[A creative approach to psychoeducation for ADHD in adults]. / Une offre de soins créative de psychoéducation du TDAH chez l'adulte.

A group-based online psycho-education program for adults with attention deficit hyperactivity disorder (ADHD) and their families has been set up by a multi-professional psychiatric team. Feedback from users has mainly shown benefits in terms of improving self-esteem, destigmatization and accessibility to care. This suggests a real interest in developing this care offer in the pathway of ADHD adults.

Menores em uso de Ritalina: percalços no acompanhamento da Atenção Primária à Saúde / Minors using Ritalin: obstacles in Primary Health Care surveillance

Objetivo: compreender como ocorre o acompanhamento de crianças e adolescentes em uso de Ritalina pelos profissio-nais enfermeiros das unidades Estratégias Saúde da Família. Métodos: estudo qualitativo ancorado no referencial teó-rico dos atributos essenciais da atenção primária à saúde, no qual participaram 27 enfermeiros da Estratégia Saúde da Família. A coleta de dados ocorreu por meio de entre-vistas, que passaram por análise de conteúdo, com o auxílio do software NVivo. Resultados: emergiram três categorias: (Des)conhecimento sobre a população usuária de Ritalina: sobre a co-responsabilização do processo assistencial e as dificuldades enfrentadas para o acompanhamento do uso da Ritalina; Saberes e fazeres da atenção primária no cenário de utilização da Ritalina; A prescrição da Ritalina como de-manda da instituição escolar. Conclusão: o acompanhamen-to das crianças e adolescentes em uso de Ritalina está fragi-lizado, sendo necessário que a atenção primária à saúde se estruture, amplie e fortaleça os cuidados a essa população. (AU)

Comparing the initial impact of COVID-19 on burden and psychological distress among family caregivers of children with and without developmental disabilities.

The current COVID-19 pandemic is presenting challenges for families (Cluver et al., The Lancet, 2020), which may be exacerbated for caregivers of children with developmental disabilities (DDs; Center on the Developing Child, Stress, hope, and the role of science: Responding to the coronavirus pandemic, 2020). The purpose of this study was to explore caregiver burden and psychological distress among caregivers of children with DD as compared to caregivers of typically developing children across the United States as a result of COVID-19. Between 2 weeks and 1 month following COVID-19-related school closures, a total of 460 caregivers from across the U.S. completed an online survey via Qualtrics; recruitment and initial survey completion occurred simultaneously. Of the total sample of eligible participants (N = 407), 225 were the primary caregiver of a child with autism spectrum disorder (ASD)/attention-deficit/hyperactivity disorder (ADHD) and 182 were the primary caregiver of a child without ASD/ADHD. Participants across groups indicated varying levels of exposure to COVID-19 and an impact of COVID-19 at the community and individual or family levels. However, caregivers of children with ASD/ADHD reported significantly higher levels of burden, depression, anxiety, and stress. Overall, findings are consistent with anecdotal and preliminary reports that all caregivers are experiencing COVID-19-related challenges, with caregivers of children with ASD/ADHD experiencing even greater challenges, particularly with regard to burden and psychological distress. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An Exploration of Health Behaviors in a Mind-Body Resilience Intervention for Parents of Children with Developmental Disabilities.

OBJECTIVE: Parents of children with special needs such as learning and attentional disabilities (LADs) and autism spectrum disorder (ASD) are at high risk for stress-related disorders. The demands of parenting may compete with time for self-care behaviors such as physical activity, healthy eating, and adequate sleep. The objective was to describe health behaviors among this understudied population and assess the changes after a resilience intervention. METHODS: This was a secondary data analysis of a randomized controlled pilot virtual mind-body resilience intervention (Stress Management and Resiliency Training: A Relaxation Response Resiliency Program) trial for parents of children with LADs (n = 52) and ASD (n = 47). Parents completed self-report questionnaires about their weekly physical activity, eating behaviors, sleep duration, and fatigue before and after the 8-week intervention. Descriptive statistics and pre-post intervention effect sizes (Cohen's d) were calculated. RESULTS: Both parent groups reported suboptimal levels of health behaviors at baseline, but ASD parents reported lower health behaviors than LAD parents. LAD parents improved more on physical activity, with a higher percentage meeting recommendations at postintervention follow-up (d = 0.71) than ASD parents (d = 0.01). Eating behaviors showed small effect size improvements for both groups. Although sleep duration improved only with small or medium effect sizes for both groups, ASD parents rated their fatigue lower after the intervention (d = 0.81). CONCLUSION: Parents of children with special needs who participated in a virtual resilience intervention demonstrated suboptimal health behaviors. There is a need for targeted interventions for health behaviors that can promote resilience in these high-stress populations.

Maintaining Safety and Planning for the Future.

CASE: Kevin is a 12-year-old boy with autism spectrum disorder, intellectual disability (nonverbal IQ scores in mid-40s), and attention-deficit/hyperactivity disorder who has been followed up by a developmental-behavioral pediatrician (DBP) and a child psychologist for medication and behavioral management since he was 4 years old. Kevin was placed in the care of his great-great-aunt shortly after he turned 2 years of age because of concerns of neglect. She is now his legal guardian.Kevin is predominately nonverbal but does use a few single words to make requests or label items. He attends a public school and receives full-time special education support. He has a personal care assistant (PCA) who provides in-home support 5 to 6 days/wk for 3 to 4 hours at a time. The PCA is working on toilet training, using a "clock-training" approach, and also takes Kevin outdoors to play or on short outings during her visits. In his free time, Kevin prefers to watch cooking shows on television.Over the past year, Kevin's behaviors have become more concerning. There have been several episodes of Kevin waking up during the early morning hours and going to the kitchen to "cook." After one of these episodes, his guardian was not aware that Kevin had woken up until the next morning when she found a concoction of corn starch, coffee grounds, cottage cheese, and powdered drink mix in the blender. Kevin had also woken up during the night and ventured out of the house into the back yard. His guardian had woken up immediately as the alarm system sounded when he opened the outer door from the house to the yard.A door alarm was added to Kevin's bedroom door so that his guardian would be alerted when he leaves his bedroom; however, the alarm is not used consistently because there are times when the alarm cannot be found at bedtime. Kevin's guardian was able to obtain a GPS device for him to wear on his shoe from the local police department. He wears this without resistance every day.Kevin's guardian is in her mid-70s, and she has had several health issues over the past 2 to 3 years. There are no other family members who are willing or able to care for Kevin if his guardian were no longer able to. The DBP and child psychologist have encouraged Kevin's guardian to explore long-term residential care options with the state agency that provides support for individuals with intellectual disabilities and with Kevin's insurance provider, but the guardian is very reluctant to do this. She fears that Kevin will be removed from her care or placed in a "home" where someone will "do bad things to him."What else would you recommend or actions would you take to support Kevin's guardian in ensuring Kevin's safety and planning for his future care?

NPs' use of guidelines to diagnose and treat childhood ADHD.

Current research on NPs' use of the American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents is limited. This cross-sectional survey examined 89 NPs in Upstate New York regarding self-reported practice behaviors based on the guideline. Most NPs followed at least 50% of the AAP guideline for diagnosis and treatment. However, use of all criteria was less than optimal.

School Nurse Perceptions of Nurse-Family Relationships in the Care of Elementary Students With Chronic Conditions.

The purpose of this study was to explore school nurse perceptions of the nurse-family relationship in the care of elementary students with asthma and attention-deficit hyperactivity disorder (ADHD). A cross-sectional survey design was used to collect data from 97 school nurses in Minnesota. The Family Nursing Practice Scale measured nurses' perceptions of their family nursing practice. Bivariate analyses were conducted to compare scores by factors at the community, school, nurse, and child levels. Results suggest that school nurses have positive appraisals of their family nursing practice, though scores were generally lower in the context of ADHD compared to asthma. Participants with a graduate degree reported greater skill in working with families, whereas novice nurses reported less confidence working with families and less comfort initiating family involvement in care. Results suggest that interventions at the nurse and school levels may support enhanced family nursing practice by nurses caring for students with chronic conditions.

Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neuro-developmental disorder characterized by persistent inattention, hyperactivity, and impulsivity that impairs functioning of the child/adolescent. Although ADHD is the most commonly seen psychiatric disorder in childhood and adolescence, diagnosis of ADHD in children and adolescents in the United States has grown over the past 20 years, with prevalence rates increasing from 6.1% to 10.2% from 1997 to 2016. The current article describes the epidemiology of ADHD, factors that contribute to successful treatment, and recommendations to improve nursing practice. [Journal of Psychosocial Nursing and Mental Health Services, 56(12), 7-10.].

Animal-Assisted Therapy Supports Student Connectedness.

Animal-assisted therapy is a complementary approach to supporting the well-balanced student. In particular, therapy dogs in school can have a direct impact on students' social interactions, class participation, and behavior, as well as strengthening feelings of connectedness in school-a protective factor against risk-taking behaviors. School nurses have the unique charge of acting as liaisons between optimal health and academic success, and they can serve an integral role in animal-assisted therapy programs at school. The benefits of animal-assisted therapy in elementary schools along with the role of the school nurse in the planning and success of the program are described.

Association Between Changes in Caregiver Depressive Symptoms and Child Attention-Deficit/Hyperactivity Disorder Symptoms.

OBJECTIVE: Depression is highly prevalent among caregivers of children with attention-deficit/hyperactivity disorder (ADHD). We examined the association between caregiver depressive symptom trajectories and changes in child ADHD symptoms. METHODS: We analyzed data from a randomized trial of 2 ADHD care management systems for children aged 6 to 12 years and their caregivers (n = 156 dyads). Child ADHD symptoms were measured using the Swanson, Nolan, and Pelham rating scale (SNAP-IV). Caregiver depressive symptoms were measured using the Quick Inventory of Depressive Symptomatology (QIDS). Measures were assessed at baseline, 6 months, and 12 months. We used multivariable models to examine associations between changes in caregiver depressive symptoms and changes in child ADHD symptoms. RESULTS: From baseline to 12 months, children of caregivers with improved depressive symptoms had significantly greater reductions in SNAP-IV scores (change score: -1.43) compared with those whose depressive symptoms did not change (change score: -0.97) or worsened (change score: -0.23, p = 0.003). In adjusted models, improved caregiver depressive symptoms were associated with greater reductions in SNAP-IV scores over the 12-month period. Compared with those with worsening caregiver depressive symptoms, children whose caregivers showed no significant changes in depressive symptoms had a -0.78 point (95% confidence interval [CI]: -1.40 to -0.17) greater reduction in the SNAP-IV score, and those children whose caregiver depressive symptoms improved had a -1.31 point greater reduction in the SNAP-IV score (95% CI: -1.97 to -0.66). CONCLUSION: Given the longitudinal association between caregiver depressive symptom and child ADHD symptom trajectories, interventions that address the behavioral health needs of the family unit may offer promise for urban children with ADHD.

ADHD: From childhood to young adulthood.

Attention-deficit hyperactivity disorder (ADHD) affects approximately 11% of children between the ages of 4 and 17 years. This article discusses performing a comprehensive assessment for ADHD, the use of validated tools to make an accurate diagnosis, physical exam findings that may be suggestive of certain conditions, and ADHD treatment options.

Diagnosis and treatment of attention deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by signs and symptoms of inattention, hyperactivity, and impulsivity that typically begin in childhood. ADHD can persist into adulthood, causing impairments in occupational performance and peer and family relationships. This article reviews the epidemiology, diagnosis, and treatment of ADHD.

ESCAschool study: trial protocol of an adaptive treatment approach for school-age children with ADHD including two randomised trials.

BACKGROUND: The ESCAschool study addresses the treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) in a large multicentre trial. It aims to investigate three interrelated topics: (i) Clinical guidelines often recommend a stepped care approach, including different treatment strategies for children with mild to moderate and severe ADHD symptoms, respectively. However, this approach has not yet been empirically validated. (ii) Behavioural interventions and neurofeedback have been shown to be effective, but the superiority of combined treatment approaches such as medication plus behaviour therapy or medication plus neurofeedback compared to medication alone remains questionable. (iii) Growing evidence indicates that telephone-assisted self-help interventions are effective in the treatment of ADHD. However, larger randomised controlled trials (RCTs) are lacking. This report presents the ESCAschool trial protocol. In an adaptive treatment design, two RCTs and additional observational treatment arms are considered. METHODS: The target sample size of ESCAschool is 521 children with ADHD. Based on their baseline ADHD symptom severity, the children will be assigned to one of two groups (mild to moderate symptom group and severe symptom group). The adaptive design includes two treatment phases (Step 1 and Step 2). According to clinical guidelines, different treatment protocols will be followed for the two severity groups. In the moderate group, the efficacy of telephone-assisted self-help for parents and teachers will be tested against waitlist control in Step 1 (RCT I). The severe group will receive pharmacotherapy combined with psychoeducation in Step 1. For both groups, treatment response will be determined after Step 1 treatment (no, partial or full response). In severe group children demonstrating partial response to medication, in Step 2, the efficacy of (1) counselling, (2) behaviour therapy and (3) neurofeedback will be tested (RCT II). All other treatment arms in Step 2 (severe group: no or full response; moderate group: no, partial or full response) are observational. DISCUSSION: The ESCAschool trial will provide evidence-based answers to several important questions for clinical practice following a stepped care approach. The adaptive study design will also provide new insights into the effects of additional treatments in children with partial response. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00008973 . Registered 18 December 2015.

Evaluation of a drop-in clinic for young people with attention deficit hyperactivity disorder.

Aims To implement and evaluate a nurse-led, multi-agency drop-in clinic for young people with attention deficit hyperactivity disorder (ADHD). Method A repeated measures observational study over 12 months exploring clinic attendance and user satisfaction, crisis management and did not attend (DNA) rates, consultant time spent with patients, benefits to quality of care, and service flexibility. Results A total of 62 service users participated. A significant improvement in service user experience was observed (P=0.001). Crisis management attendances significantly increased (P=0.005). DNA rates did not reduce significantly (P=0.057). Service users attended for their medication review before or on their due date (P=0.011). Those who needed to were able to spend more time with the staff (P=0.001). Conclusion The clinic improved service accessibility and flexibility. It allowed adherence to clinical guidance, including uptake of psychosocial interventions. There was an overwhelmingly positive improvement in service user experience. Importantly, as contact with the ADHD nurse specialists increased, this significantly reduced the amount of time consultant community paediatricians spent with service users. Further research should examine the cost-effectiveness and longitudinal effect of the drop-in model.

Adapting an attention-deficit hyperactivity disorder parent training intervention to different cultural contexts: The experience of implementing the New Forest Parenting Programme in China, Denmark, Hong Kong, Japan, and the United Kingdom.

The New Forest Parenting Programme (NFPP) is a parenting program developed for parents who have a child with attention-deficit hyperactivity disorder (ADHD). It is a manualized program that is delivered in a parent's home over 8 weeks, or in a group format, or through a self-help manual. Three randomized controlled trials have been carried out in the United Kingdom. The NFPP group has adapted the program according to feedback from parents and therapists, and for use with different populations, both within the United Kingdom and internationally. The first international trial took place in New York, United States. Trials in Denmark, Hong Kong, and Japan followed. More recently, a trial of the self-help manual has been carried out in mainland China. This paper will outline the adaptions that were needed in order to be able to deliver the program in different countries with their own expectations of parenting, culture, and language. Training had to be differently focused; manuals and handouts had to be revised, translated and back-translated; and supervision had to be delivered at a distance to maintain the fidelity of the program. The international group will outline their experience of running trials in their own countries with the NFPP in a face-to-face format (Denmark), a group format (Hong Kong and Japan), and a self-help format (mainland China).

School Nurses' Role in Helping Children With Attention-Deficit/Hyperactivity Disorders.

Attention-deficit/hyperactivity disorder (ADHD) is a multifaceted disease characterized by core symptoms of hyperactivity, inattention, and impulsivity, affecting children across every socioeconomic and ethnic group. An estimated 40% to 60% of children with ADHD have comorbidities such as anxiety, depression, and learning disabilities. School nurses must be an integral part of the process of increasing awareness about ADHD through improving the service delivery model for affected children and their families. There is a solid foundation of research on which they can build to improve the benefits through study, workshops, community programs, and national screening programs.

The effectiveness of therapeutic conversation intervention for caregivers of adolescents with ADHD: a quasi-experimental design.

WHAT IS KNOWN ON THE SUBJECT?: Caregivers of adolescents with ADHD experience major difficulties as care providers and are in need of guidance and support. Adolescents with ADHD may develop oppositional and criminal behaviour. More than 50 % have the symptoms in adulthood, and up to one-fourth with severe emotional or antisocial difficulties. There is a lack of evidence of caregivers' supporting intervention although caregiver groups have been found to contribute to better coping, decreased stress and improvements in ADHD symptoms. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Primary caregivers of adolescents with ADHD experienced better quality of life after the Therapeutic Conversation Intervention. The intervention contributed to better social functioning among secondary caregivers. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The content of the Therapeutic Conversation Intervention is significant and highlights the utility of a combination of group and private sessions for caregivers of people with ADHD. The intervention can influence how services for families are organized, such that a Therapeutic Conversation Intervention could be offered on a regular basis. ABSTRACT: Introduction Caregivers of adolescents with Attention Deficit Hyperactivity Disorder are burdened with tasks and many suffer from distress. Adolescents with ADHD may develop antisocial behaviour and caregiver's group can empower caregiver's supporting role. Aim/Question To evaluate the effectiveness of a Therapeutic Conversation Intervention on caregivers of adolescents with ADHD regarding strengthening the supportive role. Method The study utilized a quasi-experimental design. The participants (n = 60) were caregivers of adolescents (13-17 years old) with ADHD. The intervention consisted in-group and parent sessions. The Calgary Family Model and the Family Illness Beliefs Model were used as theoretical frameworks. Results The study revealed significant differences in the improvement of quality of life; regarding primary caregiver (PC) worry, daily activities, family relationships and collaboration post-intervention, as well emotional functioning at both post-intervention and follow-up. Secondary caregiver (SC) social functioning was significantly improved at follow-up. Discussion The intervention proved to be beneficial to the caregivers and is filling a gap in much needed intervention. Implication for practice The results will expand health care professionals' knowledge of how to increase PC quality of life when supporting their adolescent with ADHD. This treatment information should improve service at health care centres/hospitals where adolescents with ADHD receive care.