A double-blind placebo-controlled randomised trial of omega-3 supplementation in children with moderate ADHD symptoms.

OBJECTIVE: Clinical trials and inconclusive meta-analyses have investigated the effects of omega-3 supplements in children with Attention-Deficit Hyperactivity Disorder (ADHD). We performed a randomised placebo-controlled trial to evaluate the efficacy of omega-3 fatty acids. METHODS: Children aged 6-15 years with established diagnosis of ADHD were randomised 1:1 to receive either supplements containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) or a placebo for 3 months. Psychotropic or omega-3-containing treatments were not authorised during the study. The primary outcome was the change in the Attention-Deficit Hyperactivity Disorder Rating Scale version 4 (ADHD-RS-IV). Other outcomes included safety, lexical level (Alouette test), attention (Test of Attentional Performance for Children-KiTAP), anxiety (48-item Conners Parent Rating Scale-Revised-CPRS-R), and depression (Children's Depression Inventory-CDI). RESULTS: Between 2009 and 2011, 162 children were included in five French child psychiatry centres. The mean age was 9.90 (SD 2.62) years and 78.4% were boys. The inclusion ADHD-RS-IV at was 37.31 (SD 8.40). The total ADHD-RS-IV score reduction was greater in the placebo group than in the DHA-EPA group: -19 (-26, -12)  % and -9.7 (-16.6, -2.9) %, respectively, p = 0.039. The other components of the Conners score had a similar variation but the differences between groups were not significant. Two patients in the DHA-EPA group and none in the placebo group experienced a severe adverse event (hospitalisation for worsening ADHD symptoms). CONCLUSION: This study did not show any beneficial effect of omega-3 supplement in children with mild ADHD symptoms.

[Videogame addiction: a danger for only at-risk children or for all children]. / Addiction aux jeux vidéo: des enfants à risque ou un risque pour tous les enfants?

With the rapid growth in the number of children and adolescents having access to videogames, there is a risk of addictive behavior, especially among those with underlying mental illnesses. Yet there is no consensual definition of videogame addiction. Depression, anxiety disorders and hostility are all associated with overuse, but attention-deficit hyperactivity disorder (ADHD) is the most significant predictor.

[School phobia or school refusal?]. / Phobie scolaire ou refus scolaire?

The scope of the concept of school phobia, associated with anxiety disorders, is now broadened to include other underlying disorders such depression, conduct disorders and behaviors such as school truancy. The term "school refusal" is now preferred in the literature. This article reviews the main clinical and terapeutical dimensions of school refusal. Its aim is to increase practionners' awareness of this disorder and to describe a treatment plan centred on school attendance.

Can growth hormone treatment improve growth in children with severe growth failure due to anorexia nervosa? A preliminary pilot study.

BACKGROUND/AIMS: Growth failure is a difficult but key aspect of care in children with anorexia nervosa (AN). The effects of hGH therapy have not been studied. The aim was to investigate the effect of hGH treatment on height velocity (HV) in children with AN. METHODS: We carried out a retrospective observational study. Ten girls diagnosed with AN at 10.0 ± 1.9 years, with prolonged severe growth failure (HV < 2.5 cm/year for at least 18 months) at the age of 13.3 ± 1.1 years and delayed puberty after nutritional rehabilitation, were treated with hGH (0.040 mg/kg/day) from a bone age of 10.9 ± 1.7 years until they reached adult height. Height and HV were measured before treatment and at 12-month intervals during treatment. RESULTS: Mean body mass index SDS remained unchanged, but HV increased significantly, from a median of 1.0 (0.7-2.1) to 7.1 (6.0-9.5) cm/year after one year (P < 0.002) and 5.6 (4.8-6.2) cm/year after two years of treatment. Height SDS increased from -2.2 ± 1.3 to -1.6 ± 1.3 after one year (P < 0.002) and -1.1 ± 1.5 after two years of GH treatment. Adult height (-0.1 ± 1.0 SDS) was close to target height after 3.6 ± 1.4 years of GH treatment. Serum IGF-I levels increased significantly during treatment (P < 0.01). The treatment was well tolerated. CONCLUSIONS: This proof-of-concept study shows that hGH treatment is associated with significant improvements in linear growth in adolescents with AN and severe growth failure. A randomized placebo-controlled trial is required to determine the ultimate impact of GH treatment in patients with this severe, rare condition.

[Conduct disorder in childhood]. / Le trouble des conduites de l'enfant.

Conduct disorder is a repetitive and persistent pattern of behaviour in which the basic rights of others or societal rules are violated. It is at the junction of psychiatry, social field and law. The early diagnosis of this disorder and the identification of risk factors must go to preventive programs and psycho-educational treatments, to prevent juvenile delinquency.

Phonological skills, visual attention span, and visual stress in developmental dyslexia.

In this study, we concurrently investigated 3 possible causes of dyslexia-a phonological deficit, visual stress, and a reduced visual attention span-in a large population of 164 dyslexic and 118 control French children, aged between 8 and 13 years old. We found that most dyslexic children showed a phonological deficit, either in terms of response accuracy (92.1% of the sample), speed (84.8%), or both (79.3%). Deficits in visual attention span, as measured by partial report ability, affected 28.1% of dyslexic participants, all of which also showed a phonological deficit. Visual stress, as measured by subjective reports of visual discomfort, affected 5.5% of dyslexic participants, not more than controls (8.5%). Although phonological variables explained a large amount of variance in literacy skills, visual variables did not explain any additional variance. Finally, children with comorbid phonological and visual deficits did not show more severe reading disability than children with a pure phonological deficit. These results (a) confirm the importance of phonological deficits in dyslexia; (b) suggest that visual attention span may play a role, but a minor one, at least in this population; (c) do not support any involvement of visual stress in dyslexia. Among the factors that may explain some differences with previously published studies, the present sample is characterized by very stringent inclusion criteria, in terms of the severity of reading disability and in terms of exclusion of comorbidities. This may exacerbate the role of phonological deficits to the detriment of other factors playing a role in reading acquisition. (PsycINFO Database Record

[Early diagnosis of language disorders]. / Dépistage précoce des troubles du langage.

Talking is normal and not talking is not. In case of developmental language delay, "wait and see" is not a good medical practice. In many cases, this delay is secondary to conditions such as hearing loss, mental retardation, brain damage, pervasive developmental disorder, environmental deprivation... In other cases, it is a specific language delay or a specific language disorder (dysphasia). Specific speech assessment and speech therapy are indicated to prevent behavioural problems, and learning disabilities.

The use of prn medication in a child and adolescent mental health inpatient service in France.

Objective. The aim of this study was to investigate the use of "as needed" (pro re nata or prn) psychotropic medication in a child and adolescent psychiatric inpatient population. The study was carried out on the psychiatry ward of a paediatric teaching hospital in Paris, France. Methods. A prospective analysis of prn psychotropic drug prescriptions and administrations was conducted for all patients hospitalised over a period of 4 months. The study group consisted of 187 patients. Results. In total, 93 prn prescriptions were written, for 27% of the patients (51) but only 14% (26) received a total of 76 administrations. Antipsychotic drugs accounted for 54% of the prescriptions, anxiolytics for 33%, antiepileptic drugs for 8%, antiparkinsonian drugs for 4% and hypnotic drugs for 1%. Anxiety was the reason given for 67% of the prn administrations, with hydroxyzine used in 69% of these cases. Disruptive behaviour accounted for 22% of prn administrations, with antipsychotic drugs accounting for 88% of these administrations. Insomnia accounted for 8% of prn administrations, and antipsychotic drug-induced dystonia accounted for 3% of such administrations. Conclusion. Controlled studies are required to assess the efficacy and safety of prn medication and the conditions in which its use is indicated.

Psychotropic medication use in the child and adolescent psychiatry wards of a French hospital.

OBJECTIVE: The aim of this study was to investigate the use of psychotropic medication in children and adolescents hospitalised in a psychiatric ward. METHODS: A prospective analysis of psychotropic drug prescriptions was conducted for all patients hospitalised in two acute psychiatric hospitalisation units of a paediatric teaching hospital in Paris, France. The study group consisted of 187 patients and was characterised in terms of age, sex, prior psychiatric hospitalisation and DSM-IV-Tr diagnosis. All prescriptions were assessed for off-label use. RESULTS: Overall, 46% of patients received at least one dose of psychotropic medication. Antipsychotic drugs were the most frequently prescribed drugs (44%), regardless of diagnosis. Ninety percent of patients who received antipsychotic drugs did not have psychosis. We found that 69% of the 421 prescriptions written were for off-label uses. The percentage distribution of off-label prescriptions by medication class was as follows: antipsychotic drugs, 90%; anxiolytics, 28%; stimulants, 26%; antidepressants, 89%; antiepileptic drugs, 89% and antiparkinsonian drugs, 91%. CONCLUSION: The extensive use of drugs for off-label indications in children and adolescents suggests that prospective post-marketing studies should be carried out to evaluate efficacy and safety.

Predictors of late menarche and adult height in children with anorexia nervosa.

OBJECTIVES: The onset of anorexia nervosa (AN) during childhood can affect the timing of puberty and adult height. The aim of the study was to evaluate the determinants of late menarche and adult height in children with AN. PATIENTS AND METHODS: We carried out a retrospective, longitudinal, university hospital-based study. All prepubertal or early pubertal girls diagnosed with AN between 1998 and 2002 were selected for the study. Participants (n = 33) were studied at a median age of 21 (19.8-24.3) years. AN was diagnosed at 11.8 (10.7-12.3) years. RESULTS: Patients with AN reached menarche at significantly greater ages than their mothers [15.4 (13.5-16.8) vs. 13.2 (12.0-14.5) years, P < 0.01]. Chronological age at onset of AN and lowest body mass index (BMI) were important independent predictive factors for delayed menarche (P < 0.01). Adult height was 165.0 (163.0-172.0) cm, 2.5 (-1.5 to 5.0) cm above target height. Twelve patients (36%) did not reach their target height and had a median height deficit of -3.9 cm with respect to their target height. The duration of hospitalization, a marker of disease severity and chronicity, was an independent predictor of the difference between adult height and target height for a given individual (beta coefficient = -0.07; P = 0.01). The other factors studied (i.e. age at onset of AN, pubertal stage at diagnosis of AN, lowest BMI reached, associated comorbidity if any, type of AN, age at menarche) had no significant effect on adult height. CONCLUSION: The intensity of the disease affects the timing of menarche but not adult height in most patients. Hospitalization, despite often being an effective means of managing AN, does not reduce the impact of AN on growth.