Temperamental and psychomotor predictors of ADHD symptoms in children born after a threatened preterm labour: a 6-year follow-up study.

Children born after threatened preterm labour (TPL), regardless of whether it ends in preterm birth, may represent an undescribed "ADHD cluster". The aim of this cohort study is to identify early temperament and psychomotor manifestations and risk factors of TPL children who present ADHD symptoms. One hundred and seventeen mother-child pairs were followed from TPL diagnosis until the child's 6 years of life. TPL children were divided according to the prematurity status into three groups: full-term TPL (n = 26), late-preterm TPL (n = 53), and very-preterm TPL (n = 38). A non-TPL group (n = 50) served as control. Temperament and psychomotor development at age 6 months and ADHD symptoms at age 6 years were assessed. Perinatal and psychosocial factors were also recorded. All TPL groups showed higher severity of ADHD symptoms compared with non-TPL children (difference in means + 4.19 for the full-term group, + 3.64 for the late-preterm group, and + 4.99 for the very-preterm group, all ps < 0.021). Concretely, very-preterm and late-preterm TPL children showed higher restless/impulsive behaviours, whereas full-term TPL children showed higher emotional lability behaviours. Higher surgency/extraversion and delayed fine motor skills at age 6 months predicted ADHD symptoms at 6 years in TPL children. Male sex, maternal state anxiety symptoms at TPL diagnosis, low parental education, and past maternal experience of traumatic events predicted higher ADHD symptoms in TPL children. Therefore, TPL children may have a higher risk for developing ADHD symptoms, presenting a phenotype that depends on the prematurity status. Moreover, the specific combination of early manifestations and risk factors suggests that TPL children may conform an undescribed group at-risk of ADHD symptoms.

The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG).

ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems.

A Phase III Study of Bumetanide Oral Liquid Formulation for the Treatment of Children and Adolescents Aged Between 7 and 17 Years with Autism Spectrum Disorder (SIGN 1 Trial): Participant Baseline Characteristics.

The efficacy of bumetanide (oral liquid formulation 0.5 mg bid) as a treatment for the core symptoms of autism spectrum disorders in children and adolescents aged 7-17 years is being investigated in an international, randomised, double-blind, placebo-controlled phase III study. The primary endpoint is the change in Childhood Autism Rating Scale 2 (CARS2) total raw score after 6 months of treatment. At baseline, the 211 participants analysed are broadly representative of autistic subjects in this age range: mean (SD) age, 10.4 (3.0) years; 82.5% male; 47.7% with intelligence quotient ≥ 70. Mean CARS2 score was 40.1 (4.9) and mean Social Responsiveness Scale score was 116.7 (23.4). Final study results will provide data on efficacy and safety of bumetanide in autistic children and adolescents.

Are infants born after an episode of suspected preterm labor at risk of attention deficit hyperactivity disorder? A 30-month follow-up study.

BACKGROUND: An episode of suspected preterm labor may be by itself a pathologic event that may alter the normal course of pregnancy and the offspring's neurodevelopment. Certainly, the association between preterm birth and neurodevelopmental disorders can only be partially explained by the immaturity of the nervous system, as evidenced by the increased risk of attention deficit hyperactivity disorder in late-preterm infants without any neurologic alteration. OBJECTIVE: This study aimed to examine whether infants born after suspected preterm labor may be at an increased risk of developing attention deficit hyperactivity disorder. Moreover, potential obstetrical, perinatal, and psychosocial risk factors associated with attention deficit hyperactivity disorder in this population are examined. STUDY DESIGN: A prospective cohort study of 120 mother-infant pairs was conducted from the moment the mothers received a diagnosis of suspected preterm labor until the infants' 30 months of life. Infants were divided according to the prematurity status: full-term infants born after a suspected preterm labor (n=28; born at ≥37 weeks of gestation), late-preterm infants (n=56; born between 32 and <37 weeks of gestation), very-preterm infants (n=36; born before <32 weeks of gestation). At-term infants born without obstetric complications served as a control group (n=46). Infants' attention deficit hyperactivity disorder symptoms were assessed at the age of 30 months. Furthermore, obstetrical, perinatal, and psychosocial risk factors were recorded. RESULTS: All groups of infants born after a suspected preterm labor showed more attention deficit hyperactivity disorder symptoms at the age of 30 months than the control group. Concretely, very-preterm infants showed higher restless or impulsive behaviors, whereas full-term infants born after a suspected preterm labor and late-preterm infants showed higher emotional lability behaviors. Among potential risk factors, male sex and maternal experience of posttraumatic stress symptoms predicted the severity of attention deficit hyperactivity disorder symptoms in infants born after a suspected preterm labor. CONCLUSION: Infants born after a suspected preterm labor had a higher risk of developing attention deficit hyperactivity disorder symptoms, including those born at term. Infants born after a suspected preterm labor showed a distinctive phenotype and shared specific risk factors suggesting that they conform an undescribed population at risk of attention deficit hyperactivity disorder.

Jumping to conclusions in autism: integration of contextual information and confidence in decision-making processes.

Individuals with Autism spectrum condition (ASC) present cognitive biases and a difficulty to integrate emotional responses in decision-making, which is necessary for adequate social functioning. Thus, understanding the underlying mechanisms of the altered decision-making in individuals with ASC may eventually have a positive impact on their social functioning. The Picture decision task was employed to observe the effect of new information (fragments of an incomplete picture), interpretative context (verbal cues), and the level of confidence on decision-making processes. Our study administered the task to 49 children with ASC and 37 children with Typical Development (TD). Children with TD showed a higher probability of success when an interpretative context was given. Conversely, children with ASC had an equal probability of success regardless of whether an interpretative context was provided or not. In addition, unlike children with TD, the level of confidence did not allow predicting the probability of successful decisions in children with ASC. Finally, children with ASC had more probability of jumping to conclusions, a decision made quickly with only one fragment of the picture while being completely sure of it. These results are discussed in light of current cognitive and emotional theories on ASC.

Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder.

BACKGROUND: Behavioural interventions are recommended for use with children and young people with attention deficit hyperactivity disorder (ADHD); however, specific guidance for their implementation based on the best available evidence is currently lacking. METHODS: This review used an explicit question and answer format to address issues of clinical concern, based on expert interpretation of the evidence with precedence given to meta-analyses of randomised controlled trials. RESULTS: On the basis of current evidence that takes into account whether outcomes are blinded, behavioural intervention cannot be supported as a front-line treatment for core ADHD symptoms. There is, however, evidence from measures that are probably blinded that these interventions benefit parenting practices and improve conduct problems which commonly co-occur with ADHD, and are often the main reason for referral. Initial positive results have also been found in relation to parental knowledge, children's emotional, social and academic functioning - although most studies have not used blinded outcomes. Generic and specialised ADHD parent training approaches - delivered either individually or in groups - have reported beneficial effects. High-quality training, supervision of therapists and practice with the child, may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence to limit behavioural treatments to parents with parenting difficulties or children with conduct problems. There are positive effects of additive school-based intervention for the inattentive subtype. Targeting parental depression may enhance the effects of behavioural interventions. CONCLUSIONS: Parent training is an important part of the multimodal treatment of children with ADHD, which improves parenting, reduces levels of oppositional and noncompliant behaviours and may improve other aspects of functioning. However, blinded evidence does not support it as a specific treatment for core ADHD symptoms. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and explore potential barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use, it seems important to acknowledge and respond to parental treatment preferences.

Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD).

While pharmacotherapy and psychosocial interventions are recommended as the primary frontline treatment for attention deficit hyperactivity disorder (ADHD), alternative approaches to managing ADHD are becoming increasingly popular among patients and their families. Supplementation with polyunsaturated fatty acids (PUFAs) is an example of this. PUFA supplementation is not recommended by guidelines for managing ADHD; however, patients may still decide to use it. To provide direction to healthcare professionals (HCPs) managing ADHD, eight international experts in the field of adult and child ADHD came together for the Continuum Education Board: Omega Supplements in ADHD meeting. This commentary summarises the panel's consensus that current evidence suggests PUFA supplementation has a small beneficial effect on behaviour in children with ADHD, and that further high-quality research is needed to clearly evaluate and define its role in the management of ADHD of children, adolescents and adults. The panel concluded that in cases where patients use PUFA supplementation, HCPs should be comfortable explaining the potential gains that they may have and their possible side effects. The panel also concluded HCPs should not reinforce the idea that PUFA supplementation should replace treatment approaches with a more robust evidence base for managing ADHD.

Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder--an appraisal of the evidence on efficacy and recommendations on the design of future studies.

BACKGROUND: The efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). There have been three systematic reviews and associated meta-analyses of the RCTs for each of these treatments. SCOPE: The aim of this review is to critically appraise the studies on the dietary treatments of ADHD, to compare the various meta-analyses of their efficacy that have been published and to identify where the design of such RCTs could be improved and where further investigations are needed. FINDINGS: The meta-analyses differ in the inclusion and exclusion criteria applied to potentially eligible studies. The range of average effect sizes in standard deviation units is RED (0.29-1.2), AFCE (0.18-0.42) and SFFA (0.17-0.31). The methodology of many of the trials on which the meta-analyses are based is weak. CONCLUSIONS: Nevertheless, there is evidence from well-conducted studies for a small effect of SFFA. Restricted elimination diets may be beneficial, but large-scale studies are needed on unselected children, using blind assessment and including assessment of long-term outcome. Artificial food colour elimination is a potentially valuable treatment but its effect size remains uncertain, as does the type of child for whom it is likely to be efficacious. There are additional dietary supplements that have been used with children with ADHD. A systematic search identified 11 RCTs that investigated the effects of these food supplements. Despite positive results for some individual trials, more studies are required before conclusions can be reached on the value in reducing ADHD symptoms of any of these additional supplements.

Differential effects of anxiety and depressive symptoms on working memory components in children and adolescents with ADHD combined type and ADHD inattentive type.

Working memory (WM) deficits have been shown to be associated with core ADHD symptoms, worse academic achievement and peer-relationship problems. Internalizing symptoms, such as anxiety and depression, have also been associated with impaired WM performance. However, the association of anxiety and depression and WM performance remains unclear for children and adolescents with ADHD. Further, it is unknown how these comorbid conditions might affect WM performance in the two main ADHD subtypes. The association of anxiety and depression and the specific components of spatial (SWM) and verbal working memory (VWM) were examined in 303 children and adolescents with ADHD, combined type (ADHD-CT) and 77 ADHD, inattentive type (ADHD-IA) compared to 128 age- and gender-matched typically developing participants. The relationship between anxiety and depression and WM was assessed using multiple linear regression analyses and separate simple regression analyses. Higher levels of anxiety/depression were associated with (1) increased between-search errors in the typically developing participants alone, (2) a better strategy performance in the ADHD-CT group, and (3) a better spatial span performance in the ADHD-IA group. VWM was equally impaired in the ADHD-CT and ADHD-IA groups, independent of the levels of anxiety and depression. The results suggest that the effects of internalizing symptoms on WM differ in typically developing children and adolescents compared to those with ADHD. Further, high levels of anxiety and depression modified WM performance differently according to the specific ADHD subtypes. This might help explain contradictory findings observed in previous studies of mixed samples of participants with ADHD-CT and ADHD-IA.

Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: immediate and long-term effects using a blind randomized controlled trial.

Recent guidelines for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) have claimed the possible benefits of psychoeducational techniques in the comprehensive management of ADHD. To evaluate the efficacy of a psychoeducation programme for parents of children and adolescents with ADHD in a clinical setting using a blind randomized trial. 81 children/adolescents with ADHD were randomly assigned for their families to receive either a well-structured psychoeducation programme (intervention group, n = 44), or a parent counselling and support intervention (control group, n = 37). Measures of child ADHD symptoms, psychopathology, quality of life and family stress were taken before and after intervention and after a year follow-up. Parents and evaluators were unaware of the condition received. Compared to the support control group, the psychoeducation group showed ADHD Index and cognitive/inattention levels significantly reduced after the intervention ended (Mann-Whitney U = 3.34; p = 0.001; Mann-Whitney U = 3.47; p = 0.001). An improvement in the pro-social domain was also observed after 1 year follow-up (Mann-Whitney U = -2.37; p = 0.018), and clinical global impression found a statistically significant effect for severity over the time. Differences were initially found for the impact of the disorder in the family in different domains, including emotional and social functioning; these differences were no longer significant after alpha correction. No significant differences in quality of life or family stress were found in comparison with the control group. This psychoeducation programme is a valuable treatment for parents/carers of children/adolescents with ADHD, which needs to be considered when evaluating different non-pharmacological treatment options. Psychoeducation and other kind of non-pharmacological approaches need to be regarded not as a substitute, but as a complementary treatment to medications; these approaches might help other very crucial aspects of ADHD including social and familiar outcomes.

Are Socially Relevant Scenes Abnormally Processed in Complex Trauma-Exposed Children?

Abnormal attentional processes to socially relevant information may underlie behavioral dysfunctional symptoms in children exposed to a complex trauma. Attentional biases to social scenes close to real-world situations and their association with behavioral symptomatology were examined in complex trauma-exposed children. A visual dot-probe task involving neutral versus emotional (i.e., threatening, sad, or happy) scenes was applied to twenty-one maltreated children (mean age 10.43; 42.8% female; 61.1% White). These children were exposed to a complex trauma (i.e., severe, repeated, multiple, prolonged, and interpersonal) and were safeguarded in a juvenile welfare home after all parental responsibility was removed. Twenty-four comparable non-maltreated children (mean age 10.13; 29.2% female; 76% White), served as control group. All participants were at risk of social exclusion and every legal representative completed the Child Behavior Checklist (CBCL). Complex trauma-exposed children showed an attentional bias toward threatening scenes, while the control group showed an attentional bias toward sad scenes. There were no differences for happy scenes between groups. Attentional bias toward threatening scenes was associated with withdrawn symptoms in complex trauma-exposed children. Children exposed to a complex trauma show an abnormal attention to threatening social situations, which can trigger maladaptive behaviors such as withdrawn. The understanding of how complex trauma-exposed children process affective environmental information may provide new targets in the social skills interventions such as diminishing maladaptive behaviors and improving coping strategies to face threatening situations.

Examination of neurological subtle signs in ADHD as a clinical tool for the diagnosis and their relationship to spatial working memory.

BACKGROUND: Neurological subtle signs (NSS) are minor neurological abnormalities that have been shown to be increased in a number of neurodevelopmental conditions. For attention deficit/hyperactivity disorder (ADHD), it remains unclear whether NSS may aid the clinical diagnostic process. METHODS: This study explored the association of total and specific domains of NSS in 1,055 children and adolescents with ADHD compared to 130 age-matched typically developing participants; the relationship between NSS and Spatial Working Memory (SWM) as a cognitive process integrally involved in ADHD was also assessed. To determine the diagnostic and predictive efficiency of NSS, a receiver operating curve analysis was performed and the area under the curve (AUC) quantified. The best discriminant points for differentiating between ADHD and typically developing participants and the predictive power of NSS for SWM impairment in ADHD young people were also calculated. RESULTS: Area under the curves for total NSS, smoothness/accuracy, cerebellar signs and choreo-athetoid movements scores were considered good (.84, .79, .74 and .73 respectively), and the results remained after controlling for gender and IQ. A total score of 13 or over on the Scored Developmental Neurological Examination proved to be a good threshold point for differentiating between the ADHD and typically developing participants. For ADHD children, the AUC of total NSS to distinguish between those below 25th and above 75th percentile were .77 and .73 for Spatial Span and for Between Search Errors respectively (the two SWM-dependent measures examined). CONCLUSIONS: This study provides evidence suggesting that NSS may aid the clinical evaluation of a child or adolescent with ADHD. In children and adolescents with ADHD, NSS are associated with difficulties in SWM, specifically the Spatial Span and Between Search Error components.

Evaluation of attitudes towards treatment in adolescents with attention deficit hyperactivity disorder (ADHD).

A substantial proportion of adolescents with attention deficit hyperactivity disorder (ADHD) do not appropriately adhere to prescribed treatments, especially to pharmacological treatments. It is important to disentangle the specific attitudes that contribute to treatment adherence. A 33-item questionnaire was applied to 120 adolescents diagnosed with ADHD and their respective parents. Reliability of the scale was explored using factor analysis, Cronbach's alpha, and test-retest. Validity was explored by face validity and the known-groups method. For the young people's version, three main dimensions (preoccupations, insight and self-concept) emerged. The parents' version showed six main dimensions (child's personal attitudes, worries, social stigma, insight, future side effects and knowledge). The potential of this questionnaire to explore the attitudes of patients and their families towards treatments and for clinicians to predict treatment adherence is discussed.

Correction: Santa-Marina et al. Maternal Ferritin Levels during Pregnancy and ADHD Symptoms in 4-Year-Old Children: Results from the INMA-INfancia y Medio Ambiente (Environment and Childhood) Prospective Birth Cohort Study. Int. J. Environ. Res. Public Health 2020, 17, 7704.

In the original article [...].

A Randomized Controlled Trial Evaluating the Efficacy of a Psychoeducation Program for Families of Children and Adolescents With ADHD in the United Kingdom: Results After a 6-Month Follow-Up.

Objective: Psychoeducation forms part of the current practice for ADHD; however, its efficacy is yet to be established. Method: Sixty-nine children/adolescents with ADHD were randomly assigned for their families to receive either a well-structured psychoeducation program (n = 35), or belong to a control group (treatment-as-usual, n = 34). Results: One-way analyses of variance showed a statistically significant Treatment × Time interaction, for ADHD total symptoms, inattention/cognition, and hyperactivity/impulsivity subdomains according to the parents, the first two with medium-large effect sizes. The effects of the intervention on the ADHD total and the inattention/cognition domain persisted after 6 months follow-up. No significant differences in teacher ratings were found; however, an improvement in clinical functioning as measured by clinicians was observed. Conclusion: This psychoeducation program has shown effectiveness in reducing ADHD symptoms when compared with treatment as usual. Psychoeducation needs to be considered as a valid and additional approach in ADHD.

Maternal Ferritin Levels during Pregnancy and ADHD Symptoms in 4-Year-Old Children: Results from the INMA-INfancia y Medio Ambiente (Environment and Childhood) Prospective Birth Cohort Study.

Ferritin status during prenatal brain development may influence the risk of attention deficit and hyperactivity disorder (ADHD) symptoms in childhood. We investigated the association of maternal ferritin in pregnancy and ADHD-like symptoms in offspring. A total of 1095 mother-child pairs from three birth cohorts of the INMA Project (Spain) were studied. Maternal plasma ferritin in pregnancy was measured at 11.57 weeks of gestation. Children's ADHD-like symptoms at ages 4-5 years were assessed using the ADHD Rating Scale-IV. The count model of the zero-inflated Poisson regression model showed a significant inverse association between ferritin (continuous variable) and inattention, ß = -0.19 (-0.32, -0.07), for boys. Comparing ferritin level by tertiles, significant differences were observed between the first tertile ([1.98, 20.92]) and the second ([20.92, 38.79]) and third tertiles ([38.79, 216.5]) (mg/L).The number of symptoms was lower for those in the third tertile, ß = -0.3 (-0.55, -0.5), and for those in the second one, ß = -0.37 (-0.6, -0.14). The model stratification by sex also showed this inverse association for boys only, ß = -0.21 (-0.34, -0.08). No associations were found between ferritin level and hyperactivity or total ADHD symptoms. High ferritin levels during pregnancy show a protective association with child inattentive-type ADHD symptoms.

Fewer neurological soft signs among first episode psychosis patients with heavy cannabis use.

BACKGROUND: Although neurological soft signs (NSS) have been consistently associated with schizophrenia and a variety of risk factors, few studies have focused on the association between NSS and environmental factors such as cannabis use, particularly in patients with first episode psychosis. METHODS: We administered the Neurological Evaluation Scale (NES) to 92 patients during their first episode of functional psychosis. Psychopathology was assessed with the Positive And Negative Syndrome Scale (PANSS) and the family history of psychotic disorder was established on the basis of the Family Interview for Genetic Studies (FIGS). We also assessed lifetime cannabis and cocaine use utilizing that specific section of the Composite International Diagnostic Interview. The outcome variable was the presence of high NSS, defined by a score above the median split of the NES score (>21). RESULTS: Most patients (80/92, 87%) presented a non-affective psychosis. The presence of high NSS showed a significant independent association with not having been a heavy cannabis user (OR=8.3; 95% CI, 2.4-33.3), family history of psychosis (OR=4.3; 95% CI, 1.2-14.9), male sex (OR=4.0; 95% CI, 1.2-14.0), lower score in verbal fluency and higher score in negative symptoms (both p<0.01). CONCLUSION: Our cross-sectional results support the hypothesis that potentially different pathways associated with the emergence of first episode psychosis may exist, including neurological premorbid alteration and environmental cannabis abuse.

Factors influencing primary care attendance in adolescents with high levels of depressive symptoms.

BACKGROUND: Although depression is common amongst adolescents attending general practice, little is known about factors which influence consultation. This study aims to identify factors that contribute to GP attendance in adolescents with high levels of mood symptoms. METHODS: Case-control study of 13 to 17-year-olds attending (cases, N = 156) and not attending (controls, N = 120) an urban general practice during a 6-month period; questionnaires on depressive symptoms (Mood and Feelings Questionnaire), physical symptoms (Child Somatisation Inventory), socio-demographic data and attitudes were completed. RESULTS: Attenders had significantly more depressive and physical symptoms. In the comparison between 63 attenders and 34 non-attenders with a high level of depressive symptoms, attendance was significantly linked to lower socio-economic status, non-White ethnicity, non-intact families, and not believing that doctors are only interested in physical symptoms. On logistic regression analysis, attendance in males with depressive symptoms was predicted by more physical and less marked depressive symptoms; in females by non-White ethnicity and not believing doctors are only interested in physical symptoms. CONCLUSION: Both socio-demographic factors and adolescent attitudes influence general practitioner attendance in adolescents with high levels of depressive symptoms. These findings may help inform interventions to facilitate help seeking in primary care for young people with high levels of depressive symptoms.

Neurodevelopmental markers in different psychopathological dimensions of first episode psychosis: the ESPIGAS study.

OBJECTIVE: The main aim of this study was to explore whether specific groups of patients with first episode non-affective psychosis could be identified on a psychopathological basis and, then, whether such identified groups could be validated by exploring their correlation with a variety of neurodevelopmental markers. METHOD: Eighty-seven patients with a first episode of non-affective psychotic disorder were consecutively recruited. We assessed psychopathology and neurological soft signs using the PANSS and the Neurological Evaluation Scale, respectively. We collected information on obstetric complications, premorbid adjustment and family history. RESULTS: All PANSS symptoms were analysed using principal component analysis and four factors were obtained (negative, disorganization, positive and paranoid). Subsequently, the four factors were subjected to a cluster analysis where three groups emerged: "paranoid" (n=40), "low score" (n=29) and "negative" (n=18) subtype. After adjusting by sex and age, we found that the "negative group" had poorer social premorbid adjustment, worse verbal fluency and higher prevalence of both obstetric complications and neurological soft signs, when compared with the "low score" group. Similarly, the "negative group" showed significantly poorer social premorbid adjustment and higher number of neurological soft signs than the "paranoid group". CONCLUSIONS: Our results support that, among non-affective first onset psychotic patients, those with predominant negative symptoms are more likely to correlate with higher presence of neurodevelopmental markers.

Abnormal emotional processing in maltreated children diagnosed of Complex Posttraumatic Stress Disorder.

Maltreated children usually show a specific pattern of emotional and behavioral symptoms that exceed those relating to posttraumatic stress disorder (PTSD). These symptoms have been defined as Complex PTSD (CPTSD). The underlying attentional mechanisms of abnormal emotional processing and their relation to the clinical presentation of CPTSD are not well understood. A visual dot-probe paradigm involving pre-attentive (i.e., 500ms) and attentive (i.e., 1500ms) presentation rates of neutral versus emotional (i.e., angry, happy or sad) facial expressions was applied. Twenty-one maltreated CPTSD children were compared with twenty-six controls. The results are as follows: an attention bias away from threatening faces and an attentional bias towards sad faces were observed in maltreated CPTSD children during pre-attentive and attentive processing. Whereas the attentional bias away from angry faces was associated with social problems, the attentional bias towards sad faces was associated with depressive and withdrawn symptoms. Therefore, CPTSD children develop maladaptive negative cognitive styles, which may underlie not only social problems (by a cognitive avoidance of threatening stimuli) but also depressive symptoms (by a cognitive approach to sad stimuli). Attention processing abnormalities should be considered as therapeutic targets for new treatment approaches in this population.