Prevalence of Common Child Mental Health Disorders Using Administrative Health Data and Parent Report in a Prospective Community-Based Cohort from Alberta, Canada: Prévalence des troubles communs de santé mentale de l'enfant à l'aide des données de santé administratives et des rapports des parents dans une cohorte prospective communautaire d'Alberta, Canada.

OBJECTIVE: Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age. METHODS: Data from a prospective pregnancy cohort was linked with provincial administrative health data for children in Alberta, Canada. We report the positive agreement, negative agreement, and Cohen's Kappa of parent-reported child diagnoses provided by a health professional ("parent report"), exceeding a clinical cut-off on a standardized questionnaire completed by parents (the Behavior Assessment System for Children, 3rd edition ["BASC-3"]), and cumulative inpatient, outpatient, or physician claims diagnoses ("administrative data"). RESULTS: Positive and negative agreement for administrative data and parent-reported ADHD diagnoses were 70.8% and 95.6%, respectively, and 30.5% and 94.9% for administrative data and the BASC-3, respectively. For emotional disorders, administrative data and parent-reported diagnoses had a positive agreement of 35.7% and negative agreement of 96.30%. Positive and negative agreement for emotional disorders using administrative data and the BASC-3 were 20.0% and 87.4%, respectively. Kappa coefficients were generally low, indicating poor chance-corrected agreement between these data sources. CONCLUSIONS: The data sources highlighted in this study provide disparate agreement for the prevalence of ADHD and emotional disorder diagnoses in young children. Low Kappa coefficients suggest that parent-reported diagnoses, clinically elevated symptoms using a standardized questionnaire, and diagnoses from administrative data serve different purposes and provide discrete estimates of mental health difficulties in early childhood.Plain Language Title: Prevalence of child mental health disorders according to different data sources in Canada.

Knowing the prevalence of mental health difficulties in young children is critical for informing mental health policy and decision-making. Yet, different sources yield different estimates and we do not know how these estimates compare. In the current study, we examine the agreement among three different information sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age. To estimate the prevalence of mental disorders, we asked parents if their child had ever been diagnosed, we asked parents to complete a questionnaire using clinical symptom cut-offs for diagnosis, and we looked at data collected in the health care system to see if a child was ever diagnosed by a healthcare provider. We found that for ADHD, parent report that their child had received a diagnosis and their child having received a diagnosis in the healthcare system were similar. There were larger differences between a parent report of elevated symptoms on a questionnaire and whether they had been diagnosed by a healthcare provider. For emotion disorders, there were larger differences between parent report that their child had received a diagnosis and whether one was documented in the health record. Overall, there was somewhat low agreement between these three sources of data. We conclude that the different sources of data used in this study provide different estimates of ADHD and emotional disorder diagnoses in children. Therefore, when trying to understand the burden of child mental health disorders in young children, it is important to consider multiple sources to obtain a comprehensive picture of the issue.

Attention deficit hyperactivity disorder, self-esteem and the impact of treatments.

OBJECTIVES: Children with attention deficit hyperactivity disorder (ADHD) experience repetitive failures in their school and social life and often receive negative feedback from their environment, endangering the development of their self-esteem. Self-esteem is a forecasting factor for social, psychological, professional and familial well-being. Poor self-esteem is a risk factor for the development of depression, anxiety disorder, and personality disorder. The aim of this article is to evaluate the child's self-esteem at the initial time of ADHD diagnosis, describe self-esteem evolution after diagnosis and identify clinical and therapeutic factors associated with improved self-esteem. METHODS: In a longitudinal descriptive study, 6-12-year-old patients with ADHD underwent a multidisciplinary evaluation including a diagnostic interview (Kiddie Schedule for Affective Disorders and Schizophrenia Present/Lifetime version: K-SADS), a symptoms severity assessment with parent questionnaires (Attention Deficit Hyperactivity Disorder Rating Scale: ADHD-RS), a neurocognitive testing of attention and IQ, and a self-esteem interview (Self-Esteem Inventory of Coopersmith: SEI). The follow-up assessment included a K-SADS-PL, ADHD-RS and SEI assessments and recorded treatment history. We compared the score of self-esteem between these two assessments. RESULTS: Among the 108 screened patients, we obtained complete data from 55 patients at the second assessment. At first evaluation, two-thirds of children with ADHD had low self-esteem scores. At the second evaluation, our results indicate a significant improvement of global, personal, and social self-esteem score (SEI) and symptoms severity score (K-SADS-PL and ADHD-RS). CONCLUSIONS: Self-esteem improved in patients with ADHD after specific treatments.

Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD.

Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.

Healthcare pathways and practitioners' knowledge about ADHD in children.

INTRODUCTION: Access to care for children and adolescents affected by ADHD in France remains below the levels attained in most industrialised countries. To contribute to improving ADHD care in France, we assessed existing ADHD knowledge among medical doctors (MDs) and described associated care pathways in two large French regions in 2021. We produced tools to evaluate the regional impact of implementing a stepped-care pathway for ADHD. METHODS: A SurveyMonkey® study was sent to professionals from two regions in France accounting for 14 million inhabitants, allowing them to describe their role in child/adolescent ADHD, as well as their representations and knowledge about the disorder. RESULTS: Around 9.4% of all MDs potentially involved with children took part in the study; 34.9% considered themselves untrained, 40.5% were involved in ADHD care at a first-tier level, and 19.6% at a second-tier level. Access to a second or third-tier service for ADHD was associated with mean waiting times of 5.7 and 8.5 months, respectively. Initiation of stimulant therapy remained mainly restricted to second or third-tier MDs, and adaptation of dosage or change in the galenic formulation was rarely performed by first-tier MDs (27.2% and 18%, respectively). Training in neurodevelopmental disorders and tier-level were the strongest determinants of knowledge, attitudes and self-assessed expertise about ADHD. CONCLUSIONS: This study provides insight into training needs for MDs regarding healthcare pathways in ADHD and should support the implementation of health policies, such as a stepped healthcare access for ADHD. The study design and dissemination have been validated and will be available in France and other countries facing similar obstacles in care pathways for ADHD. Official recommendations on ADHD in children and adults are being updated in France, and our data and the survey design will be a starting point for their implementation.

ADHD and addictive behavior in crack-cocaine users.

BACKGROUND: Crack consumption is a major public health issue in Martinique with a poor prognosis. A preliminary study has found a high prevalence of history of childhood ADHD (C-ADHD) in crack users. OBJECTIVE: To determine the prevalence of C-ADHD and adult ADHD (A-ADHD) in crack users and their potential associations with substance use behavior. METHODS: All consecutive patients consulting in the public academic hospital covering 376,000 inhabitants were included in the present study and received a comprehensive battery measuring addictive behavior, psychiatric and somatic comorbidities. C-ADHD groups and A-ADHD groups were defined with the Wender-Utah Rating Scale-25 and the Brown ADD Rating Scale, respectively. Impulsivity was evaluated with the Barratt Impulsiveness Scale (BIS-11). FINDINGS: In total, 111 participants were evaluated. Among them, 50 (45%) were classified in the C-ADHD group and 20 (18%) in the A-ADHD group. Compared to the patients without ADHD, those with ADHD were found to have higher impulsivity (C-ADHD: BIS total score 67.90 (10.1) vs. 63.28 (10.5), P=0.021, BIS attentional score 17.5 (3.6) vs. 15.3 (3.4), P=0.002, A-ADHD: BIS total score 75.1 (11.3) vs. 63.4 (9.2), P<0.001, BIS motor impulsivity 26.9 (5.3) vs. 22.6 (4.3), P<0.001, BIS attentional score 19.3 (3.3) vs. 15.6 (3.5), P<0.001, BIS planification 28.9 (5.7) vs. 25.10 (4.7), P=0.003). Fifty percent of A-ADHD patients were found with high impulsivity vs. 15% of patients without A-ADHD (P<0.001). However, ADHD was not associated with more severe addictive behavior or history of legal consequences. INTERPRETATION: ADHD prevalence is high in cocaine-crack users and associated with increased impulsivity. However, neither ADHD nor impulsivity explains addictive behaviors or legal consequences.

Retrospective diagnosis of childhood ADHD using the Wender Utah Rating Scale.

OBJECTIVE: An external validation of the Wender Utah Rating Scale (WURS) against a clinical assessment is lacking, especially for French-speaking populations. METHOD: Participants completed three subsets of the WURS-61 and were assessed for ADHD using the DIVA 2.0 semi-structured interview. Exploratory factor analyses were performed. Logistic regression models and Receiver-Operating Curves were used to determine the cut-off scores that predicted childhood ADHD with best accuracy. RESULTS: One hundred three adults were included. Three factors were extracted for the WURS-25 and WURS-K, and four for the WURS-29. Cut-off scores are 44, 24 and 42, respectively. When considering DSM-5 rather than DSM-IV criteria, these values changed to 44, 36 and 44, respectively. More than 83% of the participants had been correctly classified. CONCLUSION: All three subsets of the WURS-61 retrospectively predict the presence of ADHD in childhood. This result might prove to be useful in screening and research procedures.

Attention-deficit hyperactivity disorder and executive dysfunction in preschool children. A comparison of NEPSY and BRIEF-P assessments.

OBJECTIVE: The aim of the study was to explore prevalence, interrelations and accuracy of assessing psychopathology, intelligence, and executive functions (EF) in preschool children with ADHD (age 2.1-6.5 years). METHOD: We prospectively investigated 115 preschool outpatient children (91 boys, 24 girls, aged 4.3±1.0 years) with the clinical diagnosis of ADHD. Assessment included clinical history, background, psychosocial problems (CBCL, C-TRF), ADHD (DISYPS external ratings), cognitive performance (WPPSI-III, K-ABC), and executive functions (BRIEF-P, NEPSY). RESULTS: We found a high frequency of dysexecutive problems in up to 64 % in the parental BRIEF-P assessments, up to 62 % in the BRIEF-P teachers' assessments, and 62 % in the NEPSY functional assessments. Parental and teachers' BRIEF-P scores were only correlated in one subscale, inhibition, and NEPSY and BRIEF-P were not correlated at all. It was found that 42.5 % of the children with noticeable findings had agreeing results in all three, and another 45 % in two tests. CONCLUSIONS: About 2/3 of the ADHD preschool children had detectable EF dysfunctions. In order to assess dysexecutive problems, multi-method testing is mandatory.

[Improvement of the impulsive control in adolescents with attention deficit hyperactivity disorder (ADHD) after a cognitive behavioral therapy]. / Amélioration du contrôle impulsif chez les adolescents avec un trouble de l'attention avec hyperactivité (TDAH) ayant suivi une thérapie cognitive comportementale.

AIM: MPH is the more often prescribed stimulant for Attention Deficit Hyperactivity Disorder (ADHD), but it has been estimated that 30% of patients do not adequately respond or cannot tolerate it. Therefore, some other therapies are needed, such as cognitive behavioral therapy. Cognitive behavioral therapy is an intervention proposed over several sessions and aimed at modifying behavior by teaching different techniques that participants can re-use to control their symptoms. In our Institute, we used a program centered on attentional and metacognitive functions. It consists of a series of workshops performed in group at the rate of one workshop of 90minutes per week for 12 weeks. Positive effects on the behavior of adolescents with ADHD have been reported by parents and educators, but the effects of the program on specific cognitive processes have never been precisely investigated. METHOD: In the present study, we evaluated the impact of the program on impulsive control in adolescents with ADHD who are known to present impaired impulsive control. Impulsive control is required each time there is a conflict between an inappropriate prepotent action and a goal-directed action. At an experimental level, impulsive control can be studied with conflict tasks, such as the Simon reaction time task. Interpreted within the theoretical framework of the so-called « Dual-process activation suppression ¼ (DPAS) model, this task is a powerful conceptual and experimental tool to separately investigate the activation and inhibition of impulsive actions, which is almost never done in studies about impulsive control. Twenty adolescents followed the program and were tested before and at the end of the program by using dynamic analyses of performance associated with DPAS model. RESULTS: The results have shown an improvement of the impulsive control after three months of cognitive behavioral therapy, and this improvement was due to both a decrease of the propensity to trigger impulsive actions and an improvement of inhibitory processes efficiency. CONCLUSION: This program could be a relevant alternative to the stimulant medication, more particularly when parents are reluctant with medication or when the adolescent suffers from important side effects.

Transition from child and adolescent mental health care to adult services for young people with Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD) in Europe: Barriers and recommendations.

Transition in mental health care is the process ensuring continuity of care of a young patient arriving at the CAMHS (Child and Adolescent Mental Health Service) age boundary within mental health services. Transition refers to a transfer to an adult mental health service (AMHS), to private care or other mental health community services. A transition plan can also lead to a managed end of specialized care with involvement of a general practitioner or social services. For young people with a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) or ASD (Autism Spectrum Disorder), two disorders that persist into adulthood, an optimal transition would ensure continuity of care or facilitate access to specialized care in the case of a discharge. Transition typically occurs during adolescence, a known sensitive period when young people may experience major changes at several levels: physiological, psychological and social. Any barrier in the transition process resulting in discontinuity of care may worsen the symptoms of ADHD or ASD and can ultimately adversely affect the global mental health of young people with such neurodevelopmental disorders. The objectives of this narrative review are: 1/to identify the barriers in the transition process in mental health services often faced by young people with these two disorders; 2/to highlight specific recommendations for strengthening the CAMHS-AMHS interface that have been proposed by various countries in Europe.

Communication between infant boys and their mothers with ADHD symptoms.

AIM: This preliminary longitudinal study examined timing features and type of interaction between infant boys and their mothers with attention deficit hyperactivity disorder (ADHD) symptoms METHOD: Ten infants and their mothers with ADHD symptoms and 10 control dyads were video recorded at home during free play interactions when infants were 2-, 4-, 6-, and 9-month old. Microanalysis of the video recordings was carried out to assess synchronization, turn-taking, and type of interaction. Infants' temperament was also assessed RESULTS: ADHD dyads showed shorter synchronization at 2 months and shorter duration of Joint Attention. Partial least squares regression analysis revealed that infant's ability for Joint Attention is predicted mainly by duration of maternal behavior as well as by earlier forms of communication, that is, protoconversations. CONCLUSION: The data from our preliminary study suggest that mothers with ADHD symptoms may have difficulties maintaining their behavior for enough time possibly due to the core symptoms of the disorder, that is, inattention, hyperactivity, and impulsivity. This maternal deficit seems to affect temporal coordination with their infants and maybe the development of more complex forms of interaction. Clinical implications of these findings are also discussed.

Propósito: Este preliminar estudio longitudinal examinó las características de tiempo y el tipo de interacción entre infantes varones y sus madres con síntomas de Trastorno con Déficit de Atención con Hiperactividad (TDAH). Método: Diez infantes y sus madres con síntomas de TDAH y 10 díadas de control fueron grabados en video en casa durante interacciones de juego libre cuando los infantes tenían 2, 4, 6 y 9 meses de edad. Se llevó a cabo un microanálisis de las grabaciones de video para evaluar la sincronización, el turnarse y el tipo de interacción. También se evaluó el temperamento de los infantes. Resultados: Las díadas TDAH mostraron una más corta sincronización a los 2 meses y una duración más corta de la Atención Compartida. El análisis de Regresión de Cuadrados Mínimos Parciales reveló que la habilidad del infante para la Atención Compartida es afirmada principalmente por la duración de la conducta materna, así como también por formas más tempranas de comunicación, v.g. protoconversaciones. Conclusión: La información de nuestro estudio preliminar sugiere que las madres con síntomas de TDAH pudieran tener dificultades para mantener su conducta por suficiente tiempo posiblemente a causa de los síntomas centrales del trastorno, v.g. falta de atención, hiperactividad e impulsividad. Este déficit materno parece afectar la coordinación temporal con sus infantes y quizás el desarrollo de más complejas formas de interacción. También se discuten las implicaciones clínicas de estos resultados.

But: Cette étude longitudinale préliminaire a examiné les traits de timing et les types d'interaction entre des nourrissons garçons et leurs mères avec des symptômes de TDAH. Méthode: Dix bébés et leurs mères avec des symptômes de TDAH et 1- dyades de contrôle ont été filmés à la vidéo durant des interactions de jeu libre quand les bébés avaient 2, 4, 6, et 9 mois. Une microanalyse des enregistrements vidéo a été faite afin d'évaluer la synchronisation, les tours de role et le type d'interaction. Le tempérament des bébés a aussi été évalué. Résultats: Les dyades TDAH ont fait preuve d'une synchronisation plus courte à deux mois et d'une durée plus courte d'Attention Commune. Une analyse de régression partielle par les moindres carrés a révélé que la capacité du nourrisson à une Attention Commune est prédite essentiellement par la durée du comportement maternel ainsi que par les formes précédentes de communication, comme des protoconversations. Conclusion: Les données de notre étude préliminaire suggèrent que les mères avec des symptômes TDAH peuvent avoir des difficultés à maintenir leur comportement pour assez de temps, peut-être du fait des symptômes essentiels du trouble: inattention, hyperactivité et impulsivité. Ce déficit maternel semble affecter la coordination temporelle avec leurs bébés et peut-être le développement de formes d'interaction plus complexes. Les implications cliniques de ces résultats sont aussi discutées.

[ADHD during childhood and subsequent psychotic disorder: A link?] / TDAH dans l'enfance et trouble psychotique à l'âge adulte : quel lien ?

OBJECTIVES: Attention Deficit with/without Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with frequent comorbid psychiatric disorders. Several studies have underlined the increased risk of developing a psychotic disorder subsequent to a childhood ADHD. The aim of our review is not only to clarify this association and the related physiopathology but also to understand the consequences for therapeutic management. METHODS: We processed a narrative review of available literature based on a research of the PubMed database. Articles related to ADHD and psychotic disorder on a genetical, clinical or biological level were selected by one of the authors. RESULTS: ADHD and psychotic disorders share neonatal, environmental, and genetic risk factors. On a neurobiological level, both disorders are concerned by a dysfunction of the dopaminergic system with an abnormal regulation of dopaminergic neurons' phasic and tonic activity. Our review aims to explain the « dynamic ¼ model of dopaminergic dysfunctions and propose some guidance for pharmacological treatment of ADHD, with or without psychotic disorder. This model offers a better understanding of why methylphenidate is not associated to an increased risk of psychotic disorder and could act as a protective factor. Association between ADHD and psychotic disorders could be explained by some comorbidities such as substance use disorders which are frequently associated with both conditions and could act as mediator in the genesis of psychotic disorders following ADHD during childhood. Our review also focuses on an epidemiological bias that could be found in some studies such as possible diagnostic errors, as some non-specific clinical signs could be found in both late diagnosed ADHD and in "at risk mental state" of psychosis. CONCLUSION: ADHD and psychotic disorders share common risk factors, neurobiological pathways and clinical symptoms. Perspectives for future studies are proposed considering a dimensional aspect of psychiatric disorders using, for example, Research Domain Criteria and exploring the link between the two conditions.

[Observation and comparison of social abilities in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder children]. / Étude des altérations des habilités sociales chez des enfants ayant un Trouble Déficit de l'Attention/Hyperactivité : comparatif avec des sujets contrôles et des sujets présentant un Trouble du Spectre de l'Autisme.

OBJECTIVES: Different studies centered on social relationship issues among ADHD children struggled to provide a unicist explanation between primary social cognition process alteration on the one hand and a mere symptomatic outcome of the disorder triad on the other. Some authors support the idea of a potential "social phenotype" shared at a different intensity by Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). The point of the study is to characterize this possible social disability in a French ADHD population and compare it to control subjects and subjects with Autism Spectrum Disorder (ASD). METHODS: Three groups, composed of 319 subjects aged 6 to 12 years, were recruited in Bordeaux: 88 untreated ADHD subjects, 24 ASD subjects and 207 control subjects. The main measure was the social skill disruption through the rating of the Social Responsiveness Scale (SRS). The ADHD-RS-IV, WFIRS-P and CBCL scales were also used. RESULTS: Asignificant alteration in social abilities in ADHD children in comparison with controls was noted, with an average raw total SRS score intermediary between the control group and the ASD group (respectively 65.31±20.99, 37.15±16.37 and 95 75±30.83, P<0.05). When the 5 sub-scores of the SRS were taken into account, if the ASD subjects showed the highest average scores, the alteration pattern appeared qualitatively similar between the ADHD and TSA groups, with also an intermediate dispersion for the ADHD group between the control group and the group with ASD. Finally, more severe impairment of social skills in children with ADHD was associated with increased severity of the disorder (on ADHD-RS-IV scale cotation), higher daily functional impact (WFIRS-P scale), and more frequent behavioral issues (according to CBCL). CONCLUSIONS: Our results suggest the presence of social disturbances in ADHD and characterize a symptomatic profile qualitatively similar to that of ASD, but of less intensity. Overall results promote a need for a systematic dimensional assessment of social disability in ADHD.

Practical considerations for the evaluation and management of Attention Deficit Hyperactivity Disorder (ADHD) in adults.

Attention deficit with or without hyperactivity disorder (ADHD) is one of the most frequent neuropsychiatric disorders, and affects 2-4% of adults. In contrast with many European countries, the identification and management of adult ADHD remains underdeveloped in France, and a subject of controversy. This review provides a practical update on current knowledge about ADHD in adults for French-speaking professionals who have to detect or manage adult patients with ADHD. ADHD is classified as a neurodevelopmental disorder in the recent update of the international diagnostic classification. While symptoms and impairment due to ADHD are frequently severe during childhood, they often evolve as children grow older, with frequent persistent disabilities in adulthood. In adulthood, the clinical presentation, as in childhood, involves the symptom triad of inattention, hyperactivity and impulsivity. However, differences are noted: hyperactivity is more often internalized, symptoms of inattention may be masked by anxiety symptoms or obsessive-like compensation strategies. ADHD is often diagnosed during childhood, but it is not rare for the diagnosis to be made later. Failure to recognise symptoms resulting in misdiagnosis, or alternatively well-developed compensation factors could be two underlying reasons for the long delay until diagnosis. Other symptoms, such as emotional deregulation or executive function-related symptoms are also usually observed in adults. In addition, in adults, ADHD is often associated with other psychiatric disorders (in 80% of cases); this makes the diagnosis even more difficult. These disorders encompass a broad spectrum, from mood disorders (unipolar or bipolar), to anxiety disorders, and other neurodevelopmental disorders and personality disorders, especially borderline and antisocial personality disorder. Substance-use disorders are very common, either as a consequence of impulsivity and emotional dysregulation or as an attempt at self-treatment. Sleep disorders, especially restless leg syndrome and hypersomnolence, could share common pathophysiological mechanisms with ADHD. ADHD and comorbidity-related symptoms are responsible for serious functional impairment, in various domains, leading to academic, social, vocational, and familial consequences. The impact on other psychiatric disorders as an aggravating factor should also be considered. The considerable disability and the poorer quality of life among adults with ADHD warrant optimal evaluation and management. The diagnostic procedure for ADHD among adults should be systematic. Once the positive diagnosis is made, the evaluation enables characterisation of the levels of severity and impairment at individual level. A full examination should also assess medical conditions associated with ADHD, to provide personalized care. In recent years, a growing number of assessment tools have been translated and validated in French providing a wide range of structured interviews and standardized self-report questionnaires for the evaluation of core and associated ADHD symptoms, comorbidities and functional impairment. The treatment of ADHD in adults is multimodal, and aims to relieve the symptoms, limit the burden of the disease, and manage comorbidities. The most relevant and validated psychological approaches are psycho-education, cognitive-behavioural therapy and "third wave therapies" with a specific focus on emotional regulation. Cognitive remediation and neurofeedback are promising strategies still under evaluation. Medications, especially psychostimulants, are effective for alleviating ADHD symptoms with a large effect size. Their safety and tolerance are satisfactory, although their long-term clinical benefit is still under discussion. In France, methylphenidate is the only stimulant available for the treatment of ADHD. Unfortunately, there is no authorization for its use among adults except in continuation after adolescence. Hence the prescription, which is subject to the regulations on narcotics, is off-label in France. This article aims to provide practical considerations for the management of ADHD and associated disorders in adults, in this particular French context.

[How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak?] / Comment les enfants et adolescents avec le trouble déficit d'attention/hyperactivité (TDAH) vivent-ils le confinement durant la pandémie COVID-19 ?

OBJECTIVES: During the COVID-19 pandemic, the French government has decided a general lockdown. This unprecedented situation has raised concerns about children's and adolescent's mental health. Children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) may find this context of restrained activity particularly tricky. The objectives of our study are to gather information about the well-being and global life conditions of children and adolescents with ADHD during the COVID-19 outbreak in France. METHODS: We designed a survey including both open-ended questions and questionnaire items for parents of children and adolescents with ADHD. Parents responded to the following open-ended questions: 1) "How is your child doing since the lockdown?" 2) "How is life at home since the lockdown?" 3) "If you had a remote service provision with a mental health professional (e.g. by telephone or video technology), please share your thoughts and any suggestions with us" 4) "Please share any other items that you think are important about ADHD symptoms of your child and the lockdown situation". This survey was posted on social media on the 6th of April and disseminated by French ADHD-parent and patient organizations. The present article reports the descriptive, qualitative and textometrical analyses of the survey. RESULTS: Between day 20 and 30 of lockdown, 538 parents responded to the survey, and we included 533 responses in the final analysis. The vast majority of responders were women 95 % (95 % CI 93,50; 97,18) with children whose mean age was 10,5 (95 % CI 7.58; 13.44). Since the lockdown, 34.71 % (95 % CI 30.70; 38.94) of children experienced a worsening in well-being, 34.33 % (95 % CI 30.34; 38.56) showed no significant changes and 30.96 % (95 % CI 27.09; 35.10) were doing better according to their parents. The thematic analysis showed that an improvement of their children's anxiety was one of the main topics addressed by parents. This improvement related to less school-related strain and flexible schedules that respected their children's rhythm. Improved self-esteem was another topic that parents linked with a lesser exposure of their children to negative feed-back. Parents repeatedly reported both inattention and hyperactivity/impulsivity. However, optimal lockdown life conditions seemed to compensate for the impact of ADHD symptoms (e.g. sufficient space at home, presence of a garden). Some parents reported worsening of general well-being in their children, and this manifested as oppositional/defiant attitudes and emotional outbursts. Parents also cited sleep problems and anxiety in this context. As regards everyday life during lock-down, at-home schooling was another major topic-parents described that their children struggled to complete school-related tasks and that teachers seemed to have forgotten about academic accommodations. The lockdown situation seems to have raised parents' awareness of the role of inattention and ADHD symptoms in their children's learning difficulties. Due to potential selection biases, the results of our survey may not be generalizable to all children and adolescents with ADHD. The main strengths of this rapid survey-based study lies in the reactivity of the participants and the quality and diversity of their responses to the open-ended questions. CONCLUSIONS: According to their parents, most children and adolescents with ADHD experience stability or improvement of their well-being. An improvement in school-related anxiety and the flexible adjustment to the children's' rhythms as well as parents' increased awareness of the difficulties their children experience are among the key topics in parents' descriptions.

Early childhood predictors of boys' antisocial and violent behavior in early adulthood.

Research on early childhood predictors of violent behaviors in early adulthood is limited. The current study investigated whether individual, family, and community risk factors from 18 to 42 months of age were predictive of violent criminal arrests during late adolescence and early adulthood using a sample of 310 low-income male participants living in an urban community. In addition, differences in trajectories of overt conduct problems (CP), hyperactivity/attention problems (HAP), and co-occurring patterns of CP and HAP from age 1½ to 10 years were investigated in regard to their relationship to violent and nonviolent behaviors, depression, and anxiety at age 20. Results of multivariate analyses indicated that early childhood family income, home environment, emotion regulation, oppositional behavior, and minority status were all significant in distinguishing violent offending boys from those with no criminal records. In addition, trajectories of early childhood CP, but not attention deficit hyperactivity disorder, were significantly related to self-reports of violent behavior, depressive symptoms, and anxiety symptoms. Implications for the prevention of early childhood risk factors associated with adolescent and adult violent behavior for males are discussed.

[Can ADHD have an adulthood onset?] / TDA/H, trouble de l'enfance ou de l'âge adulte ?

ADHD is the most common psychiatric disorder of childhood. It is considered to be a neurodevelopmental disorder that may persist from chilhood into adulthood. In childood it is associated with several outcomes such as inattention, hyperactivity and impulsivity. Symptoms may change as a person gets older with an increased risk of developing psychiatric comorbidities such as depression, anxiety and substance addiction. However, recent studies diverge from the traditional perspective. These authors hypothesized that ADHD may appear in adulthood, not as a continuation of child ADHD, but some limitations have to be considered. Firstly, ADHD often goes unrecognized throughout childhood. Secondly, families may help the children to develop compensation strategies and adaptative behaviors. The purpose of this report is to better investigate these different and innovative clinical results and understand if adult ADHD could really be considered as a distinct, different pathology, as a late-onset disorder. We conducted a brief review of literature and included the most recent scientific longitudinal follow-up cohort studies. We conclude that, while adult ADHD is still considered a continuation from childhood, many questions of late-onset ADHD remain and further research is necessary to better understand and explain the etiology, the development, the clinical impact, and the psychotherapeutic and pharmacologic treatment of this late-onset disorder.

[Impulsivity and obesity in children with Attention Deficit Hyperactivity Disorder: A clinical, neuropsychological and magnetic resonance spectroscopy exploratory study]. / Rôle de l'impulsivité dans la relation entre surpoids et TDAH chez l'enfant : étude exploratoire des caractéristiques cliniques, neuropsychologiques et neurobiochimiques.

OBJECTIVES: Relationship between Attention Deficit Hyperactivity Disorder (ADHD) and obesity in adults and children had previously been established in research studies. Brain imaging studies pointed out the important role of the prefrontal region in both ADHD and obesity. However, the underlying link between ADHD and obesity is not well understood. The hypothesis that impulsivity could play a role has been explored in clinical studies of ADHD and Binge Eating Disorders or Loss of Control Eating, with contradictory results. Our study aims to compare children with ADHD and obesity to children with ADHD and normal weight. We propose to compare these two populations with clinical, neuropsychological and brain spectroscopy investigation, focusing specifically on impulsivity items. METHOD: Ten children presenting overweight or obesity were selected from a larger population of children with ADHD (5-12y) and paired with regard to gender and age with ten children with ADHD and normal weight from the same population. Conners Rating scales version parents (CPRS) and teachers (CTRS), Conners' Continuous Performance Test II (CPT-II), and Magnetic Resonance Spectroscopy (MRS) metabolites in five regions of interest (left and right prefrontal, left and right striatal and left cerebellum regions) were measured for all the children. For MRS, ratio to creatinine levels of following metabolites were measured: glycerophosphocholine+phosphocholine/creatinine (GPC+PCh/Cr), glutamate+glutamine (Glu+Gln/Cr), myoinositol (mI/Cr) et N-acétylaspartate+N-acétylaspartylglutamate (NAA+NAAG/Cr). RESULTS: Hyperactivity/Impusivity and Conners Global Index (CGI) subscales of Conners rating scales showed a higher rate of impulsivity in children with ADHD and obesity as compared to children with ADHD and normal weight. Neuropsychological results were comparable in the two groups. Finally, MRS showed a higher GPC+PCh/Cr ratio in right prefrontal cortex in children with ADHD and obesity as compared to children with ADHD and normal weight. CONCLUSIONS: Our results are concordant with the hypothesis that impulsivity could be the link between obesity and ADHD in a population of children with ADHD. The right prefrontal regions seem to be areas of interests that need more research in the study of the link between obesity and ADHD.

"Snips and Snails and Puppy Dog Tails": Boys and Behaviour in the USA.

In The Adventures of Tom Sawyer and Huckleberry Finn, Mark Twain introduced two of the most iconic boys in American literature. Tom and Huck become heroic figures, despite their penchant for bad behaviour. Indeed, it is their propensity to be impulsive, break rules and defy authority that win them the day. Today, however, Tom Sawyer and Huck Finn have become the posterboys for a psychiatric disorder, Attention Deficit Hyperactivity Disorder, or ADHD. I trace how and why attitudes about pathological boys' behaviour reversed during the twentieth century, from a focus on shy, introverted, and physically passive boys to the very opposite - boys like Tom and Huck. I argue that, rather than imposing limits on childhood behaviour, we should be more accepting and encouraging of all types of children.

[Children with high potential and difficulties: Contributions of clinical research]. / Les enfants à haut potentiel en difficulté : apports de la recherche clinique.

We have been sensitized to children with high intellectual potential (HIP) having difficulties given the number of children consulting in our outpatient medico-psychological centres for scholastic problems (possibly leading to school failure), anxiety disorders or behavioral disorders such as attention deficit/hyperactivity disorder (ADHD), and in which a high intellectual potential was discovered during psychological assessments. It is the contrast, and more precisely the paradox, between the high intellectual potential of these children and their scholastic difficulties (including school failure), and the psychic suffering expressed by some of them, which led us to question, challenge and propose therapeutic and educational care adapted to these children. It is in this context that we created in December 2005 the CNAHP (National Center for Assistance to High Potential children and adolescents) which is a public centre integrated into the hospital-university department of child and adolescent psychiatry at Rennes. It is noteworthy that not all children with HIP have difficulties, and children with school failure or behavioral problems are not always children with HIP. However, it is necessary not to minimize the problem raised by children with HIP with difficulties by ignoring its frequency or by considering that these children are "intelligent" enough to manage by themselves and do not need to be helped, whereas some of them can show school failure and even be de-scholarized. Indeed, based on the definition of the World Health Organization (WHO) of an intellectual Quotient (IQ) above 130 (level corresponding to a statistical threshold), the frequency of children with HIP represents 2.3% of the population of schoolchildren aged 6 to 16. The frequency is therefore not so rare. However, it remains to be determined by French epidemiological studies what is the actual frequency of children with difficulties within a population of children with HIP. The analysis of the CNAHP research data from a clinical population (children with HIP consulting for difficulties) highlights that children with HIP can show major school problems (including school failure, defined here as having or foreseeing repetition of a grade), which corresponds to 7.5% of 611 children with HIP consulting at the CNAHP) and socioemotional problems (emotional regulation disorders) in relation to their high intellectual potential. In particular, anxiety disorders were the most frequent psychiatric disorders observed in this population (40.5%) and were significantly associated with high verbal potential. This significant association requires further studies to avoid establishing a simplistic unidirectional and reductive linear cause-effect relationships. Indeed, a high verbal potential can elicit and/or reinforce anxiety-producing representations, but anxiety disorders may also lead to a defensive over investment of verbal language. The results are discussed in this article and suggest that scholastic and/or psychological difficulties encountered by some children with HIP can be related to their high intellectual potential. It is necessary to develop therapeutic and educational care adapted to these children from a better understanding, based on research results, of their possible difficulties but also cognitive abilities. Even when children with HIP have scholastic and/or psychological difficulties, some of their cognitive skills can be preserved contrary to appearances, with for example, as seen in the CNAHP results, excellent attentional capacities shown by cognitive tests contrasting with behavioral attention deficit reported by parents. These skills are important to identify as they are resources which support the therapeutic and educational project. It is probably through an articulation among professionals from national education, health and research, in alliance with the family (parents, child, and siblings), that advances will be made. In the same way that professionals have been interested in children with intellectual disabilities, it is important to be concerned by children with HIP and difficulties located at the other end of the continuum. It is a question of ethics which concerns both caregivers and teachers. It is also a societal issue that concerns all of us given that the expression of high intellectual and creative potential in children may be essential to the societal development of innovative strategies and each nation's future. Finally, the discussion can be extended to all children, independent of their potential. What we learn from children with HIP and difficulties can be applied to each child: it is important at family, school and societal levels to facilitate the expression of the potential of children, to value their skills, and to help them to remove possible inhibitions of their potential based on individualized projects. The acceptance of singularity and differences in children can contribute to tolerance and the development of creativity, in the interest of the subject and of society.