Prevalence rate of ADHD in France: Review of the literature and results from ChiP-ARD study.

OBJECTIVES: Attention Deficit Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder whose first clinical description was published more than two centuries ago. Prevalence rates have been evaluated in many countries and meta-analyses conducted, but the data collected in France are scarce. METHODS: A review of the literature was conducted by retrieving the references from four electronic databases leading to the selection of four studies in children and four in adults. Meta-analyses of prevalence rates were performed on this published data as well as unpublished results from the ChiP-ARD study (Children and Parents with ADHD and Related Disorders), separately for children and adults. RESULTS: While the quality of most studies is questionable, the prevalence rates are close to those reported in international meta-analytic studies for children (3.68%), but are higher in adults (5.5%). CONCLUSIONS: Well-conducted studies in both general and special populations are needed (e.g., in patients with depression, anxiety, bipolar disorder, developmental disorders including autism spectrum disorder, behavioural or substance abuse, and incarcerated). Nevertheless, healthcare stakeholders can conservatively consider that .8 million children and 1.4 million adults in the metropolitan French general population are likely to have ADHD and suffer from its multiple consequences.

Effect of Child Position on Pain Experience During Lumbar Puncture: A Prospective Pilot Study.

BACKGROUND: This study aimed to evaluate the impact of patient's position on pain and anxiety during lumbar puncture (LP). MATERIALS AND METHODS: A randomized controlled trial included children between 2 and 18 years old receiving at least 2 therapeutic LPs. They were randomly assigned to undergo lateral decubitus position or sitting position LP. Primary outcome was the maximum LP-induced pain, secondary endpoint the maximum LP-induced anxiety score. RESULTS: Twenty-eight patients were randomized. For patients under 6 years old, mean of Face, Leg, Activity, Cry, and Consolability were 2.8/10±3.0 (median=1) at first time and 1.5±1.7 (median=1) at second time. For patients 6 to 18 years old, mean of visual analog scale were 2.2±2.2 (median=1.5) at first time and 3.2±2.8 (median=3) at second time. There was no significant differences according to position on anxiety among children. CONCLUSIONS: Results did not demonstrate whether lateral decubitus position could generate less pain and anxiety than sitting position.

Multimodal intervention in 8- to 13-year-old French dyslexic readers: Study protocol for a randomized multicenter controlled crossover trial.

BACKGROUND: Developmental dyslexia, a specific and long-lasting learning disorder that prevents children from becoming efficient and fluent readers, has a severe impact on academic learning and behavior and may compromise professional and social development. Most remediation studies are based on the explicit or implicit assumption that dyslexia results from a single cause related to either impaired phonological or visual-attentional processing or impaired cross-modal integration. Yet, recent studies show that dyslexia is multifactorial and that many dyslexics have underlying deficits in several domains. The originality of the current study is to test a remediation approach that trains skills in all three domains using different training methods that are tailored to an individual's cognitive profile as part of a longitudinal intervention study. METHODS: This multicenter randomized crossover study will be conducted in three phases and will involve 120 dyslexic children between the ages of 8 and 13 years. The first phase serves as within-subject baseline period that lasts for 2 months. In this phase, all children undergo weekly speech-language therapy sessions without additional training at home (business-as-usual). During the second phase, all dyslexics receive three types of intensive interventions that last 2 month each: Phonological, visual-attentional, and cross-modal. The order of the first two interventions (phonological and visual-attentional) is swapped in two randomly assigned groups of 60 dyslexics each. This allows one to test the efficacy and additivity of each intervention (against baseline) and find out whether the order of delivery matters. During the third phase, the follow-up period, the intensive interventions are stopped, and all dyslexics will be tested after 2 months. Implementation fidelity will be assessed from the user data of the computerized intervention program and an "intention-to-treat" analysis will be performed on the children who quit the trial before the end. DISCUSSION: The main objective of this study is to assess whether the three types of intensive intervention (phase 2) improve reading skills compared to baseline (i.e., non-intensive intervention, phase 1). The secondary objectives are to evaluate the effectiveness of each intervention and to test the effects of order of delivery on reading intervention outcomes. Reading comprehension, spelling performance and reading disorder impact of dyslexic readers are assessed immediately before and after the multimodal intervention and 2 months post-intervention. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04028310. Registered on July 18, 2019.

Otologic Outcomes With Two Different Surgical Protocols in Patients With a Cleft Palate: A Retrospective Study.

OBJECTIVE: To compare otologic outcomes in patients with cleft palate who underwent 2 different surgical protocols. DESIGN: Monocentric retrospective analysis of medical reports. PATIENTS, PARTICIPANTS: All consecutively treated patients affected by a cleft palate, born between January 1998 and December 2002 (group 1) and between January 2007 and December 2010 (group 2). INTERVENTIONS: Patients in group 1 underwent Veau-Wardill-Kilner palatoplasty at 10 months and had ventilation tubes inserted in case of otitis media with effusion (OME) during surgery. Patients in group 2 underwent Sommerlad intravelar veloplasty at 5 months. Ventilation tubes were inserted only in case of persistent OME. MAIN OUTCOME MEASURE(S): The need for a second set of ventilation tubes to be inserted in case of persistent OME, the presence of OME at the age of 2 years, and tympanic abnormalities at the age of 5 years were analyzed. RESULTS: There was no statistically significant difference either for the presence of OME at the age of 2 years (27 [45%] vs 32 [57.14%], respectively, in groups 1 and 2; P = .191) or for tympanic abnormalities at the age of 5 years (20 [33.33%] vs 15 [26.79%]; P = .433). Statistically significant difference was found for the need to insert a second set of ventilation tubes in case of persistent OME (29 [48.33%] vs 12 [21.42%], respectively; P = .02). CONCLUSION: Early Sommerlad intravelar veloplasty may reduce persistent OME and consequently the need for ventilation tubes insertion, compared to later Veau-Wardill-Kilner palatoplasty.

Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics.

OBJECTIVES: To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. STUDY DESIGN: Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. RESULTS: Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. CONCLUSIONS: RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations.

Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey.

INTRODUCTION: The Lifetime Impairment Survey, conducted in Europe, assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood, and experiences of ADHD diagnosis and treatment, as recalled by adults. METHODS: Adults with ADHD and without ADHD (control group) were invited to participate in an internet-based survey and report on their childhood experiences. History of ADHD diagnosis was self-reported. Groups were compared using impairment and symptom scales. RESULTS: Overall, 588 adults with ADHD and 736 without ADHD participated. Mean (standard deviation [SD]) age at diagnosis of ADHD was 20.0 (12.6) years (median 18.0) following consultation with 3.8 (5.1) doctors (median 2) over 44.6 (69.3) months (median 17.0). A total of 64.1% (377/588) of adults with ADHD reported frustration or difficulties during the diagnostic process. The ADHD group had a higher mean (SD) score versus control for general (3.3 [1.2] vs 2.1 [1.2]; p < 0.001) and school impairment (2.8 [0.7] vs 2.3 [0.6]; p < 0.001) but not home impairment (2.1 [0.5] for both groups). Discussion The survey demonstrated that ADHD had a negative impact on all aspects of childhood investigated, as recalled by adults. CONCLUSIONS: These data provide insights into childhood impairments and identify areas for improvement in the management and treatment of ADHD.

Investigation of a bifactor model of the Strengths and Difficulties Questionnaire.

The Strengths and Difficulties Questionnaire (SDQ) is used to measure psychopathological symptoms in children and adolescents from 4 to 17 years old, but its underlying structure is still a matter of debate. Indeed, on the basis of a systematic review of English and non-English articles conducted using multiple databases, 54 studies reporting on the factor structure of the SDQ were located. The original 5 first-order factor structure is generally supported by exploratory procedures, but support based on confirmatory factor analyses is not clear. We analysed data from 889 youths from the general French population, rated on the SDQ by their teachers. We tested the original model, hierarchical models and bifactor models. The best-fitting model is a bifactor model with the five a priori factors grouped in two global factors (Externalizing Disorders-Hyperactivity and Conduct-and Internalizing Disorders-Peer relationships and Emotions) and one Strength/Prosocial factor. However, we show that the Conduct-Specific factor should not be used in practice in its current state, that the Hyperactivity-Specific factor mainly covers hyperactivity rather than inattention, and that the Peer Problems-Specific factor mainly reflects a preference for solitude. Nevertheless, the measurement model proved to be fully invariant across gender and school levels (kindergarten, primary and secondary schools), with statistically significant differences in latent means between genders only. Beyond computing the five a priori scores when using the teacher ratings of the SDQ, our results prove the usefulness of computing Externalizing Disorders and Internalizing Disorders global scores.

A composite scale applied to evaluate anxiety in schizophrenic patients (SAES).

Anxiety in schizophrenia possesses specific features and is difficult to assess because no specific evaluating tool is currently available. The aim of this study was to develop and validate a hetero-assessment-based scale to specifically measure anxiety in schizophrenia. A literature review and a survey among psychiatrists allowed the selection of 29 items from 4 previous scales evaluating anxiety. Factor analysis allowed building up a final 22-item composite scale of anxiety evaluation in schizophrenia (SAES), which was then validated in 147 schizophrenic patients. One hundred and forty-seven (147) schizophrenic patients (70.8 % male, mean age = 36.9 years) were included in the study. Principal component analysis of the SAES revealed three factors, namely "expressed and perceived anxiety," "somatic anxiety," and "anxiety and environment". All total and factor scores of the SAES were significantly correlated (p < .001) with total and factor scores of the original scales. Finally, the SAES showed good inter-rater reliability [intra-class correlation coefficient (ICC) = .82]. In conclusion, a specific tool for evaluating anxiety in schizophrenia (SAES) was developed and validated in a sample of schizophrenic patients. The SAES can be useful to investigate clinical, psychopathological, and therapeutic aspects of anxiety in schizophrenia.

Prevalence and correlates of attention deficit hyperactivity disorder in adults from a French community sample.

Validated tools are lacking in languages such as French to diagnose attention deficit hyperactivity disorder (ADHD) in adults. The Adult ADHD Symptoms Self-Report (ASRS) was filled out by 1171 parents of 900 school-aged youths in the context of the Children and Parents With ADHD and Related Disorders study. Prevalence estimates based on three scoring methods are compared (6-item screener, all 18 items, or the screener followed by the 12 remaining items). On the basis of the recommended and more conservative scoring method, the overall prevalence of ADHD symptoms is estimated to be 2.99%, without significant group differences between sexes or between younger and older adults. Potential correlates of ADHD symptoms were also examined in their relatives (children, brothers/sisters, uncles/aunts, and parents) as follows: birth order, level of education, body mass index categories, enuresis, suicide attempts, depression, and learning disabilities. Adults can be screened for ADHD symptoms using the ASRS; negative long-term outcomes should be assessed in patients' relatives too.

Attention-deficit/hyperactivity disorder in adolescent and adult candidates for metabolic and bariatric surgery: A systematic review and meta-analysis.

AIMS: Attention-deficit with hyperactivity disorder (ADHD) is associated with obesity and impacts the outcome of metabolic and bariatric surgery (MBS). This study aimed at calculating the prevalence in candidates for MBS, which is yet unclear. METHODS: We conducted a systematic review and meta-analysis, searching three databases from their respective inception to December 2022 for studies reporting the prevalence of ADHD in adolescents and adults assessed before undergoing MBS. The protocol was registered in PROSPERO (CRD42022384914). We adhered to Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines; the quality of studies was assessed with the JBI Critical Appraisal checklist. Random-effect meta-analyses were performed; confidence intervals were computed with a binomial exact method, and the pooled estimate was calculated after double arcsine transformation. FINDINGS: Fourteen studies (24,455 adults) and three studies (299 adolescents) were selected. The quality of studies was moderate to poor; meta-analyses were performed on subgroups according to the case definition used. The prevalence is 8.94% and 9.90% in adults, and 28.73% in adolescents. CONCLUSIONS: ADHD is three times more frequent in adults and six times more frequent in adolescents than in the general population. Recommendations are provided to improve the quality of future studies and obtain more reliable estimates of prevalence.

Bibliometric analysis of publications on attention deficit hyperactivity disorder (ADHD) in France since 1974.

BACKGROUND: The predominance of the psychodynamic approach is often put forward to explain the delay in diagnosis and treatment of attention-deficit disorder with hyperactivity (ADHD) reported in France. OBJECTIVE: A bibliometric study of abstracts, articles, or letters authored by French researchers may provide objective insight into this issue. METHODS: Online electronic databases were searched without any date limits for documents related to ADHD, and allocated to the AllFR group when all authors had an affiliation in France or to the notAllFR group when at least one author had an affiliation in France. Publications expressing any psychodynamic point of view on the causes and/or treatment of ADHD were identified. RESULTS: A total of 747 documents were analyzed: 417 were exclusively indexed in SCOPUS, and 418 were allocated to the AllFR group. Compared with documents in the notAllFR group, documents in the AllFR group were written by a smaller number of authors (median 3 vs. 6, p<0.002), more frequently evoked psychodynamic concepts (10.45% vs. 1.67%, p<0.001), and less frequently acknowledged the persistence of ADHD in adulthood (29.10% vs. 42.14%). The psychodynamic approach was likely to rely on case reports of fewer than three children. CONCLUSIONS: Any serious review of the literature should pool documents from several online databases, especially SCOPUS. In publications by only French authors, the psychodynamic approach seems predominant and the persistence of ADHD in adulthood is overlooked. This may concur with the excessive delay observed in the diagnosis and treatment of children and adults in France compared to other European countries.

The EPIDIA4Kids protocol for a digital epidemiology study on brain functioning in children, based on a multimodality biometry tool running on an unmodified tablet.

Introduction: Neurodevelopment and related mental disorders (NDDs) are one of the most frequent disabilities among young people. They have complex clinical phenotypes often associated with transnosographic dimensions, such as emotion dysregulation and executive dysfunction, that lead to adverse impacts in personal, social, academic, and occupational functioning. Strong overlap exists then across NDDs phenotypes that are challenging for diagnosis and therapeutic intervention. Recently, digital epidemiology uses the rapidly growing data streams from various devices to advance our understanding of health's and disorders' dynamics, both in individuals and the general population, once coupled with computational science. An alternative transdiagnostic approach using digital epidemiology may thus better help understanding brain functioning and hereby NDDs in the general population. Objective: The EPIDIA4Kids study aims to propose and evaluate in children, a new transdiagnostic approach for brain functioning examination, combining AI-based multimodality biometry and clinical e-assessments on an unmodified tablet. We will examine this digital epidemiology approach in an ecological context through data-driven methods to characterize cognition, emotion, and behavior, and ultimately the potential of transdiagnostic models of NDDs for children in real-life practice. Methods and analysis: The EPIDIA4Kids is an uncontrolled open-label study. 786 participants will be recruited and enrolled if eligible: they are (1) aged 7 to 12 years and (2) are French speaker/reader; (3) have no severe intellectual deficiencies. Legal representative and children will complete online demographic, psychosocial and health assessments. During the same visit, children will perform additionally a paper/pencil neuro-assessments followed by a 30-min gamified assessment on a touch-screen tablet. Multi-stream data including questionnaires, video, audio, digit-tracking, will be collected, and the resulting multimodality biometrics will be generated using machine- and deep-learning algorithms. The trial will start in March 2023 and is expected to end by December 2024. Discussion: We hypothesize that the biometrics and digital biomarkers will be capable of detecting early onset symptoms of neurodevelopment compared to paper-based screening while as or more accessible in real-life practice.

A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment.

BACKGROUND: In childhood, attention deficit/hyperactivity disorder (ADHD) is characterized by age-inappropriate levels of inattentiveness/disorganization, hyperactivity/impulsiveness, or a combination thereof. Although the criteria for ADHD are well defined, the long-term consequences in adults and children need to be more comprehensively understood and quantified. We conducted a systematic review evaluating the long-term outcomes (defined as 2 years or more) of ADHD with the goal of identifying long-term outcomes and the impact that any treatment (pharmacological, non-pharmacological, or multimodal) has on ADHD long-term outcomes. METHODS: Studies were identified using predefined search criteria and 12 databases. Studies included were peer-reviewed, primary studies of ADHD long-term outcomes published between January 1980 to December 2010. Inclusion was agreed on by two independent researchers on review of abstracts or full text. Published statistical comparison of outcome results were summarized as poorer than, similar to, or improved versus comparators, and quantified as percentage comparisons of these categories. RESULTS: Outcomes from 351 studies were grouped into 9 major categories: academic, antisocial behavior, driving, non-medicinal drug use/addictive behavior, obesity, occupation, services use, self-esteem, and social function outcomes. The following broad trends emerged: (1) without treatment, people with ADHD had poorer long-term outcomes in all categories compared with people without ADHD, and (2) treatment for ADHD improved long-term outcomes compared with untreated ADHD, although not usually to normal levels. Only English-language papers were searched and databases may have omitted relevant studies. CONCLUSIONS: This systematic review provides a synthesis of studies of ADHD long-term outcomes. Current treatments may reduce the negative impact that untreated ADHD has on life functioning, but does not usually 'normalize' the recipients.

Season of birth and handedness in young adults.

This study explored the relationship between season of birth and handedness, taking into account gender and nationality variables. Young adults from three countries (2120 females and 1353 males; 877 Spanish, 2184 Italian, and 412 French), aged from 18 to 30 years, filled the Edinburgh Handedness Inventory (EHI). According to the literature, the percentage of left-handed participants in the whole sample was 9.30%. The distribution of left- and right-handed participants was not significantly different among the seasons of birth. The present data do not support a significant season of birth effect on handedness in young adults.

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

An aid for diagnosing attention-deficit/hyperactivity disorder at adulthood: psychometric properties of the French versions of two Wender Utah Rating Scales (WURS-25 and WURS-K).

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects up to 4% of the adults in the general population. The Utah criteria were devised in the 1970s to help a retrospective diagnosis of ADHD during childhood, a necessary but not sufficient condition for diagnosing ADHD at adulthood. A sample of 466 adults was collected from a referral center and a large university. We investigated the psychometric properties (reliability and factor structure) of the original WURS-25 and the WURS-K, two shortened versions of the Wender Utah Rating Scale. These scales have similar psychometric properties; both have a 3-factor structure with only the first two factors highly and positively correlated. The third factor in the WURS-K, antisocial behavior, is less specific to the construct of ADHD than the third factor in the WURS-25, mood/self-esteem. The 18-item Adult ADHD Self-Rating Scale (ASRS) was used as a screening tool for actual ADHD. The composite total scores and the factorial scores correlated moderately with ASRS total and subscores. Research is warranted to assess the cutoff scores against a diagnosis of ADHD using a structured interview.

Health Care Trajectories for Children With ADHD in France: Results From the QUEST Survey.

Objective: The objective of this study is to retrospectively describe the pathway toward ADHD diagnosis and treatment, and identify potential areas for improvement. Method: Parent-reported questionnaires were collected by a national sample of ADHD specialists. Results: In total, 473 complete questionnaires were analyzed. Initial onset of ADHD symptoms was reported at a mean age of 4.45 years. Mean age at diagnosis was 8.07 years, and half of the families had seen at least three health care professionals previously. Psychiatrists were most commonly consulted. A "combined" (89% boys) and inattentive (49% boys) profile was identified. Diagnosis was made 1 year later for the latter group. Two thirds of patients received pharmacological treatment. The delay in diagnosis was identified as the main source of concern for caregivers. Conclusion: The 4-year delay in diagnosis may represent a loss of opportunity. Training health care professionals in the core symptoms of ADHD may help reduce disparities and improve patient trajectory.

Comparing three morningness scales: age and gender effects, structure and cut-off criteria.

OBJECTIVE: To add to the validity of the French version of the Composite Scale of Morningness (CSM) by comparing its structure with that of the Morningness-Eveningness Questionnaire (MEQ), the most widely used scale to measure circadian typology. Second, to compare the cut-off criteria used to transform the continuous scores into categorical chronotypes. Third, to further test the effects of age and gender on morningness scores. The rMEQ, a shortened version of the MEQ, is also considered. METHODS: Four hundred and fifty-six students served as volunteer subjects and filled the CSM and the MEQ. RESULTS: There was no effect of gender, and the CSM and MEQ scores correlated above (+) 0.90 in both genders. Regarding age, morningness was stable before age 35 and increased afterwards. We replicated the three-factor structure of the CSM previously reported in five different cultures. The MEQ is longer and counted a fourth factor while the first three factors were quite identical to those extracted from the CSM. This comparative study emphasizes the recurrent problem of cut-off scores: the available values for both instruments result in a very poor concordance of chronotypes. CONCLUSIONS: Belonging to the evening-type is regarded as a risk factor for sleep disorders and its positive predictive value should be correctly assessed. Hence, normative scores standardized in such a way they reflect the effects of age, gender and culture are needed for the total score and the factor scores. To this extent, T-scores (with a mean of 50 and standard deviation of 10) would be suitable, and normative tables for French subjects (N = 1598) are given as supplemental data.

The moulded baby syndrome: incidence and risk factors regarding 1,001 neonates.

Postural deformities are frequent in neonates. The moulded baby syndrome (MBS) comprises one or more of the following disorders: plagiocephaly, torticollis, congenital scoliosis, pelvic obliquity, adduction contracture of a hip and/or malpositions of the knees or feet. We analysed the incidence of MBS in healthy neonates and identified the risk factors of its composing elements. One thousand and one healthy neonates were examined on the second or third day of life by the same paediatrician. Familial, obstetrical, perinatal history and putative risk factors for postural deformities were collected. Families of newborns with a torticollis or plagiocephaly were given positioning advice and the outcome was evaluated by a phone survey 2 months later. MBS was detected in 107 neonates (10.7%): 97 plagiocephalies or torticollis, 25 congenital scoliosis or pelvic obliquities, and 13 malpositions of the knees or feet. We identified risk factors related to the mother (age: OR=1.39, parity: OR=0.643), to the obstetrical history (preterm labour: OR=1.65, oligoamnios: OR=10.179, breech presentation: OR=2.746, pregnancy toxaemia: OR=3.773, instrumental delivery: OR=6.028) and to the newborn (male gender: OR=1.982, birth length: OR=1.196). The initial plagiocephaly or torticollis improved in 77% of infants after 2 months of stimulation and positioning measures. Paediatricians should be alert regarding the frequent but subtle MBS postural deformities and give positioning advice to the parents. A neonate of male gender or greater birth length, with an older primiparous mother, a history of preterm labour, oligoamnios or pregnancy toxaemia, a breech presentation or an assisted delivery is more likely to have MBS.

Inattentive symptoms of ADHD are related to evening orientation.

OBJECTIVE: Morningness is a stable characteristic of individuals, related to impulsivity and novelty seeking. The evening orientation is a risk factor for psychiatric conditions such as depression and personality disorders. The authors hypothesized that adults suspected of having ADHD are more evening oriented than adults without ADHD. METHOD: Exploratory factor analyses were performed on the polychoric correlation matrices of the full Adult Self-Report Scale for ADHD (ASRS) and the Composite Scale of Morningness (CSM). RESULTS: As expected, two factors for the ASRS--Inattention and Impulsivity- Hyperactivity--and three factors for the CSM were retrieved. All three CSM factors correlated negatively with ASRS Inattention, none with ASRS Impulsivity-Hyperactivity. CONCLUSION: Inattention is more strongly related to eveningness than is Impulsivity-Hyperactivity, and therefore eveningness may constitute an endophenotype of the predominantly inattentive subtype of ADHD. These findings need to be replicated in a patient population with a standardized assessment of sleep quality.