Prevalence rate of ADHD in France: Review of the literature and results from ChiP-ARD study.

OBJECTIVES: Attention Deficit Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder whose first clinical description was published more than two centuries ago. Prevalence rates have been evaluated in many countries and meta-analyses conducted, but the data collected in France are scarce. METHODS: A review of the literature was conducted by retrieving the references from four electronic databases leading to the selection of four studies in children and four in adults. Meta-analyses of prevalence rates were performed on this published data as well as unpublished results from the ChiP-ARD study (Children and Parents with ADHD and Related Disorders), separately for children and adults. RESULTS: While the quality of most studies is questionable, the prevalence rates are close to those reported in international meta-analytic studies for children (3.68%), but are higher in adults (5.5%). CONCLUSIONS: Well-conducted studies in both general and special populations are needed (e.g., in patients with depression, anxiety, bipolar disorder, developmental disorders including autism spectrum disorder, behavioural or substance abuse, and incarcerated). Nevertheless, healthcare stakeholders can conservatively consider that .8 million children and 1.4 million adults in the metropolitan French general population are likely to have ADHD and suffer from its multiple consequences.

Effect of Child Position on Pain Experience During Lumbar Puncture: A Prospective Pilot Study.

BACKGROUND: This study aimed to evaluate the impact of patient's position on pain and anxiety during lumbar puncture (LP). MATERIALS AND METHODS: A randomized controlled trial included children between 2 and 18 years old receiving at least 2 therapeutic LPs. They were randomly assigned to undergo lateral decubitus position or sitting position LP. Primary outcome was the maximum LP-induced pain, secondary endpoint the maximum LP-induced anxiety score. RESULTS: Twenty-eight patients were randomized. For patients under 6 years old, mean of Face, Leg, Activity, Cry, and Consolability were 2.8/10±3.0 (median=1) at first time and 1.5±1.7 (median=1) at second time. For patients 6 to 18 years old, mean of visual analog scale were 2.2±2.2 (median=1.5) at first time and 3.2±2.8 (median=3) at second time. There was no significant differences according to position on anxiety among children. CONCLUSIONS: Results did not demonstrate whether lateral decubitus position could generate less pain and anxiety than sitting position.

Multimodal intervention in 8- to 13-year-old French dyslexic readers: Study protocol for a randomized multicenter controlled crossover trial.

BACKGROUND: Developmental dyslexia, a specific and long-lasting learning disorder that prevents children from becoming efficient and fluent readers, has a severe impact on academic learning and behavior and may compromise professional and social development. Most remediation studies are based on the explicit or implicit assumption that dyslexia results from a single cause related to either impaired phonological or visual-attentional processing or impaired cross-modal integration. Yet, recent studies show that dyslexia is multifactorial and that many dyslexics have underlying deficits in several domains. The originality of the current study is to test a remediation approach that trains skills in all three domains using different training methods that are tailored to an individual's cognitive profile as part of a longitudinal intervention study. METHODS: This multicenter randomized crossover study will be conducted in three phases and will involve 120 dyslexic children between the ages of 8 and 13 years. The first phase serves as within-subject baseline period that lasts for 2 months. In this phase, all children undergo weekly speech-language therapy sessions without additional training at home (business-as-usual). During the second phase, all dyslexics receive three types of intensive interventions that last 2 month each: Phonological, visual-attentional, and cross-modal. The order of the first two interventions (phonological and visual-attentional) is swapped in two randomly assigned groups of 60 dyslexics each. This allows one to test the efficacy and additivity of each intervention (against baseline) and find out whether the order of delivery matters. During the third phase, the follow-up period, the intensive interventions are stopped, and all dyslexics will be tested after 2 months. Implementation fidelity will be assessed from the user data of the computerized intervention program and an "intention-to-treat" analysis will be performed on the children who quit the trial before the end. DISCUSSION: The main objective of this study is to assess whether the three types of intensive intervention (phase 2) improve reading skills compared to baseline (i.e., non-intensive intervention, phase 1). The secondary objectives are to evaluate the effectiveness of each intervention and to test the effects of order of delivery on reading intervention outcomes. Reading comprehension, spelling performance and reading disorder impact of dyslexic readers are assessed immediately before and after the multimodal intervention and 2 months post-intervention. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04028310. Registered on July 18, 2019.

Otologic Outcomes With Two Different Surgical Protocols in Patients With a Cleft Palate: A Retrospective Study.

OBJECTIVE: To compare otologic outcomes in patients with cleft palate who underwent 2 different surgical protocols. DESIGN: Monocentric retrospective analysis of medical reports. PATIENTS, PARTICIPANTS: All consecutively treated patients affected by a cleft palate, born between January 1998 and December 2002 (group 1) and between January 2007 and December 2010 (group 2). INTERVENTIONS: Patients in group 1 underwent Veau-Wardill-Kilner palatoplasty at 10 months and had ventilation tubes inserted in case of otitis media with effusion (OME) during surgery. Patients in group 2 underwent Sommerlad intravelar veloplasty at 5 months. Ventilation tubes were inserted only in case of persistent OME. MAIN OUTCOME MEASURE(S): The need for a second set of ventilation tubes to be inserted in case of persistent OME, the presence of OME at the age of 2 years, and tympanic abnormalities at the age of 5 years were analyzed. RESULTS: There was no statistically significant difference either for the presence of OME at the age of 2 years (27 [45%] vs 32 [57.14%], respectively, in groups 1 and 2; P = .191) or for tympanic abnormalities at the age of 5 years (20 [33.33%] vs 15 [26.79%]; P = .433). Statistically significant difference was found for the need to insert a second set of ventilation tubes in case of persistent OME (29 [48.33%] vs 12 [21.42%], respectively; P = .02). CONCLUSION: Early Sommerlad intravelar veloplasty may reduce persistent OME and consequently the need for ventilation tubes insertion, compared to later Veau-Wardill-Kilner palatoplasty.

Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics.

OBJECTIVES: To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. STUDY DESIGN: Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. RESULTS: Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. CONCLUSIONS: RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations.

Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey.

INTRODUCTION: The Lifetime Impairment Survey, conducted in Europe, assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in childhood, and experiences of ADHD diagnosis and treatment, as recalled by adults. METHODS: Adults with ADHD and without ADHD (control group) were invited to participate in an internet-based survey and report on their childhood experiences. History of ADHD diagnosis was self-reported. Groups were compared using impairment and symptom scales. RESULTS: Overall, 588 adults with ADHD and 736 without ADHD participated. Mean (standard deviation [SD]) age at diagnosis of ADHD was 20.0 (12.6) years (median 18.0) following consultation with 3.8 (5.1) doctors (median 2) over 44.6 (69.3) months (median 17.0). A total of 64.1% (377/588) of adults with ADHD reported frustration or difficulties during the diagnostic process. The ADHD group had a higher mean (SD) score versus control for general (3.3 [1.2] vs 2.1 [1.2]; p < 0.001) and school impairment (2.8 [0.7] vs 2.3 [0.6]; p < 0.001) but not home impairment (2.1 [0.5] for both groups). Discussion The survey demonstrated that ADHD had a negative impact on all aspects of childhood investigated, as recalled by adults. CONCLUSIONS: These data provide insights into childhood impairments and identify areas for improvement in the management and treatment of ADHD.

Investigation of a bifactor model of the Strengths and Difficulties Questionnaire.

The Strengths and Difficulties Questionnaire (SDQ) is used to measure psychopathological symptoms in children and adolescents from 4 to 17 years old, but its underlying structure is still a matter of debate. Indeed, on the basis of a systematic review of English and non-English articles conducted using multiple databases, 54 studies reporting on the factor structure of the SDQ were located. The original 5 first-order factor structure is generally supported by exploratory procedures, but support based on confirmatory factor analyses is not clear. We analysed data from 889 youths from the general French population, rated on the SDQ by their teachers. We tested the original model, hierarchical models and bifactor models. The best-fitting model is a bifactor model with the five a priori factors grouped in two global factors (Externalizing Disorders-Hyperactivity and Conduct-and Internalizing Disorders-Peer relationships and Emotions) and one Strength/Prosocial factor. However, we show that the Conduct-Specific factor should not be used in practice in its current state, that the Hyperactivity-Specific factor mainly covers hyperactivity rather than inattention, and that the Peer Problems-Specific factor mainly reflects a preference for solitude. Nevertheless, the measurement model proved to be fully invariant across gender and school levels (kindergarten, primary and secondary schools), with statistically significant differences in latent means between genders only. Beyond computing the five a priori scores when using the teacher ratings of the SDQ, our results prove the usefulness of computing Externalizing Disorders and Internalizing Disorders global scores.

A composite scale applied to evaluate anxiety in schizophrenic patients (SAES).

Anxiety in schizophrenia possesses specific features and is difficult to assess because no specific evaluating tool is currently available. The aim of this study was to develop and validate a hetero-assessment-based scale to specifically measure anxiety in schizophrenia. A literature review and a survey among psychiatrists allowed the selection of 29 items from 4 previous scales evaluating anxiety. Factor analysis allowed building up a final 22-item composite scale of anxiety evaluation in schizophrenia (SAES), which was then validated in 147 schizophrenic patients. One hundred and forty-seven (147) schizophrenic patients (70.8 % male, mean age = 36.9 years) were included in the study. Principal component analysis of the SAES revealed three factors, namely "expressed and perceived anxiety," "somatic anxiety," and "anxiety and environment". All total and factor scores of the SAES were significantly correlated (p < .001) with total and factor scores of the original scales. Finally, the SAES showed good inter-rater reliability [intra-class correlation coefficient (ICC) = .82]. In conclusion, a specific tool for evaluating anxiety in schizophrenia (SAES) was developed and validated in a sample of schizophrenic patients. The SAES can be useful to investigate clinical, psychopathological, and therapeutic aspects of anxiety in schizophrenia.

Prevalence and correlates of attention deficit hyperactivity disorder in adults from a French community sample.

Validated tools are lacking in languages such as French to diagnose attention deficit hyperactivity disorder (ADHD) in adults. The Adult ADHD Symptoms Self-Report (ASRS) was filled out by 1171 parents of 900 school-aged youths in the context of the Children and Parents With ADHD and Related Disorders study. Prevalence estimates based on three scoring methods are compared (6-item screener, all 18 items, or the screener followed by the 12 remaining items). On the basis of the recommended and more conservative scoring method, the overall prevalence of ADHD symptoms is estimated to be 2.99%, without significant group differences between sexes or between younger and older adults. Potential correlates of ADHD symptoms were also examined in their relatives (children, brothers/sisters, uncles/aunts, and parents) as follows: birth order, level of education, body mass index categories, enuresis, suicide attempts, depression, and learning disabilities. Adults can be screened for ADHD symptoms using the ASRS; negative long-term outcomes should be assessed in patients' relatives too.

Attention-deficit/hyperactivity disorder in adolescent and adult candidates for metabolic and bariatric surgery: A systematic review and meta-analysis.

AIMS: Attention-deficit with hyperactivity disorder (ADHD) is associated with obesity and impacts the outcome of metabolic and bariatric surgery (MBS). This study aimed at calculating the prevalence in candidates for MBS, which is yet unclear. METHODS: We conducted a systematic review and meta-analysis, searching three databases from their respective inception to December 2022 for studies reporting the prevalence of ADHD in adolescents and adults assessed before undergoing MBS. The protocol was registered in PROSPERO (CRD42022384914). We adhered to Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines; the quality of studies was assessed with the JBI Critical Appraisal checklist. Random-effect meta-analyses were performed; confidence intervals were computed with a binomial exact method, and the pooled estimate was calculated after double arcsine transformation. FINDINGS: Fourteen studies (24,455 adults) and three studies (299 adolescents) were selected. The quality of studies was moderate to poor; meta-analyses were performed on subgroups according to the case definition used. The prevalence is 8.94% and 9.90% in adults, and 28.73% in adolescents. CONCLUSIONS: ADHD is three times more frequent in adults and six times more frequent in adolescents than in the general population. Recommendations are provided to improve the quality of future studies and obtain more reliable estimates of prevalence.