Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers.

Children with Attention Deficit Hyperactivity Disorder (ADHD) are more at risk for academic underachievement compared to their typically developing peers. Understanding their greatest strengths and challenges at school, and how these can be supported, is vital in order to develop focused classroom interventions. Ten primary school pupils with ADHD (aged 6-11 years) and their teachers (N = 6) took part in semi-structured interviews that focused on (1) ADHD knowledge, (2) the child's strengths and challenges at school, and (3) strategies in place to support challenges. Thematic analysis was used to analyse the interview transcripts and three key themes were identified; classroom-general versus individual-specific strategies, heterogeneity of strategies, and the role of peers. Implications relating to educational practice and future research are discussed.

Anxiety, concerns and COVID-19: Cross-country perspectives from families and individuals with neurodevelopmental conditions.

Background: The COVID-19 pandemic had a major impact on the mental health and well-being of children with neurodevelopmental conditions (NDCs) and of their families worldwide. However, there is insufficient evidence to understand how different factors (e.g., individual, family, country, children) have impacted on anxiety levels of families and their children with NDCs developed over time. Methods: We used data from a global survey assessing the experience of 8043 families and their children with NDCs (mean of age (m) = 13.18 years, 37% female) and their typically developing siblings (m = 12.9 years, 45% female) in combination with data from the European Centre for Disease Prevention and Control, the University of Oxford, and the Central Intelligence Agency (CIA) World Factbook, to create a multilevel data set. Using stepwise multilevel modelling, we generated child-, family- and country-related factors that may have contributed to the anxiety levels of children with NDCs, their siblings if they had any, and their parents. All data were reported by parents. Results: Our results suggest that parental anxiety was best explained by family-related factors such as concerns about COVID-19 and illness. Children's anxiety was best explained by child-related factors such as children's concerns about loss of routine, family conflict, and safety in general, as well as concerns about COVID-19. In addition, anxiety levels were linked to the presence of pre-existing anxiety conditions for both children with NDCs and their parents. Conclusions: The present study shows that across the globe there was a raise in anxiety levels for both parents and their children with NDCs because of COVID-19 and that country-level factors had little or no impact on explaining differences in this increase, once family and child factors were considered. Our findings also highlight that certain groups of children with NDCs were at higher risk for anxiety than others and had specific concerns. Together, these results show that anxiety of families and their children with NDCs during the COVID-19 pandemic were predicted by very specific concerns and worries which inform the development of future toolkits and policy. Future studies should investigate how country factors can play a protective role during future crises.

Management of Supratherapeutic International Normalized Ratio without Bleeding after Warfarin Use: An Evaluation of Vitamin K Administration (SUPRA-WAR-K Study).

BACKGROUND: For patients with supratherapeutic international normalized ratio (INR) and no evidence of bleeding, the 2012 guidelines of the American College of Chest Physicians discourage administration of vitamin K. At the study hospital, it was observed that vitamin K was frequently prescribed for patients with INR of 4.5 or higher and no bleeding. OBJECTIVES: To compare efficacy and safety outcomes between holding warfarin alone and holding warfarin with administration of vitamin K and to compare these outcomes among various doses and routes of vitamin K administration in non-critical care inpatients experiencing supratherapeutic INR without evidence of bleeding. METHODS: This single-centre retrospective chart review involved noncritical care inpatients with supratherapeutic INR (4.5-8.9) without evidence of bleeding. The primary outcomes were the change in INR 1 day after implementation of supratherapeutic INR management and the time to reach INR less than 3.0. The secondary outcomes were length of stay, frequency of warfarin resistance, incidence and duration of bridging anticoagulation, incidence of thromboembolism and major bleeding, and death. RESULTS: Regardless of vitamin K dose, the administration of vitamin K combined with holding warfarin, relative to holding warfarin alone, was associated with a greater INR decrease 1 day after the intervention (mean ± standard deviation -3.2 ± 1.9 versus -0.9 ± 1.0, p < 0.001) and a shorter time to reach INR below 3.0 (1.9 ± 1.0 days versus 2.6 ± 1.4 days, p = 0.003). No statistically significant differences in any other outcomes were observed. CONCLUSIONS: In hospitalized non-critical care patients with INR between 4.5 and 8.9 without evidence of bleeding, the combination of holding warfarin and administering vitamin K was associated with greater and faster decreases in INR than holding warfarin alone. No significant differences were found in clinically important outcomes. The practice of administering vitamin K in this population warrants further study and re-evaluation.

CONTEXTE: Dans ses lignes directrices de 2012, l'American College of Chest Physicians déconseille l'administration de vitamine K aux patients ayant des résultats de rapport international normalisé (RIN) suprathérapeutiques et ne présentant aucun saignement. À l'hôpital des auteurs, on a remarqué que l'on prescrivait fréquemment de la vitamine K aux patients répondant aux critères ci-dessus. OBJECTIFS: Comparer l'efficacité et l'innocuité entre un simple arrêt de la warfarine et l'arrêt de la warfarine combiné à l'administration de vitamine K, puis comparer ces résultats thérapeutiques selon différentes doses et voies d'administration de la vitamine K chez des patients hospitalisés qui ne sont pas en phase critique, qui ont un RIN suprathérapeutique et qui ne présentent aucun saignement. MÉTHODES: La présente étude menée dans un seul centre comportait une analyse des dossiers médicaux de patients hospitalisés n'étant pas en phase critique, ayant un RIN suprathérapeutique (4.5­8.9) et ne présentant aucun saignement. Les principaux paramètres d'évaluation étaient le changement du RIN un jour après la mise en œuvre de mesures pour corriger un RIN suprathérapeutique et le temps nécessaire pour atteindre un RIN de moins de 3,0. Les paramètres d'évaluation secondaires étaient la durée du séjour, la fréquence des cas de résistance à la warfarine, le nombre et la durée des relais anticoagulants, l'incidence des cas de thromboembolie et de saignement important et les cas de décès. RÉSULTATS: L'administration de vitamine K, peu importe la dose, combinée à l'arrêt de la warfarine comparativement au simple arrêt de la warfarine était associée à une réduction plus importante du RIN un jour après l'intervention (moyenne ± écart-type −3.2 ± 1,9 contre −0,9 ± 1,0, p < 0,001) et à un plus court délai pour atteindre un RIN de moins de 3,0 (1,9 ± 1,0 jour contre 2,6 ± 1,4 jours, p = 0.003). Aucune différence statistiquement significative n'a été observée pour le reste des paramètres d'évaluation. CONCLUSIONS: Chez les patients hospitalisés n'étant pas en phase critique, ayant un RIN entre 4,5 et 8,9 et ne présentant aucun saignement, l'arrêt de la warfarine combiné à l'administration de vitamine K a été associé à une réduction plus rapide et plus importante du RIN que le simple arrêt de la warfarine. On n'a observé aucune différence significative en ce qui touche aux résultats thérapeutiques cliniquement importants. L'administration de vitamine K pour cette population est une pratique qui nécessite de plus amples études et doit être évaluée à nouveau.