Caregiver-reported emotional-behavioral symptoms in Spanish youth during the COVID-19 pandemic: a longitudinal study.

BACKGROUND: COVID-19 pandemic stressors affected youth's mental health. This longitudinal study aims to explore these effects while considering predictive factors such as age and sex. METHODS: An initial sample of 1502 caregivers answered a longitudinal survey evaluating their youths' (4-17 years of age) emotional/behavioral symptoms using the Pediatric Symptom Checklist (PSC) screening tool. First assessment in May-July 2020 included the prior year's retrospective (TR) and since-lockdown-start (T0) PSC, followed by monthly evaluations until February 2021. RESULTS: A positive screening PSC (PSC+) was reported in 13.09% of cases at TR and 35.01% at T0, but the likelihood of PSC+ quickly decreased over time. At T0, a more pronounced impact was found on children (39.7%) compared to adolescents (25.4%); male children exhibited higher risk for a PSC+ at T0 and longitudinally than females. Adolescents presented a weaker effect of time-improvement. PSC+ at TR, experienced stressors, and caregiver's stress/depressive symptoms positively predicted PSC+ at T0 and longitudinally; adolescents' unproductive coping style predicted PSC+ at T0. CONCLUSION: The study shows a caregiver-reported increase in emotional/behavioral symptoms in youths during the COVID-19 pandemic, affecting predominantly younger children in the early stages and showing gradual improvement over time, albeit possibly slower in adolescents. IMPACT: The results show the anticipated surge in emotional and behavioral symptoms during the COVID-19 lockdown in youth reported by caregivers, followed by subsequent amelioration. Of greater significance, the study reveals a heightened impact on young children initially, yet it suggests a slower improvement trajectory in adolescents. The study also identifies risk factors linked to emotional and behavioral symptoms within each age group. Alongside the longitudinal approach, the authors underscore the remarkable inclusion of a significant representation of young children, an unusual feature in such surveys.

Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in childhood (5.3% to 7.1% worldwide prevalence), with substantial overall financial burden to children/adolescents, their families, and society. The aims of this study were to describe the clinical characteristics of children and adolescents with ADHD in Spain, estimate the associated direct/indirect costs of the disorder, and assess whether the characteristics and financial costs differed between children/adolescents adequately responding to currently available pharmacotherapies compared with children/adolescents for whom pharmacotherapies failed. METHODS: This was a multicenter, cross-sectional, descriptive analysis conducted in 15 health units representative of the overall Spanish population. Data on demographic characteristics, socio-occupational status, social relationships, clinical variables of the disease, and pharmacological and non-pharmacological treatments received were collected in 321 children and adolescents with ADHD. Direct and indirect costs were estimated over one year from both a health care system and a societal perspective. RESULTS: The estimated average cost of ADHD per year per child/adolescent was €5733 in 2012 prices; direct costs accounted for 60.2% of the total costs (€3450). Support from a psychologist/educational psychologist represented 45.2% of direct costs and 27.2% of total costs. Pharmacotherapy accounted for 25.8% of direct costs and 15.5% of total costs. Among indirect costs (€2283), 65.2% was due to caregiver expenses. The total annual costs were significantly higher for children/adolescents who responded poorly to pharmacological treatment (€7654 versus €5517; P = 0.024), the difference being mainly due to significantly higher direct costs, particularly with larger expenses for non-pharmacological treatment (P = 0.012). CONCLUSIONS: ADHD has a significant personal, familial, and financial impact on the Spanish health system and society. Successful pharmacological intervention was associated with lower overall expenses in the management of the disorder.

Delphi Consensus on Attention Deficit Hyperactivity Disorder (ADHD): evaluation by a panel of experts.

INTRODUCTION: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in childhood, which is frequently maintained in adolescent and adult age. It presents great clinical heterogeneity, significantly affecting the functioning of those who suffer it. Although drug treatments obtain results by themselves, the approach should be multidisciplinary and be adapted to the specific needs of each patient and his/ her family. Given the variety of drugs currently available to treat ADHD, there are diverse opinions on the most effective way to approach this disorder. The objective of this work is to study the opinion of an expert clinical panel and to know the professional criteria used to define key concepts and therapeutic guidelines of ADHD in Spain. METHODOLOGY: The project was carried out in four phases: 1) Constitution of a Scientific Committee, responsible for the preliminary biographic review and the formulation of the questionnaire; 2) selection of an expert panel of specialists with special interest and/or experience in the treatment of ADHD; 3) Likert type structured survey (online platform) in two rounds with interim processing of opinions; and 4) collection and final analysis of results. RESULTS: The experts’ panel achieved a consensus in 55 of the 58 items making up the questionnaire, finding 3 items in which sufficient unanimity of criteria was not achieved because of the high number of experts were found in positions of non-certainty. CONCLUSIONS: Overall, the experts of this study reached a high level of agreement in the criteria proposed in the survey, which could be generalized as indications for the clinical practice in the management of ADHD. Similarly, and given the dispersion of the results in some of the items and the lack of consensus in others, some points remain as object of discussion.

Neurological Adverse Effects of Antipsychotics in Children and Adolescents.

OBJECTIVE: The aim of this study was to evaluate demographic, clinical, and treatment factors that may impact on neurological adverse effects in naive and quasi-naive children and adolescents treated with antipsychotics. METHODS: This was a 1-year, multicenter, observational study of a naive and quasi-naive pediatric population receiving antipsychotic treatment. Two subanalyses were run using the subsample of subjects taking the 3 most used antipsychotics and the subsample of antipsychotic-naive subjects. Total dyskinesia score (DyskinesiaS) and total Parkinson score (ParkinsonS) were calculated from the Maryland Psychiatric Research Center Involuntary Movement Scale, total UKU-Cognition score was calculated from the UKU Side Effect Rating Scale. Risk factors for tardive dyskinesias (TDs) defined after Schooler-Kaine criteria were studied using a logistic regression. RESULTS: Two hundred sixty-five subjects (mean age, 14.4 [SD, 2.9] years) with different Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders were recruited. DyskinesiaS (P < 0.001) and ParkinsonS (P < 0.001) increased at 1-year follow-up. Risperidone was associated with higher increases in DyskinesiaS compared with quetiapine (P < 0.001). Higher increases in ParkinsonS were found with risperidone (P < 0.001) and olanzapine (P = 0.02) compared with quetiapine. Total UKU-Cognition Score decreased at follow-up. Findings were also significant when analyzing antipsychotic-naive subjects. Fifteen subjects (5.8%) fulfilled Schooler-Kane criteria for TD at follow-up. Younger age, history of psychotic symptoms, and higher cumulative exposure time were associated with TD at follow-up. CONCLUSIONS: Antipsychotics increased neurological adverse effects in a naive and quasi-naive pediatric population and should be carefully monitored. Risperidone presented higher scores in symptoms of dyskinesia and parkinsonism. Quetiapine was the antipsychotic with less neurological adverse effects. Younger subjects, psychosis, and treatment factors predicted an increased risk of TD.

Antipsychotic use in children and adolescents: a 1-year follow-up study.

OBJECTIVE: The objective of this study was to analyze the initial treatment with antipsychotics (APs) and its changes during the first year of treatment in patients visited in specialized child and adolescent psychiatry departments. METHODS: Participants were 265 patients, aged 4 to 17 years, who attended consecutively at 4 different centers and were naive of AP or quasi-naive (less than 30 days since the beginning of AP treatment). Type of AP, dosage, and concomitant medication were registered at baseline, 1, 3, 6, and 12 months after beginning the treatment with AP. RESULTS: At baseline, the patients' mean age was 14.4 (2.9) years, and 145 (54.7%) patients were males. Antipsychotics were more prescribed in the following: schizophrenia spectrum disorders (30.2%), disruptive behavior disorders (DBDs) (18.9%), bipolar disorders (14.3%), depressive disorders (12.8%), and eating disorders (11.7%). A total of 93.2% of the patients were on an off-label indication of AP. Risperidone was the AP most prescribed in all the assessments, but differences were observed in the type of AP according to diagnosis. Thus, risperidone was significantly most prescribed in patients with DBD and olanzapine was most prescribed in patients with eating disorders. Olanzapine and quetiapine were the second-generation APs (SGAs) most prescribed after risperidone, and haloperidol was the most prescribed first-generation AP. Up to 8.3% of patients during the follow-up were on AP polypharmacy. Almost 16% patients had a change in its AP treatment during the follow-up, and the main switch was from one SGA to another. CONCLUSIONS: Second-generation APs were the APs most prescribed in our sample and approximately 93% of the patients used AP off-label. Risperidone was the most common AP used above all in patients with DBD, whereas olanzapine was most prescribed in patients with eating disorders. Antipsychotic polypharmacy and switch rates were low during the follow-up.

Expert recommendation: contributions to clinical practice of the new prodrug lisdexamfetamine dimesylate (LDX) in the treatment of attention deficit hyperactivity disorder (ADHD).

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobiological disorders in childhood, and is characterized by inappropriate levels of inattention, hyperactivity and/or impulsiveness, with an estimated prevalence of 5.29%. ADHD can have a negative impact upon all areas of the life of the patient. The main clinical guides accept multimodal treatment, involving both pharmacological and psychological measures, as the best management approach in ADHD (psychoeducational, behavioural and academic). Lisdexamfetamine dimesylate (LDX) is a new drug for the treatment of ADHD. A multidiscipline expert document has been developed, compiling the scientific evidence referred to this new molecule. The study also addresses the existing shortcomings in current drug therapy for ADHD and the contributions of LDX to routine clinical practice, in an attempt to help and guide physicians in the use of this new treatment. This document is endorsed by the ADHD and Psychoeducational Development task Group of the Spanish Society of Primary Care Pediatrics (Grupo de TDAH y Desarrollo Psicoeducativo de la Asociación Española de Pediatría de Atención Primaria, AEPap), the Spanish Society of Pediatric Neurology (Sociedad Española de Neurología Pediátrica, SENEP) and the Spanish Society of Out-hospital Pediatrics and Primary Care (Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria, SEPEAP).

Attention-deficit hyperactivity disorder: agreement between clinical impression and the SNAP-IV screening tool.

INTRODUCTION: The CONCOR study aimed to determine the predictive value of the SNAP-IV screening tool for ADHD relative to the pediatricians' clinical global impression of the presence of ADHD in children attending their practice. METHODS: In this multicentre, cross-sectional, case-control study participated pediatricians from all over Spain and each pediatrician enrolled at least six children over the age of 6 years who had no previous diagnosis of ADHD, three whom they considered to have symptoms characteristic of ADHD (DSM-IV criteria) and three children who did not. Screening with the SNAP-IV tool was completed by parents in the waiting room prior to a consultation (for any reason) and results were compared with the pediatrician's clinical global impression. RESULTS: Results for 7263 Spanish children (>6 years of age) showed 'good' concordance between the SNAP-IV screening tool and the pediatricians' clinical impression of ADHD (kappa concordance index 0.6471; 95% confidence intervals: 0.6296-0.6646), with acceptable sensitivity and specificity (82.3% and 82.4%, respectively). Based on an estimated ADHD prevalence of 3-10%, the negative predictive values of SNAP-IV were 97.7%-99.3% and positive predictive values were 12.6-34.2%. CONCLUSIONS: SNAP-IV is a useful screening tool that identifies children who are unlikely to have ADHD, and brings those in whom there is a high possibility of ADHD to the attention of the pediatrician for clinical evaluation.

Deficient Emotional Self-Regulation and Sleep Problems in ADHD with and without Pharmacological Treatment.

OBJECTIVE: The purpose of this study is to analyse DESR and its influence on sleep parameters in three different groups of children and adolescents: a group newly diagnosed with ADHD naïve, a group with ADHD under pharmacological treatment and a control group. METHOD: Subjects were a total of 327 children and adolescents. Two groups diagnosed with ADHD: 108 medication-naïve and 80 under pharmacological treatment; and one group with 136 healthy subjects. DESR was defined using anxious/depressed, attention problems and aggressive behaviors (AAA) scales from the Child Behavior Checklist (CBCL), and sleep through the Sleep Disturbance Scale for Children. RESULTS: Significant differences were found comparing the three groups (p = .001), with a significantly higher profile on DESR in ADHD subjects, especially those who did not undergo treatment, and a positive correlation between DESR and sleep. CONCLUSION: Children and adolescents with ADHD without treatment present higher DESR than healthy controls and consequently higher sleep problems.

Psychometric properties of the Young Mania Rating Scale for the identification of mania symptoms in Spanish children and adolescents with attention deficit/hyperactivity disorder.

BACKGROUND: Diagnosing mania in children is difficult, due to the high comorbidity and symptom overlap with attention deficit/hyperactivity disorder (ADHD). The detection of manic symptoms in ADHD has important implications for prognosis and choice of treatment. Our objective was to study the utility of the Young Mania Rating Scale (YMRS) for discriminating mania in Spanish children with ADHD. METHOD: One hundred children and adolescents with ADHD between 8 and 17 years of age were evaluated with a structured diagnostic interview (Diagnostic Interview for Children and Adolescents-IV), the YMRS, the Parent-Young Mania Rating Scale (P-YMRS), the Child Mania Rating Scale-Parent Version (CMRS-P) and the Children's Global Assessment Scale. RESULTS: The YMRS showed a 1-dimensional structure with good internal consistency and test-retest reliability. The YMRS was associated with the P-YMRS and the CMRS-P. The scores obtained with the YMRS differentiated between ADHD with and without mania. The receiver operating characteristic curve analysis showed good diagnostic efficiency in differentiating mania in ADHD (area under the curve of 0.90). CONCLUSIONS: The Spanish version of the YMRS is a valid and reliable instrument for detecting and quantifying the symptoms of mania in children and adolescents with ADHD. The results provide further knowledge about the frequent association between ADHD and manic symptoms in children.

Difference in Psychic Distress Lived by Parents With ADHD Children and Parents With Healthy Children: Focus on Gender Differences.

Objective: ADHD has a complex and negative influence on the family system. The aim of this study was to analyze the perception of emotional distress in a group of parents of children with ADHD. Method: A sample was recruited from the public health system ADHD Unit at Sant Joan de Déu Hospital (Barcelona). The parents of 60 children with newly diagnosed ADHD and the parents of 60 healthy children were included. Results: Higher levels of distress in families with children with ADHD were seen. The distress is present in both parents, with a higher prevalence in the mothers group. A positive correlation was found between ADHD symptoms in the children and the distress reported by parents. A three times higher rate of separations and divorce among parents of children with ADHD was seen. Conclusion: ADHD in children and adolescents increases the emotional distress reported by parents, mainly related to the severity of symptoms present in the children.

Metabolic effects of second-generation antipsychotics in bipolar youth: comparison with other psychotic and nonpsychotic diagnoses.

OBJECTIVES: Despite known metabolic effects of second-generation antipsychotics (SGAs) on children and adolescents, comparative effects in youth with different diagnoses remain underreported. We compared differences in metabolic changes three months after starting treatment with SGAs in youth with bipolar disorder and with other psychotic and nonpsychotic disorders. METHODS: Weight and metabolic differences among diagnostic groups before and three months after starting treatment with SGAs were compared in a naturalistic cohort of children and adolescents (14.9 +/- 3.0 years) diagnosed with bipolar disorder (n = 31), other psychotic disorders (n = 29), and other nonpsychotic disorders (n = 30), with no (35.6%) or very little (6.6 +/- 9.0 days) previous exposure to antipsychotics. Composite measurements of significant weight gain [weight increase > or = 5% at three months or increase > or = 0.5 in body mass index (BMI) z-score] and 'risk for adverse health outcome' (> or = 95(th) BMI percentile, or > or = 85(th) BMI percentile plus presence of one other obesity-related complication) were included. SGAs (risperidone, olanzapine, and quetiapine) were prescribed in comparable proportion among groups. RESULTS: Baseline weight and metabolic indices were not significantly different among diagnoses. Three months after starting treatment with SGAs, more than 70% patients had significant weight gain, BMI z-score increased in all diagnostic groups (p < 0.001 for all comparisons), total cholesterol increased in the bipolar (p = 0.02) and psychotic (p = 0.01) disorder groups, low-density lipoprotein cholesterol increased in the bipolar group (p = 0.02), and free T4 decreased in the psychotic disorder group (p = 0.05). More patients with bipolar disorder presented overweight plus > or = 1 obesity-related complication at follow-up. CONCLUSIONS: There are early weight gain and metabolic changes across diagnoses in youth treated with SGAs.

ADHD Symptoms, Academic and Social Difficulties in Parents of Children with ADHD.

Objective: To evaluate the prevalence of ADHD in a group of parents of children with ADHD compared with the general population. To compare academic level, unemployment aid rate and marital separations/divorce of this parents sample. Methodology: The experimental group was formed by the parents of 60 children with ADHD. The control group was formed by the parents of 60 healthy children. To assess the retrospective and current ADHD symptomatology among the parents of the sample the Wender Utah Rating Scale (WURS) and the Attention Deficit Hyperactivity Disorder-rating scale (ADHD.rs) were used. Also, the Hollingshead Four-Factor Index of Socioeconomic status (SES-Child) was used. Results: 20.33% of the mothers in the case group met criteria for a retrospective diagnosis of ADHD, while none of the control group mothers met criteria (p < .01). Regarding fathers, there was a retrospective ADHD diagnosis in 25% of the case group compared to 10% in the control group (p < .01). In terms of the current symptoms, 25.42% of the mothers and 21.43% of fathers in the case group met diagnostic criteria for probable ADHD compared to 1.67% in the control group (p < .01 in both genders). Parents in the case group had a lower academic level (p < .01), received more unemployment aid (p = .02) and reported a higher rate of marital separation or divorce (p = .02). Conclusions: Parents of children with ADHD have a higher incidence of retrospective and current ADHD diagnosis and they also present worse socioeconomic factors.

Deficient Emotional Self-Regulation in Children with Attention Deficit Hyperactivity Disorder: Mindfulness as a Useful Treatment Modality.

OBJECTIVE: The aim of this study was to investigate the efficacy of a structured mindfulness group intervention program targeting deficient emotional self-regulation (DESR) in a sample of children with attention deficit hyperactivity disorder (ADHD). METHOD: Seventy-two children aged 7 to 12 years with ADHD were randomized into 2 groups (mindfulness and control). The dysregulation profile was measured using the Child Behavior Checklist (CBCL) Attention/Anxiety-Depression/Aggression scales. RESULTS: Children with ADHD who received mindfulness-based group therapy showed lower levels of DESR after treatment, with a reduction in CBCL dysregulation profile (F (1,63) = 4.81; p = 0.032). All ADHD symptoms showed a moderately significant positive correlation with DESR (p < 0.01). Children with combined-type showed higher levels of DESR than children with inattentive-type (p = 0.018); however, no statistically significant changes were observed in the combined-type after mindfulness treatment. CONCLUSION: This study suggests that mindfulness in the form of structured group therapy might be clinically relevant in treating children with ADHD and thus make an impact on the overall clinical outcome, regardless of the ADHD subtype.

The Mediterranean Diet and ADHD in Children and Adolescents.

OBJECTIVES: Although attention-deficit/hyperactivity disorder (ADHD) has been related to nutrient deficiencies and "unhealthy" diets, to date there are no studies that examined the relationship between the Mediterranean diet and ADHD. We hypothesized that a low adherence to a Mediterranean diet would be positively associated with an increase in ADHD diagnosis. METHODS: A total of 120 children and adolescents (60 with newly diagnosed ADHD and 60 controls) were studied in a sex- and age-matched case-control study. ADHD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Energy, dietary intake, adherence to a Mediterranean diet, and familial background were measured. Logistic regression was used to determine associations between the adherence to a Mediterranean diet and ADHD. RESULTS: Lower adherence to a Mediterranean diet was associated with ADHD diagnosis (odds ratio: 7.07; 95% confidence interval: 2.65-18.84; relative risk: 2.80; 95% confidence interval: 1.54-5.25). Both remained significant after adjusting for potential confounders. Lower frequency of consuming fruit, vegetables, pasta, and rice and higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis (P < .05). High consumption of sugar, candy, cola beverages, and noncola soft drinks (P < .01) and low consumption of fatty fish (P < .05) were also associated with a higher prevalence of ADHD diagnosis. CONCLUSIONS: Although these cross-sectional associations do not establish causality, they raise the question of whether low adherence to a Mediterranean diet might play a role in ADHD development. Our data support the notion that not only "specific nutrients" but also the "whole diet" should be considered in ADHD.

Absence of Change in Corrected QT Interval in Children and Adolescents Receiving Antipsychotic Treatment: A 12 Month Study.

BACKGROUND: Prescriptions of antipsychotic drugs (AP) in children and adolescents have significantly increased in Europe as well as in the United States. However, there is limited evidence of the cardiac safety of second-generation antipsychotics (SGA) in the pediatric population. OBJECTIVE: The aim of the study is to evaluate the cardiac side effects of SGA in children and adolescents, and how they are influenced by clinical, demographic, and treatment factors. METHODS: This article presents a naturalistic, longitudinal, multicenter study conducted in 216 treatment-naïve or quasi-naïve children and adolescents receiving AP treatment. It analyzed the possible influence of AP treatment on variables such as corrected QT (QTc) intervals and heart rate for a period of 12 months (baseline, 3 months, 6 months, and 12 months). Differences among the three main prescribed drugs used in the sample (risperidone, quetiapine, and olanzapine) were assessed. RESULTS: A total of 211 received one of the three most prescribed AP (quetiapine, risperidone or olanzapine). There were no significant QTc variations in the sample during follow-up (p = 0.54). There were no differences in QTc rates between the different SGA (risperidone-olanzapine p = 0.43; risperidone-quetiapine p = 0.42; olanzapine-quetiapine p = 0.23). When demographic, clinical, or concomitant treatment variables were considered, only baseline overweight correlated with QTc prolongation (p = 0.003). The heart rate in the whole sample tended to decrease during follow-up (p = 0.054). However, patients on quetiapine showed increased heart rate compared with those on risperidone (p = 0.04). CONCLUSIONS: In this sample, SGA seem to have a safe heart side effect profile in the child and adolescent population. There was no observed mean increase in QTc or in heart rate.

Prognostic factors of improvement in health-related quality of life in atomoxetine-treated children and adolescents with attention-deficit/hyperactivity disorder, based on a pooled analysis.

The objective of this study is to identify prognostic factors of treatment response to atomoxetine in improvement of health-related quality of life (HR-QoL), measured by the Child Health and Illness Profile-Child Edition Parent Report Form (CHIP-CE PRF) Achievement and Risk Avoidance domains, in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Pooled data from 3 placebo-controlled trials and separate data from 3 open-label trials of atomoxetine in children and adolescents with ADHD were analyzed using logistic regression methods. Based on baseline impairment in the Achievement and/or Risk Avoidance domains (CHIP-CE PRF < 40 points), 2 subsamples of subjects were included. Treatment outcome was categorized as <5 points or ≥5 points increase in the CHIP-CE PRF Achievement and Risk Avoidance domains. Data of 190 and 183 subjects from the pooled sample, and 422 and 355 subjects from the open-label trials were included in the analysis of Achievement and Risk Avoidance domains. Baseline CHIP-CE subdomain scores proved to be the most robust prognostic factors for treatment outcome in both domains, based on data from the pooled sample of double-blind studies and from the individual open-label studies (odds ratios [OR] 0.74-1.56, p < 0.05; OR < 1, indicating a worse baseline score associated with worse odds of responding). Initial treatment response (≥25 % reduction in ADHD Rating Scale scores in the first 4-6 weeks) was another robust prognostic factor, based on data from the open-label studies (OR 2.99-6.19, p < 0.05). Baseline impairment in HR-QoL and initial treatment response can be early prognostic factors of atomoxetine treatment outcome in HR-QoL in children and adolescents with ADHD.

A pilot study of the efficacy of a mindfulness program for children newly diagnosed with Attention-Deficit Hyperactivity Disorder: Impact on core symptoms and executive functions

Mindfulness has emerged as a new approach for treating mental disorders. The aim of this study is to investigate preliminary efficacy of group-based mindfulness meditation training for children on core symptoms, executive functioning and comorbidity symptoms in a children naïve Attention-Deficit Hyperactivity Disorder (ADHD) sample. Five children aged 7-12 years newly diagnosed with ADHD received an eight-week group-based mindfulness treatment. The program consisted of once-per-week sessions lasting 75 minutes and daily homework assignments. The study assessments included pre-and posttest measure of psychiatric symptoms and cognitive functioning. Data were analyzed using Wilcoxon signed-rank test. Pre-post improvements in ADHD symptoms and test performance on tasks measuring executive functioning were noted. Significant results were observed in total ADHD symptoms (p= .042), anxiety symptoms (p= .042), cognitive inhibition (p= .042) and processing speed (p= .043). In summary, although the sample size was small, our pilot study suggests that mindfulness training for children is a feasible intervention in at least a subset of ADHD children and may improve behavioral and neurocognitive impairments (AU)

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Evaluation of atomoxetine for first-line treatment of newly diagnosed, treatment-naïve children and adolescents with attention deficit/hyperactivity disorder.

OBJECTIVE: To test the hypothesis that first-line treatment with atomoxetine provides superior efficacy than placebo for up to 12 weeks in improving the symptoms of Attention Deficit/Hyperactivity Disorder (ADHD). RESEARCH DESIGN AND METHODS: This double-blind, randomized, placebo-controlled, parallel clinical trial included 151 treatment-naïve children (n = 113) and adolescents (n = 38) with newly diagnosed (< or =3 months) ADHD. Atomoxetine dose was uptitrated from 0.5 to 1.2 mg/kg/day after two weeks. Outcome assessments included the ADHD Rating Scale-IV-Parent-reported Investigator-rated (ADHDRS-IV-Parent:Inv), the Clinical Global Impression of Severity of ADHD (CGI-ADHD-S), and the incidence of adverse events. Mixed-model repeated measures analysis was used to compare scale score changes between groups. CLINICAL TRIAL REGISTRATION: Trial registered at www.clinicaltrials.gov (study internal code: B4Z-XM-LYDM, identifier: NCT00191945). RESULTS: Most patients were male (79.2%), of caucasian origin (96.0%) and severely ill (72.5%). Their mean age was 10.3 years. Atomoxetine-treated patients showed greater reductions from baseline to week 12 of total ADHDRS-IV-Parent:Inv score than placebo-treated patients (least square mean difference: -7.9 [95% CI: -11.0 to -4.8], corresponding to a large effect size of 0.8). Between-group mean differences increased progressively with treatment exposure from week 6 to 12 (-2.7 [-4.9 to -0.6] for total and -1.6 [-2.9 to -0.3] for inattention scores). At the end of the study, 50% of atomoxetine-treated patients (14% with placebo) showed a reduction > or =40% in total ADHDRS-IV-Parent:Inv score, and only 29% (46% with placebo) were severely ill (by CGI-ADHD-S). Treatment-related adverse events were significantly more frequent with atomoxetine (65.0%) than with placebo (37.3%), the most frequent being decreased appetite and somnolence. Only one case of decreased appetite was rated as severe. No patient discontinued treatment because of adverse events. CONCLUSIONS: A continued improvement of symptoms is expectable until 12 weeks in treatment-naïve ADHD patients treated with atomoxetine as first-line medication. Chief limitations are the small, national sample size and the absence of data beyond the 12-week time-point.

Consenso Delphi sobre el Trastorno por Déficit de Atención e Hiperactividad (TDAH): valoración por un panel de expertos / Delphi Consensus on Attention Deficit Hyperactivity Disorder (ADHD): evaluation by a panel of experts

Introducción. El Trastorno por Déficit de Atención e Hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo más prevalentes en la infancia, que frecuentemente se mantiene en la adolescencia y edad adulta. Presenta una gran heterogeneidad clínica, afectando notablemente al funcionamiento de quien lo padece. Si bien los tratamientos farmacológicos obtienen resultados por s. mismos, el abordaje debe ser multidisciplinar y adaptado a las necesidades específicas de cada paciente y su familia. Dada la variedad de fármacos disponibles actualmente para tratar el TDAH, existen opiniones diversas sobre cuál es la manera más efectiva de abordar este trastorno. El objetivo de este trabajo es explorar la opinión de un panel clínico experto y conocer el criterio profesional utilizado para definir conceptos clave y las pautas terapéuticas del TDAH en España. Metodología. El proyecto se efectuó en cuatro fases: 1) constitución de un Comité Científico, responsable de la revisión bibliográfica preliminar y de la formulación del cuestionario; 2) selección de un panel experto de especialistas con especial interés y/o experiencia en el tratamiento del TDAH; 3) encuesta estructurada tipo Likert (plataforma online) en dos rondas con procesamiento intermedio de opiniones; y 4) recopilación y análisis final de resultados. Resultados. El panel de expertos logró un consenso en 55 de los 58 ítems que conformaron el cuestionario, encontrando 3 ítems en los que no se consiguió suficiente unanimidad de criterio, debido a que gran cantidad de expertos se situaron en posiciones de indeterminación. Conclusiones. De manera global, los expertos de este estudio alcanzaron un elevado grado de acuerdo en los criterios propuestos en la encuesta, que podrían generalizarse como indicaciones para la práctica clínica en el manejo del TDAH Del mismo modo, y dada la dispersión de los resultados en algunos de los ítems y el no consenso en otros, quedan algunos puntos objeto de discusión (AU)

Introduction. Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in childhood, which is frequently maintained in adolescent and adult age. It presents great clinical heterogeneity, significantly affecting the functioning of those who suffer it. Although drug treatments obtain results by themselves, the approach should be multidisciplinary and be adapted to the specific needs of each patient and his/her family. Given the variety of drugs currently available to treat ADHD, there are diverse opinions on the most effective way to approach this disorder. The objective of this work is to study the opinion of an expert clinical panel and to know the professional criteria used to define key concepts and therapeutic guidelines of ADHD in Spain. Methodology. The project was carried out in four phases: 1) Constitution of a Scientific Committee, responsible for the preliminary biographic review and the formulation of the questionnaire; 2) selection of an expert panel of specialists with special interest and/or experience in the treatment of ADHD; 3) Likert type structured survey (online platform) in two rounds with interim processing of opinions; and 4) collection and final analysis of results. Results. The experts’ panel achieved a consensus in 55 of the 58 items making up the questionnaire, finding 3 items in which sufficient unanimity of criteria was not achieved because of the high number of experts were found in positions of non-certainty. Conclusions. Overall, the experts of this study reached a high level of agreement in the criteria proposed in the survey, which could be generalized as indications for the clinical practice in the management of ADHD. Similarly, and given the dispersion of the results in some of the items and the lack of consensus in others, some points remain as object of discussion (AU)