For Which Children with ADHD is TBR Neurofeedback Effective? Comorbidity as a Moderator.

We examined psychiatric comorbidities moderation of a 2-site double-blind randomized clinical trial of theta/beta-ratio (TBR) neurofeedback (NF) for attention deficit hyperactivity disorder (ADHD). Seven-to-ten-year-olds with ADHD received either NF (n = 84) or Control (n = 58) for 38 treatments. Outcome was change in parent-/teacher-rated inattention from baseline to end-of-treatment (acute effect), and 13-month-follow-up. Seventy percent had at least one comorbidity: oppositional defiant disorder (ODD) (50%), specific phobias (27%), generalized anxiety (23%), separation anxiety (16%). Comorbidities were grouped into anxiety alone (20%), ODD alone (23%), neither (30%), or both (27%). Comorbidity (p = 0.043) moderated acute effect; those with anxiety-alone responded better to Control than to TBR NF (d = - 0.79, CI - 1.55- - 0.04), and the other groups showed a slightly better response to TBR NF than to Control (d = 0.22 ~ 0.31, CI - 0.3-0.98). At 13-months, ODD-alone group responded better to NF than Control (d = 0.74, CI 0.05-1.43). TBR NF is not indicated for ADHD with comorbid anxiety but may benefit ADHD with ODD.Clinical Trials Identifier: NCT02251743, date of registration: 09/17/2014.

Exploring the Efficacy of a Mindfulness Program for Boys With Attention-Deficit Hyperactivity Disorder and Oppositional Defiant Disorder.

Objective: This study was the first attempt to explore the efficacy of a mindfulness protocol for children with attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), and their parents. Method: Fifty male children with ADHD and ODD diagnosis, aged 8 to 12, were randomly assigned to the mindfulness intervention (n = 25) or the wait-list (n = 25) group. Outcome measures included children, parents', and teachers' reports and objective measures of attention. Results: Children from the intervention group had a greater reduction in hyperactive behaviors in the school context (effect size [ES] = 0.59) and a greater improvement in visual sustained attention (ES = 0.77) and in Avoidance and Fusion Questionnaire scores (ES = 0.43) than those in the wait-list control group. No significant effect of the intervention on aggressive behaviors was revealed. Conclusion: A mindfulness intervention for children and their parents showed partial beneficial effects in children with ADHD + ODD.

Effects of taijiquan and qigong practice over behavioural disorders in school-age children: A pilot study.

Child development and wellness are strictly dependent on several factors among them physical activity, a proper nutrition and, of critical importance, a healthy mind. Psychopathologies like attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) have a direct negative impact on social, academic or occupational functioning of the affected children. If left untreated, these pathologies may progress to adulthood, thus requiring research strategies on conventional and nonconventional modalities of treatment. In this pilot study, conducted during the academic year 2015/2016, a combination of exercises of TaijiQuan (TJQ) and Qi Gong (QG) were taught to four selected children, three males and one female, aged between 6 and 10, suffering from the above mentioned behavioural disorders. The main goal was to understand if it is possible to achieve any kind of improvement in their condition, by evaluating the scores of the Achenbach Teacher's Report Form (TRF) in the beginning and ending of the experimental period. Results showed very interesting improvements in symptoms of CD, ODD and ADHD-HI (hyperactive-impulsive), while ADHD-PI (predominantly inattentive) showed only minor improvements. The overall symptom improvement was 43% across pathologies, which demonstrates that TJQ and QG may be a promising treatment of symptoms for children with behavioural disorders. More research is needed with controlled experimental designs and statistically representative samples in order to fully comprehend the versatility of these modalities.

Social skills training and play group intervention for children with oppositional-defiant disorders/conduct disorder: Mediating mechanisms in a head-to-head comparison.

Objective: Social-cognitive information processing, social skills, and social interactions are problem-maintaining variables for aggressive behavior in children. We hypothesized that these factors may be possible mediators of the mechanism of change in the child-centered treatment of conduct disorders (CDs). The aim of the present study (Clinical trials.gov Identifier: NCT01406067) was to examine putative mechanisms of change for the decrease in oppositional-defiant behavior resulting from child-centered treatment of patients with oppositional-defiant disorder (ODD) or CD. Method: 91 children (age 6-12 years) with ODD/CD were randomized to receive either social skills training or to a resource activating play group. Mediator analyses were conducted using path analyses. Results: The assumed mediating effects were not significant. However, alternative models with the putative mediators and outcome in reversed positions showed significant indirect effects of the oppositional-defiant symptoms as mediator for the decrease of disturbance of social-information processing, social skills, and social interactions. Conclusions: The proposed model for mechanisms of change could not be confirmed, with the results pointing to a reversed causality. Variables other than those hypothesized must be responsible for mediating the effects of the intervention on child oppositional-defiant behavior. Possible mechanisms of change were discussed.

Therapeutic body wraps (TBW) for treatment of severe injurious behaviour in children with autism spectrum disorder (ASD): A 3-month randomized controlled feasibility study.

INTRODUCTION: The use of therapeutic body wraps (TBW) has been reported in small series or case reports, but has become controversial. OBJECTIVES: This is a feasibility, multicentre, randomized, controlled, open-label trial with blinded outcome assessment (PROBE design). SETTING: Children with autism and severe-injurious behaviours (SIB) were enrolled from 13 specialized clinics. INTERVENTIONS: Dry-sheet TBW (DRY group) vs. wet-sheet TBW (WET group). PRIMARY OUTCOME MEASURES: 3-month change in the Aberrant Behaviour Checklist irritability score (ABC-irritability) within per-protocol (PP) sample. RESULTS: From January 2008 to January 2015, we recruited 48 children (age range: 5.9 to 9.9 years, 78.1% male). Seven patients (4 in the DRY group, 3 in the WET group) were dropped from the study early and were excluded from PP analysis. At endpoint, ABC-irritability significantly improved in both groups (means (standard deviation) = -11.15 (8.05) in the DRY group and -10.57 (9.29) in the WET group), as did the other ABC scores and the Children Autism Rating scale score. However, there was no significant difference between groups. All but 5 patients were rated as much or very much improved. A repeated-measures analysis confirmed the significant improvement in ABC-irritability scores according to time (p < .0001), with no significant difference between the two groups (group effect: p = .55; interaction time x group: p = .27). Pooling both groups together, the mean 3-month change from baseline in ABC-irritability score was -10.90 (effect size = 1.59, p < .0001). CONCLUSIONS: We found that feasibility was overall satisfactory with a slow recruitment rate and a rather good attrition rate. TBW was a safe complementary therapy in this population. There was no difference between wet and dry TBW at 3 months, and ABC-irritability significantly decreased with both wet and dry sheet TBW. To assess whether TBW may constitute an alternative to medication or behavioural intervention for treating SIB in ASD patients, a larger randomized comparative trial (e.g. TBW vs. antipsychotics) is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03164746.

Tailoring Parent-Child Interaction Therapy (PCIT) for Older Children: A Case Study.

Parent-Child Interaction Therapy (PCIT) is an evidence-based intervention designed for families of 2- to 6-year-old children with disruptive behavior disorders. This article illustrates the application of PCIT in a 10-year-old boy with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Both parents and the patient attended PCIT sessions. The course of therapy included minor changes to the PCIT protocol. After 13 PCIT sessions, the patient displayed disruptive behaviors within normal limits, and 12 months later he no longer met diagnostic criteria for ODD. Results remained stable at a 17-month follow-up assessment. This case study suggests that the use of PCIT in families of children with ODD markedly older than the recommended age range might be a promising approach for improving family functioning and reducing behavior problems. Further research with larger samples of older children with ODD is needed to replicate and elaborate the findings of this case study.

A model of integrated health care in a poverty-impacted community in New York City: Importance of early detection and addressing potential barriers to intervention implementation.

Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention.

Propiedades psicométricas del "Cuestionario de Agresividad" en adolescentes chilenos: comparación de diferentes versiones / Psychometric properties of the Five Facets Mindfulness Questionnaire (FFMQ-M) in Mexico

El objetivo de esta investigacion fue analizar las propiedades psicométricas del "Cuestionario de agresividad" (Aggression Questionnaire, AQ), en las versiones de 29, 20 y 12 items, en una muestra de 898 estudiantes chilenos de 14 a 17 anos. El analisis factorial confirmatorio identifico que la version de 12 items fue la que mostro un ajuste mas adecuado al modelo de cuatro factores propuesto por los autores de la escala. Los indices de consistencia interna de los cuatro factores fueron aceptables, oscilando entre 0,67-0,78. La validez de la escala fue analizada mediante correlaciones con el "Inventario de expresion de ira estado-rasgo en ninos y adolescentes" (State-Trait Anger Expression Inventory for Children and Adolescents, STAXI-NA). Los resultados revelaron correlaciones positivas y estadisticamente significativas entre las puntuaciones del AQ de 12 items y las dimensiones de rasgo y estado del STAXI-NA, oscilando entre 0,20 (Hostilidad-Ira/estado) y 0,57 (Puntuacion total AQ-Ira/rasgo). Los resultados obtenidos en este trabajo ponen de manifiesto que la version abreviada del AQ presenta adecuadas pruebas de fiabilidad y validez para evaluar conductas agresivas en adolescentes chilenos

The objective of this research was to analyze the psychometric properties of the Aggression Questionnaire (AQ), in its 29, 20 and 12-item versions, in a sample of 898 Chilean students from 14 to 17 years of age. The confirmatory factor analysis identified that the 12-item version was the one showing a more suitable fit to the four-factor model proposed by the authors of the scale. The internal consistency of the four dimensions was acceptable, ranging between .67 and .78. The results also revealed positive and statistically significant correlations between scores of AQ-12-item version and trait and state dimensions of the State-Trait Anger Expression Inventory for Children and Adolescents (STAXI-NA), ranging from .20 (Hostility-State anger) to .57 (AQ total score-Trait anger). These results indicate that the AQ-12-item version is an instrument that shows reliability and convergent validity for evaluating aggressive behaviors in Chilean adolescents

Pediatric emotional dysregulation and behavioral disruptiveness treated with hypnosis: a time-series design.

A case of pediatric oppositional defiant disorder (ODD) with concomitant emotional dysregulation and secondary behavioral disruptiveness was treated with hypnosis by means of the hypnotic hold, a method adapted by the authors. An A-B-A-B time-series design with multiple replications was employed to measure the relationship of the hypnotic treatment to the dependent measure: episodes of emotional dysregulation with accompanying behavioral disruptiveness. The findings indicated a statistically significant relationship between the degree of change from phase to phase and the treatment. Follow-up at 6 months indicated a significant reduction of the frequency of targeted episodes of emotional dysregulation and behavioral disruptiveness at home.

Effect of music on mealtime disruptions.

BACKGROUND: People with learning disabilities can disrupt mealtimes with non-cooperative, aggressive and self-injurious behaviours that challenge other people to tolerate and manage them. These behaviours appear to arise because the proximity of other people, and the heightened activity and noise of a dining room, causes anxiety and agitation. AIM: To examine how delivering calming background music via headphones affected anxiety-driven behaviours that disrupted mealtimes. METHOD: A sample of 30 adults with mild, moderate or severe learning disabilities were videotaped during mealtimes on two consecutive days. On the first day, half the group ate without any calming music while the other half sat opposite them wearing earphones and listening to calming music. On the second day, the non-music and music groups swapped around. RESULTS: Of the participants who tolerated the earphones, only three showed disruptive behaviour; all three had been sitting at the table waiting for their food. With so few examples, meaningful inferential analysis was not possible. However, there were signs that calming music had a positive effect on disruptive mealtime behaviours. It eliminated physical harm, complaining and verbal repetition in one person, and stopped another from shouting/swearing. It also reduced the incidence of shouting/swearing, restlessness and vocalising. CONCLUSION: Calming music and reduced waiting at tables for food may reduce disruptive behaviours.

The influence of animals on the development of children.

There is a widespread belief that interaction with an animal is beneficial for the development of children, and several studies (most with methodological shortcomings) have investigated the influence of (companion) animals on the social-emotional and cognitive development of children. In this article, the 1984 model of Professor Jay Belsky has been used to describe which variables influence the development of children and how the companion animal-child interaction influences these variables. The value of the AAA/AAT (Animal Assisted Activities/Animal Assisted Therapy) programmes in children with a wide variety of clinical and social problems, such as behaviour problems and autistic spectrum symptoms, is discussed. The findings suggest that (companion) animals positively influence children's development and have a valuable role in therapy.

Post WISC-R and TOVA improvement with QEEG guided neurofeedback training in mentally retarded: a clinical case series of behavioral problems.

According to the DSM-IV, Mental Retardation is significantly sub-average general intellectual functioning accompanied by significant limitations in adaptive functioning in at least two of the following skill areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety. In pilot work, we have seen positive clinical effects of Neurofeedback (NF) applied to children with Trisomy 21 (Down Syndrome) and other forms of mental retardation. Given that many clinicians use NF in Attention Deficit Hyperactivity Disorder and Generalized Learning Disability cases, we studied the outcomes of a clinical case series using Quantitative EEG (QEEG) guided NF in the treatment of mental retardation. All 23 subjects received NF training. The QEEG data for most subjects had increased theta, alpha, and coherence abnormalities. A few showed increased delta over the cortex. Some of the subjects were very poor in reading and some had illegible handwriting, and most subjects had academic failures, impulsive behavior, and very poor attention, concentration, memory problems, and social skills. This case series shows the impact of QEEG-guided NF training on these clients' clinical outcomes. Fourteen out of 23 subjects formerly took medications without any improvement. Twenty-three subjects ranging from 7-16 years old attending private learning centers were previously diagnosed with mental retardation (severity of degree: from moderate to mild) at various university hospitals. Evaluation measures included QEEG analysis, WISC-R (Wechsler Intelligence Scale for Children-Revised) IQ test, TOVA (Test of Variables of Attention) test, and DPC-P (Developmental Behaviour Checklist) were filled out by the parents. NF trainings were performed by Lexicor Biolex software. NX-Link was the commercial software reference database used to target the treatment protocols, along with the clinical judgment of the first author. QEEG signals were sampled at 128 samples per second per channel and electrodes were placed according to the International 10-20 system. Between 80 and 160 NF training sessions were completed, depending on the case. None of the subjects received any special education during NF treatment. Two subjects with the etiology of epilepsy were taking medication, and the other 21 subjects were medication-free at the baseline. Twenty-two out of 23 patients who received NF training showed clinical improvement according to the DPC-P with QEEG reports. Nineteen out of 23 patients showed significant improvement on the WISC-R, and the TOVA. For the WISC-R test, 2 showed decline on total IQ due to the decline on some of the subtests, 2 showed no improvement on total IQ although improvement was seen on some of the subtests, however even these cases showed improvement on QEEG and DPC-P. This study provides the first evidence for positive effects of NF treatment in mental retardation. The results of this study encourage further research.

A controlled naturalistic study on a weekly music therapy and activity program on disruptive and depressive behaviors in dementia.

AIM: This study explores the effects of a weekly structured music therapy and activity program (MAP) on behavioral and depressive symptoms in persons with dementia (PWD) in a naturalistic setting. METHODS: PWD attended a weekly group MAP conducted by a qualified music therapist and occupational therapist for 8 weeks. Two validated scales, the Apparent Emotion Scale (AES) and the Revised Memory and Behavioral Problems Checklist (RMBPC), were used to measure change in outcomes of mood and behavior. RESULTS: Twenty-eight subjects completed the intervention, while 15 wait-list subjects served as controls. Baseline AES and RMBPC scores were not significantly different between the intervention and control groups. After intervention, RMBPC scores improved significantly (p = 0.006) with 95% CI of the difference between the mean intervention and control group scores compared to baseline at -62.1 to -11.20. Total RMBPC scores in the intervention group improved from 75.3 to 54.5, but worsened in the control group, increasing from 62.3 to 78.6. AES scores showed a nonsignificant trend towards improvement in the intervention group. CONCLUSION: The results suggest that a weekly MAP can ameliorate behavioral and depressive symptoms in PWD.

The effect of multisensory stimulation on persons residing in an extended care facility.

BACKGROUND: Non-pharmacological interventions, such as multisensory stimulation environments (MSSE), have demonstrated the ability to reduce inappropriate behavior among individuals with Alzheimer's disease. METHODS: In this study, we compared the incidences of problematic behavior among individuals with Alzheimer's disease residing in a long-term care facility who were and were not exposed to an MSSE. Retrospective data were obtained using the Psychotic Behavior Assessment Record (PBAR), mandated by Medicare to be used when antipsychotic medications are administered. Psychotic Behavior Assessment Record data were collected using the first and sixth month of admission for residents after appropriate consent was secured. RESULTS: Documented disruptive behavior included pacing, exit-seeking activities, hitting, yelling, and aggressive talking. The use of the MSSE resulted in a decrease in the number of incidences of disruptive behavior, but not the behaviors present. CONCLUSION: The use of MSSE, as a non-pharmacological intervention, demonstrates the ability to decrease the number of incidences of disruptive or problematic behavior. The use of these interventions, where feasible, should be considered prior to the use of pharmacological methods.

QEEG studies in the assessment and treatment of childhood disorders.

Quantifying EEG measures across age allows the ability to establish parameters of normalcy at any age which can be used as a reference when children exhibit developmental delays in their abilities and/or other atypical and maladaptive behaviors. A review of the current literature on the utilization of QEEG methods to serve as an aid for identifying these children as distinctively different from normal, and in some cases as distinctive from other clinical considerations has been shown to provide a sufficient sensitivity and specificity worthy of consideration as a diagnostic aid in evaluating clinical deviations in development. Furthermore, these same QEEG measures can provide a means of establishing treatment efficacy for the evident brain dysfunctions underlying these childhood disorders.