efficacy of such interventions in the treatment of ADHD. Objective: The aim of this study is to present the development and feasibility of an Internet-delivered intervention for parents of children with ADHD. Methods: The intervention was based on Behavioral Parent Training and Rational Emotive Behavior Therapy. Participants were mental health specialists (N = 16) and parents of children diagnosed with ADHD (N = 24). Results: Our results indicated high usability and parental satisfaction with the intervention. Conclusion: In conclusion, an Internet-delivered intervention addressed to parents of children diagnosed with ADHD is a promising approach. Future research should investigate the efficacy of this Internet-delivered intervention in a randomized controlled trial.

Immersive virtual reality for improving cognitive deficits in children with ADHD: a systematic review and meta-analysis.

Virtual reality (VR) shows great potential in treating and managing various mental health conditions. This includes using VR for training or rehabilitation purposes. For example, VR is being used to improve cognitive functioning (e.g. attention) among children with attention/deficit-hyperactivity disorder (ADHD). The aim of the current review and meta-analysis is to evaluate the effectiveness of immersive VR-based interventions for improving cognitive deficits in children with ADHD, to investigate potential moderators of the effect size and assess treatment adherence and safety. The meta-analysis included seven randomised controlled trials (RCTs) of children with ADHD comparing immersive VR-based interventions with controls (e.g. waiting list, medication, psychotherapy, cognitive training, neurofeedback and hemoencephalographic biofeedback) on measures of cognition. Results indicated large effect sizes in favour of VR-based interventions on outcomes of global cognitive functioning, attention, and memory. Neither intervention length nor participant age moderated the effect size of global cognitive functioning. Control group type (active vs passive control group), ADHD diagnostic status (formal vs. informal) and novelty of VR technology were not significant moderators of the effect size of global cognitive functioning. Treatment adherence was similar across groups and there were no adverse effects. Results should be cautiously interpreted given the poor quality of included studies and small sample.

The Development and Usability of a Mobile App for Parents of Children with ADHD.

BACKGROUND: Attention-Deficit/ Hyperactivity Disorder (ADHD) is one of the most prevalent mental health problems in children. Behavioral parent training (BPT) is the first-line treatment recommended by clinical guidelines; however, parental dropout is high. Mobile apps could be used as an adjunct to BPT in order to increase treatment adherence, homework compliance, and parental engagement. In this paper, we describe the development process of a mobile app for parents of children with ADHD. METHODS: We conducted a study to investigate parents' perceived usability of the ADHD Coping Card. RESULTS: The mobile app developed has a high usability. Future improvements in the app were suggested by parents. CONCLUSIONS: Given the increasing importance of digital mental health interventions in psychotherapy, it is important that future research is conducted with a higher number of participants to investigate the key factors implicated in choosing such an intervention in the future, both by parents and by mental health specialists. A mobile app can be used as an add-on in psychotherapy with parents of children with ADHD. Digital health interventions could help surpass gaps in treatment access for child mental health problems.

Measurement Invariance of Alabama Parenting Questionnaire Across Age, Gender, Clinical Status, and Informant.

This study aimed to investigate the measurement invariance of the Alabama Parenting Questionnaire (for both long [APQ-lg] and short [APQ-9] forms) across age, gender, clinical status, and informant (i.e., parent vs. child reports). The sample was composed of adolescents (community sample: N = 1,746; clinical sample: N = 166) and parents (N = 149). The analyses were conducted in R. Measurement invariance was assessed via multi-group confirmatory factor analysis, equivalence test, and subsampling approach. The original model of APQ-lg (five factors) showed a significantly better fit than other concurrent models (five concurrent models were specified, based on prior literature). For APQ-lg, we found measurement invariance across gender and partial measurement invariance across age, clinical status, and informant. For APQ-9, we confirmed the measurement invariance across gender and clinical status, while across age and informant partial measurement invariance was attested. Overall, our study indicated that APQ-lg and APQ-9 are two valid tools for measuring parenting practices with some caveats.

Parental stress and child mental health: a network analysis of Romanian parents.

Parental stress is related to child mental health problems, with numerous evidence indicating that it is an important predictor of parenting and parent-child relationship. New approaches to psychopathology could be particularly informative for clinical research, however, there is limited research that employs network analysis with parents. Network analysis could contribute to a better understanding of the relationship between child mental health problems and parental stress by highlighting the most central nodes and how the two constructs influence each other. The scope of the study was to identify potential new intervention targets to reduce the mental health problems of children and prevent contagion between parent stress and child psychopathology. Furthermore, we also sought to test whether the dynamic between parental stress and child psychopathology differs across the level of parent stress and child total difficulties. In this endeavor, we had three main directions. First, we estimated a network at the level of child mental health problems and identified the most central nodes. Second, we mapped the main paths through which parent stress and child mental health problems communicate with each other. Third, we investigated the network invariance across the level of parent stress (high vs moderate) and child mental health problems (low vs. high total difficulties). Participants (N = 1014) were parents of children with ages between four and 17 years old. The analyses were conducted in RStudio. Results indicated that perceived coping was a central node, bridging the two constructs. The global strength of the network was higher for parents who reported high levels of stress compared to those who reported only moderate levels of stress. In contrast, we found that the global strength of the network was lower for children with high levels of total difficulties compared to those with low levels of total difficulties. In conclusion, we argue the importance of focusing on the targeting nodes with high bridge centrality, such as perceived coping, for designing prevention and intervention programs. Future research should use temporal dynamics between parental stress and child mental health problems and explore mechanisms between the two constructs. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03520-1.

Feasibility and clinical utility of a transdiagnostic Internet-delivered rational emotive and behavioral intervention for adolescents with anxiety and depressive disorders.

BACKGROUND: Transdiagnostic interventions delivered for children and adolescents show promising results. In order to increase access to treatment, recent developments in technology have led to alternatives to face-to-face interventions. Transdiagnostic Internet-delivered interventions can be effective for adult anxiety and depressive disorders, but research is more limited regarding the efficacy of such treatments for young populations diagnosed with anxiety and or depressive disorders. OBJECTIVE: This study aims to investigate the feasibility and clinical utility of a transdiagnostic Internet-delivered intervention based on Rational emotive behavior therapy for adolescents diagnosed with anxiety and depressive disorders. METHODS: We tested the preliminary efficacy of a six-week intervention in an open trial, pre-post design. RESULTS: Our results suggest that the intervention is feasible and can be included as a treatment for adolescents with anxiety and depressive disorders, being associated with moderate to large pre-post effect sizes on self-reported anxiety and depressive symptoms, as well as on negative patterns of thinking and knowledge acquisition. Satisfaction with the intervention was high. CONCLUSIONS: Transdiagnostic Internet-delivered interventions for adolescents with anxiety and depressive symptoms are feasible. Future testing of the efficacy of such interventions in randomized controlled trials should be conducted.

Exploring autonomic regulation in children with ADHD with and without comorbid anxiety disorder through three systematic levels of cardiac vagal control analysis: Rest, reactivity, and recovery.

Autonomic nervous system (ANS) dysregulation, characterized by reduced vagally mediated Heart Rate Variability (HRV), has been associated with Attention-Deficit/ Hyperactivity Disorder (ADHD). This study investigated the dynamic vagal modulation of cardiac output in response to shifts in environmental demands in children and adolescents with ADHD, with and without a comorbid anxiety disorder. High-frequency HRV (HF-HRV) measures were obtained from 46 children and adolescents ranging from 6 to 17 (M = 9.38; SD = 2.31) years old, during three successive experimental conditions: a baseline recording followed by a sustained attention task, and a post-task recovery period. Findings support the reliability of the d2 Test, a cancelation test of attention and concentration, to induce parasympathetic withdrawal and extend prior work on "vagal flexibility". Further, these findings suggest a pattern of group differences in ANS functioning in children with ADHD, with and without a comorbid anxiety disorder. Only the ADHD without comorbid anxiety group showed a normative autonomic response to the cognitive challenge (reduced HF-HRV). The participants did not display an adaptive process of restoration following the cognitive challenge; the HRV suppression was prolonged during post-task recovery period, suggesting that ANS responded as if the cognitive stressor was still present. The current paper covers and discusses theoretical implications for the abnormalities in neurophysiological functioning and the different physiological responses in the two ADHD subtypes.

Measurement Invariance of the ADHD Rating Scale-IV Home and School Versions Across Age, Gender, Clinical Status, and Informant.

The present study aimed to investigate the measurement invariance across age, gender, clinical status, and informant of the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) Home and School versions. The participants were 1,106 Romanian children and adolescents (mean age = 12.74 years, standard deviation = 2.84, age range 6-18 years). Both parents and teachers assessed ADHD symptoms. The factorial structure of the scale was assessed using confirmatory factor analysis, and measurement invariance was assessed using multigroup confirmatory factor analysis. The results supported the reliability of the ADHD-RS-IV, with high internal consistency coefficients for both versions. Confirmatory factor analysis validated a two-factor model. Multigroup confirmatory factor analysis confirmed the measurement invariance of ADHD-RS-IV across age, gender, clinical status, and informant. ADHD-RS-IV had good psychometric properties in a sample of Romanian children and adolescents. It is a reliable instrument given its strong invariance. Implications for evidence-based assessment of ADHD are discussed.

The Efficacy of Internet-Based Parenting Programs for Children and Adolescents with Behavior Problems: A Meta-Analysis of Randomized Clinical Trials.

Online parenting programs can increase the accessibility of mental health services. This meta-analysis investigated the effectiveness of online parenting interventions in reducing children and adolescents behavior problems (primary outcome) and improving parenting behavior, parent distress, and parenting efficacy (secondary outcomes). A systematic search was conducted on PubMed, PsycInfo, Web of Science, SCOPUS, and ProQuest on June 28th, 2019. The meta-analysis was prior registered in PROSPERO. In total, 2160 records were identified and 15 Randomized Controlled Trials (RCTs) were included (N = 1668) in the systematic review and meta-analysis. The quality of each study was assessed by two independent evaluators. When compared to waitlist, online parenting interventions are effective in reducing behavior problems with a small effect size (Hedges's g = 0.40). No significant differences were found between online and classical delivered parenting interventions in reducing behavior problems (g = - 0.07). Compared to waitlist, the interventions are effective in improving parenting behavior (g = 0.34), parent distress (g = 0.30), and parenting efficacy (g = 0.41). The results appear to be stable at follow-up measures. The factors responsible for the effectiveness of the interventions were explored through moderation analyses. Online parenting interventions are promising for improving both behavior problems and parent outcomes. Future studies should focus on methods to increase their effectiveness and measure the outcomes more objectively.

Attention-deficit/ hyperactivity disorder mobile apps: A systematic review.

BACKGROUND: Attention-Deficit/ Hyperactivity Disorder (ADHD) is a prevalent condition in children and adolescents. Although there are pharmacological and non-pharmacological treatments for this disorder, barriers in accessing evidence-based treatments are still a major problem. Digital health interventions are promising for multiple mental health problems. Recent years have brought an increase in the number of existing mobile apps designed for the management of ADHD. The aim of this study was to systematically review the existing mobile apps designed for ADHD in terms of general characteristics, empirical support for their development and efficacy/ effectiveness, and to describe the content and design of the four most downloaded ADHD apps. METHOD: We conducted systematic searches on iTunes/iOS (Apple App Store), Google Play and the National Health Service Health Apps Library up to May 2017 and checked for changes in March and September 2019. We included those apps that were designed for ADHD, target assessment, treatment, or both, were in English and were functional. We identified 355 apps in the virtual stores, out of which we included 109 apps in the present systematic review. For each app we extracted the following information: target population, developer, price, number of downloads, ratings, privacy, available language other than English, category, purpose and empirical support. A second search was conducted in literature databases up to September 2019: PsycINFO, Pubmed, Scopus, Web of Science, Cochrane database. RESULTS: We found 109 ADHD apps in the virtual stores available to both young and adult populations, developed for children, adolescents, parents, teachers, and professionals. Most of the apps included are designed for treatment, or ADHD symptoms assessment, however, we found several apps designed for both assessment and treatment purposes. Very few apps contained information regarding their development and none contained information regarding evidence for its efficacy/ effectiveness. Four apps were the most downloaded, with 10,000 (three apps) to 100,000-500,000 (one app) downloads. Out of 51 papers identified through systematic searches in the literature, we identified only one study that met our inclusion criteria, however, this study was published in 2018, outside of the 2017 app store search, therefore, there is no overlap between evidence in the literature and apps on the market. CONCLUSIONS: Given the large proliferation of mental health apps and their potential benefits in terms of dissemination and costs, future research needs to be conducted in order to establish the safety and efficacy of ADHD apps available on the commercial market.

A video-based transdiagnostic REBT universal prevention program for internalizing problems in adolescents: study protocol of a cluster randomized controlled trial.

BACKGROUND: Internalizing problems are the most prevalent mental health problems in adolescents. Transdiagnostic programs are promising manners to treat multiple problems within the same protocol, however, there is limited research regarding the efficacy of such programs delivered as universal prevention programs in school settings. Therefore, the present study aims to investigate the efficacy of a video-based transdiagnostic rational emotive behavioral therapy (REBT) universal prevention program, for internalizing problems. The second objective of the present paper will be to investigate the subsequent mechanisms of change, namely maladaptive cognitions. METHODS: A two-arm parallel randomized controlled trial will be conducted, with two groups: a video-based transdiagnostic REBT universal prevention program and a wait list control. Power analysis indicated that the study will involve 338 participants. Adolescents with ages between 12 and 17 years old, from several middle schools and high schools, will be invited to participate. Assessments will be conducted at four time points: baseline (T1), post-intervention (T2), 3 months follow-up (T3) and 12 months follow-up (T4). Intent-to-treat analysis will be used in order to investigate significant differences between the two groups in both primary and secondary outcomes. DISCUSSION: This is the first randomized controlled trial that aims to investigate the efficacy and mechanisms of change of a video-based transdiagnostic REBT universal prevention program, delivered in a school context. The present study has important implications for developing efficient prevention programs, interactive, that will aim to target within the same protocol both anxiety and depressive symptoms. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02756507 . Registered on 25 April 2016.

Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials.

Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges' g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58-1.05, depression: g = .79, 95% CI: .59-1.00) and medium on quality of life (g = .56, 95% CI: .37-.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.