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(1) Background: ADHD is recognized as one of the most common neurodevelopmental disorders. The worldwide prevalence of ADHD is estimated at 5.3%; however, estimates vary as a function of a number of factors, including diagnostic methods, age, sex and geographical location. A review of studies is needed to clarify the epidemiology of ADHD in Canada. (2) Methods: A search strategy was created in PubMed and adapted for MEDLINE and PsycINFO. Papers were included if they examined diagnosed ADHD prevalence and/or incidence rates in any region of Canada, age group and gender. A snowball technique was used to identify additional papers from reference lists, and experts in the field were consulted. (3) Results: Ten papers included in this review reported on prevalence, and one reported on incidence. One study provided an overall prevalence estimate across provinces for adults of 2.9%, and one study provided an overall estimate across five provinces for children and youth of 8.6%. Across age groups (1 to 24 years), incidence estimates ranged from 0.4% to 1.2%, depending on province. Estimates varied by age, gender, province, region and time. (4) Conclusions: The overall Canadian ADHD prevalence estimate is similar to worldwide estimates for adults. Most studies reported on prevalence rather than incidence. Differences in estimates across provinces may reflect the varying number of practitioners available to diagnose and prescribe medication for ADHD across provinces. To achieve a more comprehensive understanding of the epidemiology of ADHD in Canada, a study is needed that includes all provinces and territories, and that considers estimates in relation to age, gender, ethnicity, geographical region, socioeconomic status and access to mental healthcare coverage. Incidence rates need further examination to be determined.
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OBJECTIVES: Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. METHODS: The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. RESULTS: Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. CONCLUSION: PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.
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Psiquiatria do Adolescente , Transtorno do Deficit de Atenção com Hiperatividade , Adolescente , Criança , Família , Humanos , Atenção Primária à Saúde , Encaminhamento e ConsultaRESUMO
BACKGROUND: Primary care providers (PCPs) are increasingly called upon to assist in meeting the growing demand for paediatric mental health care in Canada, yet they report inadequate training and confidence to do so. The Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program was designed to fill this gap by teaching PCPs the skills needed to provide frontline care themselves, particularly in rural/remote regions where specialist resources are limited. This innovative educational intervention may improve paediatric mental health care capacity, but a pilot study is needed. METHODS: We designed a cluster randomized, controlled pilot of PTCAP. Random assignment to intervention or control (treatment-as-usual) will occur at the practice level. Participating PCPs (N=61) at sites randomized to intervention will receive eight hours of training in the use of practice guidelines and brief counseling techniques (i.e., common skills/elements) for addressing diagnosable conditions and more general, transdiagnostic concerns. Mental health care capacity at one-week post-intervention will be the primary outcome, assessed through self-report questionnaires of mental health care confidence, and through a more objective, observational assessment of trained skills. We will also examine retention of these skills at one-month follow-up. We expect use of trained common skills/elements to be associated with better child mental health outcomes on the Strengths and Difficulties Questionnaire (N = 250). DISCUSSION: As one of the first RCTs of its kind in Canada, this study will provide unique, preliminary evidence in regards to the feasibility and efficacy of the PTCAP intervention for enhancing rural, paediatric mental health care capacity.
CONTEXTE: Les prestataires de soins de première ligne (PSPL) sont de plus en plus sollicités pour aider à répondre à la demande croissante de soins de santé mentale pédiatriques au Canada, et pourtant, ils déplorent une formation et une confiance inadéquates pour ce faire. Le programme de Formation du médecin en psychiatrie de l'enfant et de l'adolescent (FMPEA) a été conçu pour combler cette lacune en enseignant aux PSPL les aptitudes nécessaires pour prodiguer eux-mêmes les soins de première ligne, particulièrement en région rurale/éloignée où les ressources de spécialistes sont limitées. Cette intervention éducative innovatrice peut améliorer la capacité des soins de santé mentale pédiatriques, mais une étude pilote est requise. MÉTHODES: Nous avons conçu un pilote contrôlé en grappes randomisées de la FMPEA. Cette assignation aléatoire de l'intervention ou du contrôle (traitement habituel) aura lieu au niveau de la pratique. Les PSPL participants (N = 61) aux endroits aléatoires de l'intervention recevront huit heures de formation en matière d'utilisation des lignes directrices de la pratique et de brèves techniques de consultation (c.-à-d., aptitudes/éléments communs) pour aborder les affections qui peuvent être diagnostiquées et des problèmes trans-diagnostiques plus généraux. À une semaine après l'intervention, la capacité des soins de santé mentale sera le principal résultat, évalué par des questionnaires auto-déclarés sur la confiance dans les soins de santé mentale, et par une évaluation observationnelle plus objective des aptitudes apprises. Nous examinerons également la rétention de ces aptitudes au suivi d'un mois. Nous prévoyons que l'utilisation des aptitudes/éléments communs appris soit associée à de meilleurs résultats de santé mentale des enfants au questionnaire des forces et des difficultés (N = 250). DISCUSSION: À titre d'un des premiers essais randomisés contrôlés (ERC) du genre au Canada, cette étude offrira des données probantes préliminaires uniques à l'égard de la faisabilité et de l'efficacité de l'intervention de FMPEA pour améliorer la capacité des soins de santé mentale pédiatriques en milieu rural.
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To assess the role of reflection in executive function, preschool-age children who perseverated (failed) on a pre-training version of the Dimensional Change Card Sort (DCCS) were given training with a different version (different stimuli) in which they were provided with corrective feedback and taught to reflect on the conflicting rule representations involved in the task. In Exp. 1, reflection training was based closely on Kloo and Perner (2003). Exp. 2 used a shortened (15min) version of the training protocol. In Exp. 3, this version of reflection training was compared to corrective feedback alone or mere practice with the task (without feedback). In all 3 experiments, children who received reflection training showed substantial improvements in performance on the pre-training version of the DCCS, whereas children in control conditions did not. In Exp. 3, these improvements were accompanied by a reduction from pre- to post-training in the amplitude of the N2 component of the ERP, an index of conflict detection. Results suggest not only that EF can be trained using a brief intervention targeting reflection, but also that training-related improvements in performance are associated with the down-regulation of ACC-mediated conflict detection. Implications for education are discussed.
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Cognição/fisiologia , Função Executiva/fisiologia , Memória/fisiologia , Pré-Escolar , Eletroencefalografia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Resolução de Problemas/fisiologia , Resultado do TratamentoRESUMO
To explore the neurocognitive mechanisms underlying individual differences in executive function during the preschool years, high-density electroencephalography (EEG) was used to record event-related potentials (ERPs) from 99 children (between 35 and 54 months of age) during performance on the Dimensional Change Card Sort (DCCS), a widely used measure of executive function in which participants are required to sort bivalent stimuli first by one dimension and then by another. ERP analyses comparing children who switched flexibly (passed) to those who perseverated on post-switch trials (failed) focused on the N2 component, which was maximal over fronto-central sites. N2 amplitude was smaller (less negative) for children who passed the DCCS than for children who failed, suggesting that the N2, often associated with conflict monitoring, may serve as a neural marker of individual differences in executive function. Implications for learning and education are discussed.
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Cognição/fisiologia , Potenciais Evocados/fisiologia , Função Executiva/fisiologia , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Pré-Escolar , Eletroencefalografia , Feminino , Humanos , Individualidade , Masculino , Testes Neuropsicológicos , Estimulação Luminosa , Resolução de Problemas/fisiologiaRESUMO
We used dense-array event-related potentials (ERP) to examine the time course and neural bases of evaluative processing. Participants made good vs. bad (evaluative) and abstract vs. concrete (nonevaluative) judgments of socially relevant concepts (e.g., "murder," "welfare"), and then rated all concepts for goodness and badness. Results revealed a late positive potential (LPP) beginning at about 475 ms post-stimulus and maximal over anterior sites. The LPP was lateralized (higher amplitude and shorter latency) on the right for concepts later rated bad, and on the left for concepts later rated good. Moreover, the degree of lateralization for the amplitude but not the latency was larger when participants were making evaluative judgments than when they were making nonevaluative judgments. These data are consistent with a model in which discrete regions of prefrontal cortex (PFC) are specialized for the evaluative processing of positive and negative stimuli.