Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD).

BACKGROUND: Co-occurring psychiatric disorders in adults with Attention Deficit Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorder (ASD) contribute to the burden of the healthcare and possibly to the delay of diagnosis. Aim of the study was to clinically assess the prevalence and compare lifetime co-occurring psychopathology in a sample of newly diagnosed ADHD and/or ASD adults and discuss the diagnostic challenges they pose. METHODS: The lifetime prevalence rates of ten of the most frequently co-occurring psychiatric diagnoses was registered in 336 adults of normal intelligence who underwent a thorough clinical evaluation for the diagnosis of ADHD and/or ASD for the first time in their lives. Four study groups were formed: the ADHD (n = 151), the ASD (n = 58), the ADHD+ASD (n = 28) and the nonADHD/nonASD (NN) (n = 88) group. RESULTS: At least one co-occurring psychopathology was found in 72.8% of the ADHD group, in 50% of the ASD group, in 72.4% of the ADHD+ASD group and in 76.1% of the NN group (p = 0.004). In all groups the most frequent psychiatric disorder was depressive disorder. The only significant difference regarding the patterns of psychiatric co-occurrence between the ADHD and the nonADHD groups (ASD and NN groups) was found for SUD (p = 0.001). Also, the proportion of subjects with Bipolar Disorder was significantly greater in the NN group as compared to those with ASD (p = 0.025). CONCLUSIONS: Our results support the high prevalence of co-occurring psychiatric disorders in adults with ADHD and/or ASD with the ASD group presenting the lowest rate. The most marked difference between the ADHD and the nonADHD groups was found for SUD. Moreover, our findings highlight the need for a thorough clinical assessment of all referred patients both in the presence and absence of ADHD and/or ASD.

Comorbid attention-deficit/hyperactivity disorder in adult psychiatric outpatients with depressive or anxiety disorders.

BACKGROUND: There are very few studies reporting on the prevalence and the contribution of not previously diagnosed ADHD in the clinical picture of other psychiatric disorders. The aim of our study is to determine the prevalence and clinical correlates of comorbid attention deficit/hyperactivity disorder (ADHD) in adult psychiatric outpatients with depressive or anxiety disorders. METHODS: During a 6-month period, 114 outpatients with depressive or anxiety disorders were evaluated for ADHD diagnosis. Assessment included interviews with both patient and relatives/friends and the use of a daily diary. Moreover, the patients completed the self-report scales Beck Depression Inventory (BDI), Spielberger's Anxiety Inventory (STAI), and the Symptom Checklist-90-R Rating Scale (SCL-90-R). RESULTS: A total of 22 out of 114 patients (19.3%) received an ADHD diagnosis for the first time in their life. Comorbid ADHD compared to non ADHD patients scored significantly higher (p < 0.05) for depression (BDI), state and trait anxiety (STAI) and in the following SCL-90-R factors: Positive Symptoms Distressing Index, Positive Symptoms Index, Somatization, Obsessive Compulsive, Depression, Anxiety, and Hostility. CONCLUSIONS: ADHD might go unrecognized among psychiatric outpatients. Patients with depressive or anxiety disorder reporting more severe symptomatology should be carefully screened for possible comorbid adult ADHD.

Exploring randomness in autism.

Introduction: The fast, intuitive and autonomous system 1 along with the slow, analytical and more logical system 2 constitute the dual system processing model of decision making. Whether acting independently or influencing each other both systems would, to an extent, rely on randomness in order to reach a decision. The role of randomness, however, would be more pronounced when arbitrary choices need to be made, typically engaging system 1. The present exploratory study aims to capture the expression of a possible innate randomness mechanism, as proposed by the authors, by trying to isolate system 1 and examine arbitrary decision making in autistic participants with high functioning Autism Spectrum Disorders (ASD). Methods: Autistic participants withhigh functioning ASD and an age and gender matched comparison group performed the random number generation task. The task was modified to limit the contribution of working memory and allow any innate randomness mechanisms expressed through system 1, to emerge. Results: Utilizing a standard analyses approach, the random number sequences produced by autistic individuals and the comparison group did not differ in their randomness characteristics. No significant differences were identified when the sequences were examined using a moving window approach. When machine learning was used, random sequences' features could discriminate the groups with relatively high accuracy. Conclusions: Our findings indicate the possibility that individual patterns during random sequence production could be consistent enough between groups to allow for an accurate discrimination between the autistic and the comparison group. In order to draw firm conclusions around innate randomness and further validate our experiment, our findings need to be replicated in a bigger sample.

Internet gaming disorder, exercise and attention deficit hyperactivity disorder: The role of symptoms of depression, anxiety and stress.

One of the issues that have risen the past few decades due to excessive use of technological advances is internet gaming disorder (IGD). Past research has concluded that there is a negative association between IGD and exercise as well as a positive association between IGD and attention deficit hyperactivity disorder (ADHD). However, the existing studies on these subjects are scarce. Furthermore, researchers have showcased that symptoms of depression, anxiety and stress are positively associated with IGD and ADHD but negatively associated with exercise. Consequently, maybe these symptoms mediate the relationships between IGD, exercise and ADHD. The purpose of the present study is to investigate the relationship between IGD and exercise as well as between IGD and ADHD. A correlational study was conducted on 515 adults through Google forms. The Internet Gaming Disorder Scale-Short-Form was used to detect IGD symptoms, the Leisure-Time Exercise Questionnaire was utilized so as to evaluate participants' leisure - time exercise habits, and the Barkley Adult ADHD Rating Scale was used to assess ADHD symptoms. Furthermore, the Depression, Anxiety and Stress Scale-21 was utilized to evaluate symptoms of depression, anxiety, and stress. It was found that there is a negative correlation between IGD symptoms and leisure time exercise as well as a positive correlation between IGD symptoms and ADHD symptoms. Moreover, when taking all the variables that were examined into consideration, it was indicated that inattention symptoms and impulsivity symptoms were significantly associated with IGD symptoms whereas symptoms of depression were partially and significantly mediating the association between IGD symptoms and Attention deficit as well as the association between IGD symptoms and Impulsivity. The findings of the current study suggest that people who deal with IGD symptoms tend to exercise less on their free time. Additionally, people with more IGD symptoms display not only more ADHD symptoms, symptoms of inattention and impulsivity specifically, but also more symptoms of depression. Therefore, clinicians should evaluate the possible coexistence of such symptoms when treating people with IGD, in order to prevent as well as treat more efficiently IGD and its consequences.

Virtual Reality Training of Social Skills in Adults with Autism Spectrum Disorder: An Examination of Acceptability, Usability, User Experience, Social Skills, and Executive Functions.

Poor social skills in autism spectrum disorder (ASD) are associated with reduced independence in daily life. Current interventions for improving the social skills of individuals with ASD fail to represent the complexity of real-life social settings and situations. Virtual reality (VR) may facilitate social skills training in social environments and situations similar to those in real life; however, more research is needed to elucidate aspects such as the acceptability, usability, and user experience of VR systems in ASD. Twenty-five participants with ASD attended a neuropsychological evaluation and three sessions of VR social skills training, which incorporated five social scenarios with three difficulty levels. Participants reported high acceptability, system usability, and user experience. Significant correlations were observed between performance in social scenarios, self-reports, and executive functions. Working memory and planning ability were significant predictors of the functionality level in ASD and the VR system's perceived usability, respectively. Yet, performance in social scenarios was the best predictor of usability, acceptability, and functionality level. Planning ability substantially predicted performance in social scenarios, suggesting an implication in social skills. Immersive VR social skills training in individuals with ASD appears to be an appropriate service, but an errorless approach that is adaptive to the individual's needs should be preferred.

Theophrastus's "Anaisthetos" ("The Obtuse Man"): the oldest "phenomenological" description of neurodevelopmental disorders in an adult.

Theophrastus (381-278 B.C.), was the first to adopt the term character for the description of distinct inner psychological and moral features of an individual. In his classic book 'Characters' in a simple style wording he analyses some of his contemporary individuals. The character "Αναίσθητος" (Anaisthetos) has been translated in English as "The Obtuse Man" and in Modern Greek both as "Αναίσθητος", meaning lack of appreciation and "Βραδύνους", meaning slowness of mind. Theophrastus' description of this particular character is compatible with the co-occurrence in an adult of two Neurodevelopmental Disorders: the Attention-Deficit Hyperactivity Disorder (ADHD) and the Social Pragmatic Communication Disorder (SPCD), according to the 5th Diagnostic and Statistical Manual of Mental Disorders. Ten out of the twelve statements support the possible occurrence of ADHD while five of them the occurrence of SPCD. The description does not justify a diagnosis of an intellectual disability; therefore, we consider that in the Modern Greek vocabulary the original term «Αναίσθητος¼ ("Anaisthetos"), meaning lack of appreciation, is more accurately corresponding to this particular Theophrastus's character than "Βραδύνους" ("Obtuse"), which indicates the presence of low intellectual capacities. Also the lack of repetitive and restrictive interests and behaviours excludes Autism Spectrum Disorder as a possible diagnosis. Minor psychiatric disorders and traits according to the Peripatic School were attributed to the lack of rational control over appetites and behavior. Accordingly, «Αναίσθητος¼ is a phenomenological description of a stigmatizing inappropriate social behavior and the only help that might give is in increasing self-awareness. In our contemporary clinical practice, though, the early recognition and appropriate treatment of Neurodevelopmental Disorders in affected individuals, leads to a better clinical care and may diminish stigmatization. The co-existence of these two disorders in a character in such a different historical context reinforces their validity as diagnostic constructs and provides an example of co-occurrence of Neurodevelopmental Disorders.

mPD: Introduction of a single player prisoner's dilemma application for medical experiments.

BACKGROUND: Prisoner's dilemma is one of the most popular concepts among scientific literature. In medical literature the majority of prisoner's dilemma experiments with human participants implement computerized means. Despite this, there is no shared validated tool for prisoner's dilemma tasks. METHODS: The application is developed in Javascript programming language and makes use of the pixijs library for WebGL rendering. To create a custom trial, a set of variables have to be set. These refer to the linguistics, user controls, available choices, computer strategy, interaction flow (simultaneous or sequential), opponent's choice prediction requirement, noise induction, human opponent behavior simulation, the way resulted data will be handled and more. Results are in JSON format and include time interval data. RESULTS: We have developed an application which, given the various parameters experimenter can modify, is able to simulate a large number of single player prisoner's dilemma versions. It is open source with no installation requirement, executable by any modern internet browser remotely or locally with the ability to post data results either locally or remotely. Experimenter only has to modify certain starting values in order to create his design of choice. Two examples are included, with initial settings and results, to demonstrate the use and validity of the application. CONCLUSIONS: Our aim is to assist future researchers in their methodological designs. In this scope, our application, has the minimum requirements, can be served either locally or remotely, has a wide range of modifiable parameters and takes care of the resulted data. In the long term, a shared and validated tool would contribute to increasing methodologies' credibility and mitigating cross-validation discrepancies.

Strategic decision making and prediction differences in autism.

Background: Several theories in autism posit that common aspects of the autism phenotype may be manifestations of an underlying differentiation in predictive abilities. The present study investigates this hypothesis in the context of strategic decision making in autistic participants compared to a control group. Method: Autistic individuals (43 adults, 35 male) and a comparison group (42 adults, 35 male) of age and gender matched individuals, played a modified version of the prisoner's dilemma (PD) task where they were asked, if capable, to predict their opponents' move. The predictive performance of the two groups was assessed. Results: Overall, participants in the autism group had a significantly lower number of correct predictions. Moreover, autistic participants stated, significantly more frequently than the comparison group, that they were unable to make a prediction. When attempting a prediction however, the success ratio did not differ between the two groups. Conclusions: These findings indicate that there is a difference in prediction performance between the two groups. Although our task design does not allow us to identify whether this difference is due to difficulty to form a prediction or a reluctance in registering one, these findings could justify a role for prediction in strategic decision making during the PD task.

Psychometric properties of the Greek version of Affective Lability Scale - Short Form (ALS-18) in a sample of adults with neurodevelopmental disorders.

Affect dysregulation refers to maladaptive patterns of emotional regulation that impair daily life functioning, common in many psychiatric disorders. It is expressed with the form of affective lability, an emotional construct composed of frequent and intense fluctuations in emotion in response to both pleasant and unpleasant events or the interpretations of events. The Affective Lability Scale (ALS) is a widely used self-reporting questionnaire that measures the tendency of emotions to shift from one to another as well as their tendency to oscillate between depression and elation and between depression and anxiety. The original scale had 54 items, but a shorter form of 18-items (ALS-18) was created, with three domains: anxiety-depression shift, depression-elation shift and anger shift. The aim of the present study was to evaluate the psychometric properties of the ALS-18 Greek version. The translation was conducted by two of the authors. The study took place in the 1st Department of Psychiatry of the National and Kapodistrian University of Athens, Eginition hospital. A sample of 108 adults was included in the survey in two groups, neurodevelopmental disorder group (attention deficit hyperactivity disorder or autism spectrum disorder) and controls. They all completed ALS-18, The State - Trait Anxiety Inventory (STAIT), Difficulties in Emotion Regulation Scale (DERS), The Hospital Anxiety and Depression Scale (HADS). The ALS-18 had satisfactory internal consistency; Cronbach's α value was 0.91 for the total scale and 0.89 for Anxiety/Depression, 0.86 for Depression/Elation and 0.85 for Anger. The three-factor structure was replicated in our data. The internal consistency reliability of all the ALS-18 factors in our study could be considered satisfactory with a Cronbach's alpha coefficient of 0.85 or above for all factors. Significantly higher mean values were found for all the subscales, Anxiety/Depression, Depression/Elation and Anger, in NDD subjects as compared to controls, showing good discriminative ability. The ALS factors discriminated well between clinical and non-clinical sample. The present study reveals that the Greek version of ALS-18 presents good psychometric properties, showing good internal consistency reliability as well as concurrent and discriminative validity. It has an elevated score in NDD and thus, our results indicate that affective lability could and maybe should, be a target integrated in therapeutic strategies.

Factors of influence in prisoner's dilemma task: a review of medical literature.

The Prisoner's Dilemma (PD) is one of the most popular concepts amongst the scientific literature. The task is used in order to study different types of social interactions by giving participants the choice to defect or cooperate in a specific social setting/dilemma. This review focuses on the technical characteristics of the PD task as it is used in medical literature and describes how the different PD settings could influence the players' behaviour. We identify all the studies that have used the PD task in medical research with human participants and distinguish, following a heuristic approach, seven parameters that can differentiate a PD task, namely (a) the opponent parties' composition; (b) the type of the opponent as perceived by the players; (c) the interaction flow of the game; (d) the number of rounds; (e) the instructions narrative and options that are given to players; (f) the strategy and (g) the reward matrix and payoffs of the game. We describe how each parameter could influence the final outcome of the PD task and highlight the great variability concerning the settings of these parameters in medical research. Our aim is to point out the heterogeneity of such methods in the past literature and to assist future researchers with their methodology design.

Parenting Children with Autism Spectrum Disorder during Crises: Differential Responses between the Financial and the COVID-19 Pandemic Crisis.

Parenting a child with autism can be particularly stressful and challenging, especially during periods of crises. This study focuses on parenting children with autism during the COVID-19 pandemic in comparison to the economic crisis, six years ago. We administered the same set of questionnaires (CES-D, F-COPES, PSI-SF, and WHOQoL-BREF), along with a demographic characteristic and a COVID-19-related questionnaire to the same group of parents of children with autism as we did six years ago. Results indicated that during the COVID-19 crisis, the level of parenting stress and the distress due to personal factors related to demands of parenting, were significantly lower compared to the economic crisis, while the environment facet of quality of life was significantly higher. The depressive symptomatology was elevated during both periods. Finally, when addressing the pandemic crisis, parents were more likely to passively accept problematic issues, less able to obtain social support, and less able to acquire and accept help from others. In our sample, findings differentiate the genre of crises through the parents' responses regarding the sense of competence in their parental role, their quality of life, and the coping strategies they implemented. The study implies that each crisis must be confronted with particular responses to particular needs.

Validation of the Empathy Quotient (EQ) - Greek version.

The original English language Empathy Quotient (EQ) is a self-reporting questionnaire that measures the construct of empathy in adults of normal intelligence. The EQ is sensitive to gender, and neurodevelopmental disorders. The EQ has been translated to many languages all over the world. The EQ - Greek version may be available through open access from www.autismresearchcentre.com. Aim of the present study was to validate the EQ- Greek version.The study took place in the 1st and 2nd Departments of Psychiatry of the National and Kapodistrian University of Athens (NKUA), "Eginition" and "Attikon" Hospitals respectively, and in the Korydallos Prison Psychiatric Clinic in Athens. Two groups completed the original 60 items version. One group consisted of general population and volunteer students from post graduate training programs (normal control group, N= 127) and the other group of patients recruited from the Adult Neurodevelopmental Disorders Unit of the 1st Department of Psychiatry of NKUA, the outpatients' clinic of the 2nd Department of Psychiatry of NKUA and the Korydallos Prison Psychiatric Clinic (patient group, N=196). Three versions of the EQ were examined: the EQ-40, EQ-28 and EQ-15. All versions showed very good internal validity: Cronbach's a value was 0.902, 0.892 and 0.793 respectively. They all showed good test-retest variability: the Intraclass Correlation Coefficient was 0.928, 0.924 and 0.855 respectively. Concurrent validity examined by the correlation analysis with the Interpersonal Reactivity Index (IRI) showed non-significant correlations between the EQ and the IRI. Exploratory Factor Analysis (EFA) indicated a one-factor structure for the three versions. Confirmatory Factor Analysis (CFA) for the one-factor structure showed a good fit for all the three versions. CFA for the three-factor structures (Cognitive Empathy, Emotional Empathy, Social Skills) showed also a good fit for EQ-28 and the EQ-15. When the EQ-40 was used as a measure of empathy in a single dimension in adults, the EQ discriminated the normal control group from the patients' group. The mean EQ score for the total sample was 35.84 with the lowest scoring being among Autism Spectrum Disorder (ASD) patients. As expected, females scored higher than males (p<0.001). To conclude, the Greek version of EQ showed good psychometric properties and could serve as a useful tool for clinicians to assess empathy in clinical populations and especially in subjects with ASD and other neurodevelopmental disorders.

Complexity analysis of the brain activity in Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) due to cognitive loads/demands induced by Aristotle's type of syllogism/reasoning. A Power Spectral Density and multiscale entropy (MSE) analysis.

OBJECTIVE: We aim to investigate whether EEG dynamics differ in adults with ASD (Autism Spectrum Disorders), ADHD (attention-deficit/hyperactivity disorder), compared with healthy subjects during the performance of an innovative cognitive task: Aristotle's valid and invalid syllogisms. We follow the Neuroanatomical differences type of criterion in assessing the results of our study in supporting or not the dual-process theory of Kahneman, 2011) (Systems I & II of thinking). METHOD: We recorded EEGs from 14 scalp electrodes in 30 adults with ADHD, 30 with ASD and 24 healthy, normal subjects. The subjects were exposed in a set of innovative cognitive tasks (inducing varying cognitive loads), the Aristotle's four types of syllogism mentioned above. The multiscale entropy (MSE), a nonlinear information-theoretic measure or tool was computed to extract features that quantify the complexity of the EEG. RESULTS: The dynamics of the curves of the grand average of MSE values of the ADHD and ASD participants was significantly in higher levels for the majority of time scales, than the healthy subjects over a number of brain regions (electrodes locations), during the performance of both valid and invalid types of syllogism. This result is seemingly not in accordance of the broadly accepted 'theory' of complexity loss in 'pathological' subjects, but actually this is not the case as explained in the text. ADHD subjects are engaged in System II of thinking, for both Valid and Invalid syllogism, ASD and Control in System I for valid and invalid syllogism, respectively. A surprising and 'provocative' result of this paper, as shown in the next sections, is that the Complexity-variability of ASD and ADHD subjects, when they face Aristotle's types of syllogisms, is higher than that of the control subjects. An explanation is suggested as described in the text. Also, in the case of invalid type of Aristotelian syllogisms, the linguistic and visuo-spatial systems are both engaged ONLY in the temporal and occipital regions of the brain, respectively, of ADHD subjects. In the case of valid type, both above systems are engaged in the temporal and occipital regions of the brain, respectively, of both ASD and ADHD subjects, while in the control subjects only the visuo-spatial type is engaged (Goel et al., 2000; Knauff, 2007). CONCLUSION: Based on the results of the analysis described in this work, the differences in the EEG complexity between the three groups of participants lead to the conclusion that cortical information processing is changed in ASD and ADHD adults, therefore their level of cortical activation may be insufficient to meet the peculiar cognitive demand of Aristotle's reasoning. SIGNIFICANCE: The present paper suggest that MSE, is a powerful and efficient nonlinear measure in detecting neural dysfunctions in adults with ASD and ADHD characteristics, when they are called on to perform in a very demanding as well as innovative set of cognitive tasks, that can be considered as a new diagnostic 'benchmark' in helping detecting more effectively such type of disorders. A linear measure alone, as the typical PSD, is not capable in making such a distinction. The work contributes in shedding light on the neural mechanisms of syllogism/reasoning of Aristotelian type, as well as toward understanding how humans reason logically and why 'pathological' subjects deviate from the norms of formal logic.

Differences in Performance of ASD and ADHD Subjects Facing Cognitive Loads in an Innovative Reasoning Experiment.

We aim to investigate whether EEG dynamics differ in adults with ASD (Autism Spectrum Disorders) and ADHD (attention-deficit/hyperactivity disorder) compared with healthy subjects during the performance of an innovative cognitive task, Aristotle's valid and invalid syllogisms, and how these differences correlate with brain regions and behavioral data for each subject. We recorded EEGs from 14 scalp electrodes (channels) in 21 adults with ADHD, 21 with ASD, and 21 healthy, normal subjects. The subjects were exposed in a set of innovative cognitive tasks (inducing varying cognitive loads), Aristotle's two types of syllogism mentioned above. A set of 39 questions were given to participants related to valid-invalid syllogisms as well as a separate set of questionnaires, in order to collect a number of demographic and behavioral data, with the aim of detecting shared information with values of a feature extracted from EEG, the multiscale entropy (MSE), in the 14 channels ('brain regions'). MSE, a nonlinear information-theoretic measure of complexity, was computed to extract a feature that quantifies the complexity of the EEG. Behavior-Partial Least Squares Correlation, PLSC, is the method to detect the correlation between two sets of data, brain, and behavioral measures. -PLSC, a variant of PLSC, was applied to build a functional connectivity of the brain regions involved in the reasoning tasks. Graph-theoretic measures were used to quantify the complexity of the functional networks. Based on the results of the analysis described in this work, a mixed 14 × 2 × 3 ANOVA showed significant main effects of group factor and brain region* syllogism factor, as well as a significant brain region* group interaction. There are significant differences between the means of MSE (complexity) values at the 14 channels of the members of the 'pathological' groups of participants, i.e., between ASD and ADHD, while the difference in means of MSE between both ASD and ADHD and that of the control group is not significant. In conclusion, the valid-invalid type of syllogism generates significantly different complexity values, MSE, between ASD and ADHD. The complexity of activated brain regions of ASD participants increased significantly when switching from a valid to an invalid syllogism, indicating the need for more resources to 'face' the task escalating difficulty in ASD subjects. This increase is not so evident in both ADHD and control. Statistically significant differences were found also in the behavioral response of ASD and ADHD, compared with those of control subjects, based on the principal brain and behavior saliences extracted by PLSC. Specifically, two behavioral measures, the emotional state and the degree of confidence of participants in answering questions in Aristotle's valid-invalid syllogisms, and one demographic variable, age, statistically and significantly discriminate the three groups' ASD. The seed-PLC generated functional connectivity networks for ASD, ADHD, and control, were 'projected' on the regions of the Default Mode Network (DMN), the 'reference' connectivity, of which the structural changes were found significant in distinguishing the three groups. The contribution of this work lies in the examination of the relationship between brain activity and behavioral responses of healthy and 'pathological' participants in the case of cognitive reasoning of the type of Aristotle's valid and invalid syllogisms, using PLSC, a machine learning approach combined with MSE, a nonlinear method of extracting a feature based on EEGs that captures a broad spectrum of EEGs linear and nonlinear characteristics. The results seem promising in adopting this type of reasoning, in the future, after further enhancements and experimental tests, as a supplementary instrument towards examining the differences in brain activity and behavioral responses of ASD and ADHD patients. The application of the combination of these two methods, after further elaboration and testing as new and complementary to the existing ones, may be considered as a tool of analysis in helping detecting more effectively such types of disorders.

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.

Parental involvement does not augment the effectiveness of an intense behavioral program for the treatment of childhood obesity.

OBJECTIVE: To evaluate the effectiveness of active parental involvement in a lifestyle intervention for the management of childhood obesity. DESIGN: Forty-two overweight children (32 girls and 10 boys), aged 9.2 +/- 0.2 years and with percent overweight 39.8 +/- 2.7%, were randomly allocated either to a child-and-parent group (N = 23) or a child-alone group (N = 19). Both groups attended a 3-month multidisciplinary program extended by booster sessions during follow-up, which involved many cognitive behavioral therapy principles and assigned high self-regulation to the children, but differed in parental involvement. Percent overweight was evaluated at baseline, and at 3, 6, and 18 months thereafter. RESULTS: There was no significant interaction between time and group or a significant difference between groups. Percent overweight decreased by 4.9 +/- 1.4 at 18 months (p < 0.001); the reduction occurred during the active phase of the treatment (0-3 months) and was maintained thereafter. CONCLUSION: In the setting of the present study, the active parental involvement did not significantly modify the results of lifestyle interventions for children's overweight management.

Trait-Based Dimensions Discriminating Adults with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and, Co-occurring ADHD/ASD.

This study assessed the co-occurrence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in newly diagnosed adults of normal intelligence and the contribution of trait-based dimensions deriving from the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), the Autism-Spectrum Quotient (AQ), and the Empathy Quotient (EQ) to the differentiation of patients with ADHD, ASD, and ADHD/ASD. A total of 16.1% of patients with ADHD received a co-occurring ASD diagnosis, while 33.3% of patients with ASD received an ADHD diagnosis. Subjects with ADHD or ADHD/ASD had higher scores in all ADHD traits compared to ASD subjects. Compared to the ADHD group, the ASD group had AQ scores that were significantly greater, except for attention to detail. ADHD/ASD co-occurrence significantly increased the score of attention to detail. The total EQ score was greater in the ADHD group. In the stepwise logistic regression analyses, past hyperactivity, current inattention and impulsivity, attention switching, communication, imagination, and total EQ score discriminated ADHD patients from ASD patients. Attention to detail, imagination, and total EQ score discriminated ADHD cases from ADHD/ASD cases, while past hyperactivity and current impulsivity discriminated ASD subjects from ADHD/ASD subjects. Our findings highlight the importance of particular trait-based dimensions when discriminating adults with ADHD, ASD, and co-occurring ADHD/ASD.

The Emotion of Disgust among Medical and Psychology Students.

The emotion of disgust evolved as a way to protect oneself from illness and is associated with aspects of disease avoidance. Disgust Scale-Revised (DS-R) (Olatunji et al., 2008) measures the disgust propensity of three kinds of disgust (core, animal reminder, contamination). Contextual factors, such as academic background, might influence DS-R scoring, especially among medical students, where the notion of disease is central. We examined DS-R scoring and the choice of postgraduate studies in medical (n = 94) and psychology (n = 97) students. In an anonymous web-based survey, participants completed the DS-R and a questionnaire including plans for postgraduate studies. Females outnumbered males and scored higher in total DS-R score (p = 0.003). Psychology students scored higher in all three kinds of disgust (p < 0.001 for core disgust and animal reminder, p = 0.069 for contamination disgust), indicating a higher level of disease avoidance. Medical students willing to follow Internal Medicine scored higher in core disgust (p < 0.05), while psychology students willing to study Experimental Psychology scored lower in the animal reminder subscale (p = 0.019 and p < 0.001 for the association between these subscales and the orientation of Medical and Psychology Students, respectively). In conclusion, disgust propensity as rated by DS-R is related to academic background and orientation preferences in postgraduate studies.

Psychometric Properties, Factor Structure, and Evidence for Measurement Invariance in the Greek Version of the Disgust Scale-Revised (DS-R).

The Disgust Scale has been designed to measure disgust propensity-the individual ease in experiencing disgust. The present study aimed to explore the validity, reliability, the factor structure, and the measurement invariance of the Greek version of the Disgust Scale-Revised (DS-R). A sample of 754 healthy participants completed the Greek version of the DS-R. A subset (n = 363) also completed the revised Symptom checked list and the Eysenck Personality Questionnaire, in order to examine the concurrent validity. Exploratory and Confirmatory factor analyses in different subsets were used to examine the factor structure. Multiple indicators-multiple causes model (MIMIC) models were used to assess the measurement invariance across gender and age. Demographic influences were assessed using t-tests, ANOVA, and Pearson's correlations. Exploratory factor analysis concluded to two and three factor models, with a factor structure similar to the ones proposed in the literature. Confirmatory factor analysis and bi-factor analysis provided evidence in favor of the three-factor solution. Measurement invariance test revealed differences in six items across gender, and three items across age. The psychometric properties of the factors were satisfactory. Demographic influences on the responses were present, especially with respect to gender. The Greek version of the DS-R demonstrated satisfactory psychometric properties, making it suitable for use for the Greek population.

Caffeine challenge in patients with panic disorder: baseline differences between those who panic and those who do not.

A proportion of patients with panic disorder (PD) display an increased sensitivity to the anxiogenic/panicogenic properties of caffeine. The aim of this study is to identify probable baseline differences between PD patients who panic and those who do not, after caffeine administration. In a randomized, double-blind, cross-over experiment performed in two occasions 3-7 days apart, 200 and 400 mg of caffeine, respectively, were administered in a coffee form to 23 patients with PD with or without Agoraphobia. Evaluations included the State-Trait Anxiety Inventory, the DSM-IV 'panic attack' symptoms (visual analogue scale form), the Symptom Checklist-90-Revised (SCL-90-R), as well as breath-holding (BH) duration, heartbeat perception accuracy and heart rate. Only those patients who did not present a panic attack after both challenges ('no panic group', N=14, 66.7%), and those who presented a panic attack after at least one challenge ('panic group', n=7, 33.3%) were included in the analysis. The panickers, compared to the non-panickers, presented at baseline: significantly higher total score of the SCL-90-R; significantly higher scores on all the SCL-90-R clusters of symptoms, except that of 'paranoid ideation'; significantly lower BH duration. The present preliminary findings indicate that PD patients who panic after a 200 mg or a 400 mg caffeine challenge, compared to the PD patients who do not panic after both of these challenges, may present at baseline significantly higher non-specific general psychopathology--as reflected in the SCL-90-R--and significantly shorter BH duration.