Inclusion of a computerized test in ADHD diagnosis process can improve trust in the specialists' decision and elevate adherence levels.

Attention deficit and hyperactivity disorder (ADHD) affects many life aspects of children and adults. Accurate identification, diagnosis and treatment of ADHD can facilitate better care. However, ADHD diagnosis and treatment methods are subject of controversy. Objective measures can elevate trust in specialist's decision and treatment adherence. In this observational study we asked whether knowing that a computerized test was included in ADHD diagnosis process results in more trust and intention to adhere with treatment recommendations. Questionnaires were administered to 459 people, 196 men, average age = 40.57 (8.90). Questions regarding expected trust and adherence, trust trait, trust in physician and health-care-institutions, and ADHD scales followed a scenario about parents referred to a neurologist for sons' ADHD diagnosis. The scenario presented to the test group (n = 185) mentioned that a computerized test was part of the diagnostic process. The control group scenario didn't mention any computerized test in the diagnostic process. Test group participants expressed more trust in the diagnosis and greater levels of intention for treatment adherence. Group differences in intention for treatment adherence were mediated by trust in decision. Inclusion of a computerized test in ADHD diagnosis process can improve trust in the specialists' decision and elevate adherence levels.

Mediated Online Awareness Among Adolescents With and Without ADHD: Using the Occupational Performance Experience Analysis (OPEA).

Online awareness is essential to learning from one's experiences, enabling adaptive self-management, often challenged among adolescents with attention-deficit hyperactivity disorder (ADHD). This study used an online awareness tool, the Occupational Performance Experience Analysis (OPEA), to examine (a) the online awareness of occupational performance of adolescents with ADHD and controls and (b) the potential modifiability of online awareness after a brief mediation redirecting attention to task demands and contextual factors. Seventy adolescents with and without ADHD were administered the OPEA after completing cognitive assessments. The OPEA comprises a verbal description of experiences, scored for representation of main actions, temporal context, and coherence, completed again after mediation. Results point to significantly less coherent descriptions of occupational performance among adolescents with ADHD compared with adolescents without ADHD; modifiability was only examined in the ADHD group and demonstrated significantly more coherent descriptions after mediation. Findings may elucidate online awareness of occupational performance as an occupational therapy intervention target for adolescents with ADHD.

Weekly Calendar Planning Activity (WCPA): Validating a Measure of Functional Cognition for Adolescents With Attention Deficit Hyperactivity Disorder.

IMPORTANCE: Adolescents with attention deficit hyperactivity disorder (ADHD) often experience difficulties with executive function and participation in life roles. Ecologically valid performance-based tests (PBTs) are needed to assess functional cognition in this population. OBJECTIVE: To examine the known-groups, concurrent, and ecological validity of a functional cognition PBT, the Hebrew version of the Weekly Calendar Planning Activity (WCPA) Middle/High School Version, among adolescents with and without ADHD. DESIGN: Cross-sectional between-groups design. SETTING: Community. PARTICIPANTS: One hundred two adolescents (ages 12-18 yr), with (n = 52) and without (n = 50) ADHD. OUTCOMES AND MEASURES: The Hebrew version of the WCPA Middle/High School Version, MOXO™-Continuous Performance Test (MOXO-CPT), Behavior Rating Inventory of Executive Function (BRIEF) parent form, and Child and Adolescent Scale of Participation (CASP). RESULTS: The results showed significant between-groups differences with medium to large effect sizes for scores on most WCPA measures, with the ADHD group receiving significantly lower scores. Significant correlations in the expected direction were found between scores on the MOXO-CPT Attention and Hyperactivity indices and WCPA measures. Significant correlations were also found between most WCPA measures and the BRIEF Global Executive Composite (GEC) and the CASP. Multiple linear regression on the CASP indicated that the WCPA strategy score and the BRIEF GEC were significant predictors in the model. CONCLUSIONS AND RELEVANCE: Results support the known-groups validity of the WCPA Middle/High School Version between adolescents with and without ADHD. Concurrent and ecological validity were supported by significant associations with measures of cognition and participation. What This Article Adds: These results reinforce the premise that the WCPA Middle/High School Version can be implemented as a valid measure of functional cognition among adolescents with ADHD.

Sweet but sour: Impaired attention functioning in children with type 1 diabetes mellitus.

Children diagnosed with type 1 diabetes mellitus (T1DM) are at risk for neurocognitive sequelae, including impaired attention functioning. The specific nature of the cognitive deficit varies; current literature underscores early age of diabetes diagnosis and increased disease duration as primary risk factors for this neurocognitive decline. Forty-three children with T1DM were evaluated for Attention Deficit/Hyperactivity Disorder (ADHD) symptomatology using the MOXO continuous performance test (MOXO-CPT) performed during a routine outpatient evaluation. The study cohort demonstrated a significant decline in all four domains of attention functioning. The effect was most pronounced with early age at T1DM diagnosis, a longer disease duration and with poorer glycemic control (represented by higher HbA1c values). With increased disease duration (of 5 plus years), acute hyperglycemia was associated with inattention in the real-time setting. These findings highlight the need for routine screening of neurocognitive function in children with T1DM so that early intervention can be employed during this crucial period of cognitive development.

Examining the Effect of Transcranial Electrical Stimulation and Cognitive Training on Processing Speed in Pediatric Attention Deficit Hyperactivity Disorder: A Pilot Study.

Objective: Processing Speed (PS), the ability to perceive and react fast to stimuli in the environment, has been shown to be impaired in children with attention deficit hyperactivity disorder (ADHD). However, it is unclear whether PS can be improved following targeted treatments for ADHD. Here we examined potential changes in PS following application of transcranial electric stimulation (tES) combined with cognitive training (CT) in children with ADHD. Specifically, we examined changes in PS in the presence of different conditions of mental fatigue. Methods: We used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD. Participants received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or transcranial random noise stimulation (tRNS), while completing CT, and the administration order was counterbalanced. PS was assessed before and after treatment using the MOXO-CPT, which measures PS in the presence of various conditions of mental fatigue and cognitive load. Results: tRNS combined with CT yielded larger improvements in PS compared to tDCS combined with CT, mainly under condition of increased mental fatigue. Further improvements in PS were also seen in a 1-week follow up testing. Conclusion: This study provides initial support for the efficacy of tRNS combined with CT in improving PS in the presence of mental fatigue in pediatric ADHD.

Learning based PTSD symptoms in persons with specific learning disabilities.

Specific learning disorders (SLD) persist into adulthood. Persons with SLD frequently experience emotional and social difficulties. Following qualitative descriptions of individuals with SLD who experienced learning, as traumatic, we hypothesized that individuals reporting SLD would report higher levels of learning-based post-traumatic-stress-disorder (PTSD) symptoms. In Study 1 (N = 216), participants responded to questionnaires concerning SLD and learning-based PTSD. A separate sample (N = 43) was queried about adjustment disorder symptoms. Study 2 (N = 176) examined if current psychological distress was predicted by levels of learning-based PTSD at each developmental stage (elementary/high-school/post-high-school) and whether SLD links to current psychological distress. Finally, we assessed if SLD-psychological distress associations are mediated by cumulative levels of learning-based PTSD across these school periods. In Study 1 individuals reporting SLD displayed higher learning-based PTSD levels than those without SLD. SLD-PTSD associations held beyond adjustment disorder symptom levels. In Study 2, SLD was linked with psychological distress, mediated by accumulated learning-based PTSD symptom levels across school periods. These results suggest that in individuals with SLD, learning experiences may be associated with learning-based PTSD symptoms. Further, persons with SLD may be scarred by their traumatic learning experiences linking with current psychological distress, a link mediated by cumulative difficulties experienced over school years.

Online and Intellectual Awareness of Executive Functioning in Daily Life among Adolescents with and without ADHD.

OBJECTIVE: Executive function deficits (EFD) are a central mechanism underlying negative outcomes in ADHD. This study examined awareness of EFD manifested in "real-time" task performance (Online Awareness) and in general self-knowledge of daily activities, outside the context of a specific task (Intellectual Awareness) among adolescents with and without ADHD. METHODS: 102 adolescents with (n = 52) and without (n = 50) ADHD were administered Weekly Calendar Planning Activity (WCPA) and Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF parent version. Awareness was defined using the discrepancy paradigm: performance versus estimation on WCPA for online awareness; self versus parent report on the BRIEF for intellectual awareness. RESULTS: Adolescents with ADHD overestimated their performance on the WCPA and underestimated their EFD on the BRIEF compared to parent's ratings. The discrepancy scores in both types of awareness were significantly larger among ADHD than controls (p < .005). CONCLUSIONS: Adolescents with ADHD demonstrate significantly lower rates of online and intellectual awareness of EFD compared to controls.

Increased Weight Gain of Children during the COVID-19 Lockdown.

BACKGROUND: The coronavirus disease-2019 (COVID-19) social-distancing strategy, including 7 weeks of strict lockdown, enabled an extraordinary test of stay-at-home regulations, which forced a sedentary lifestyle on all children and adolescents. OBJECTIVES: To assess the lockdown effect on pediatric weight. METHODS: A retrospective-prospective cohort study at our hospital's pediatric outpatient clinics following the COVID-19 lockdown. Patients aged 0-18 years visiting the clinic were weighed and previous weight and other clinical data were collected from the medical charts. Weight-percentile-for-age standardization was calculated according to the U.S. Centers for Disease Control and Prevention and the World Health Organization growth tables. Pre- and post-lockdown weight-percentiles-for-age were compared using paired t-test. Multivariate analysis was conducted using linear regression model. RESULTS: The study was comprised of 229 patients; 117/229 (51.1%) were boys, 60/229 (26.2%) aged under 6 years. Total mean weight-percentile was significantly higher following the lockdown (40.44 vs. 38.82, respectively, P = 0.029). Boys had a significant post-lockdown weight-percentile rise (37.66 vs. 34.42, P = 0.014), whereas girls had higher baseline pre-quarantine weight-percentile of 43.42, which did not change. Patients younger than 6 years had a significant increase in weight-percentiles (39.18 vs. 33.58, P = 0.021). In multivariate analysis these correlations were preserved.

Scaffolding the attention-deficit/hyperactivity disorder brain using transcranial direct current and random noise stimulation: A randomized controlled trial.

OBJECTIVE: Improving symptomology and cognitive deficits in neurodevelopmental disorders is a crucial challenge. We examined whether neurostimulation protocols, which have been shown to yield long-term effects when combined with cognitive training, could benefit children with Attention-deficit/hyperactivity-disorder (ADHD), the most common neurodevelopmental disorder in childhood. METHODS: We used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD, who received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or random noise stimulation (tRNS) over the bilateral dlPFC, while completing executive functions training. RESULTS: For our primary outcome, tRNS yielded a clinical improvement as indicated by the reduced ADHD rating-scale score from baseline, and in comparison to the changes observed in tDCS. The effect of brain stimulation one week after completion of treatment yielded further improvement, suggesting a neuroplasticity-related effect. Finally, tRNS improved working memory compared to tDCS, and a larger tRNS effect on ADHD rating-scale was predicted for those who showed the greatest improvement in working memory. CONCLUSIONS: We found that our intervention can have a lasting effect, rather than a merely immediate effect as was shown for in previous medical interventions in ADHD. SIGNIFICANCE: Our results provide a promising direction toward a novel intervention in ADHD.

COVID-19 related loneliness and sleep problems in older adults: Worries and resilience as potential moderators.

OBJECTIVES: Older adults may experience loneliness due to social distancing and isolation during the Coronavirus disease 2019 (COVID-19) pandemic. Loneliness may further catalyze numerous poor health outcomes including impaired sleep. This study aimed to assess COVID-19 related worries and resilience as potential moderators of the loneliness-sleep problems link. METHOD: In the midst of the lock-down period of COVID-19, we collected data using a web-based public platform from 243 Israeli older adults (mean age = 69.76, SD = 6.69, age range = 60-92). Participants completed measures of COVID-19 related loneliness, sleep problems, COVID-related worries, and resilience. RESULTS: COVID-19 related loneliness was related to more sleep problems. The loneliness-sleep association was especially strong among those with more COVID-19 related worries or among those with lower resilience. CONCLUSION: The relationship between COVID-19 related loneliness and sleep problems is not uniform across older adults. The subjective sleep quality of those with more COVID-19 related worries or less resilience (i.e., feeling less being able to adapt to the challenging circumstances) is more susceptible to feeling lonely. Considering these variables may facilitate detection of and intervention for older adults vulnerable to aversive results in the context of COVID-19.

Preliminary evidence linking complex-PTSD to insomnia in a sample of Yazidi genocide survivors.

Complex post-traumatic stress disorder (CPTSD) is a psychiatric diagnosis that includes three additional symptom clusters beyond those necessary for post-traumatic stress disorder (PTSD) diagnosis. CPTSD is typically associated with a prolonged trauma exposure in which a person's destiny is under the control of other people and escape is not an option. Insomnia prevalence in women suffering from CPTSD was compared to the prevalence of insomnia in those with no-PTSD and those with only PTSD. Yazidi women (N = 108, age = 24.41 ±â€¯5.71) former captives of the Islamic State terrorist group were queried about captivity variables, psychological distress, resilience, PTSD, CPTSD, and insomnia. CPTSD prevalence was high (>50%) and was highly correlated with insomnia (95% of those with CPTSD had insomnia). A dichotomous insomnia variable was regressed on age and marital-status (Step 1), captivity-duration and number of fellow captives (Step 2), resilience and psychological distress (Step 3), and group (no-PTSD/PTSD/CPTSD) (Step 4). Insomnia was 18 times more likely in the CPTSD group than in the no-PTSD group. There were no differences in insomnia prevalence between the no-PTSD and PTSD groups. Insomnia levels among Yazidi women released from captivity support an understanding of CPTSD as a separate entity than PTSD. Potential factors linking CPTSD to insomnia, beyond those associated with PTSD are discussed.

When the human spirit helps? The moderating role of somatization on the association between Olympic game viewing and the will-to-live.

This study examined whether participants with low somatization (no bodily manifestations of anxiety) who are assumed to identify with- and be inspired- by the Olympic-Games-spirit will present a stronger association between their Olympic-game viewing hours and their will-to-live, than persons with high somatization. One hundred and thirty seven participants reported their daily Olympic-game viewing hours, somatization and will-to-live levels. Results show that while among those with low somatization symptoms level, the relationships between Olympic game viewing hours and will-to-live was positive, the opposite was found among those with high somatization symptoms level. Viewing the Olympic Games may be beneficial for individuals with low somatization level but less so to individuals with higher somatization.

Exploring DSM-5 criterion A in Acute Stress Disorder symptoms following natural disaster.

The present study examines the DSM-5 Acute Stress Disorder (ASD) diagnostic criteria of exposure, in the context of a natural disaster. The study is based on the reports of 1001 Filipinos following the aftermath of super typhoon Haiyan in 2013. Participants reported exposure to injury, psychological distress and ASD symptoms. Findings indicated the association of criterion A with the prevalence of meeting all other ASD diagnostic criteria and high psychological distress. The diagnostic properties of Criterion A are discussed.

Trauma-Related Context Increases Sleep Disturbances in People with Acute Stress Disorder Symptoms.

In this study, we addressed how sleep is related to acute stress disorder (ASD) symptoms, and how the presence of a trauma related-context moderates this relationship. This study (N = 140) was carried out during the 2014 Israel-Gaza conflict, during which 70% of Israelis were exposed to missile attacks. Findings show that participants with clinical ASD symptom levels reported more sleep disturbances than participants without clinical ASD symptom levels. More critically, this effect was only evident among respondents who had a reinforced security room in their houses. While reinforced security rooms offer protection against indirect missile damage, their relevance is salient in negative traumatic situations, which individuals with a clinical level of ASD are more sensitive to. Conversely, in houses without a reinforced security room, there was no difference in subjective sleep reports between individuals with or without clinical levels of ASD symptoms. Results are discussed in reference to trauma being activated by context and the ensuing effects on sleep. Theoretical and clinical implications are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Enduring sleep complaints predict health problems: a six-year follow-up of the survey of health and retirement in Europe.

OBJECTIVES: Sleep complaints are common and enduring among old people. The study aimed to extend current knowledge by exploring the effects of episodic versus chronic sleep complaints on a range of physical and mental health outcomes. METHODS: Older adults (N = 8934, mean age = 64) who participated in Waves 1, 2 and 4 of the Survey of Health, Ageing and Retirement in Europe (SHARE) reported sleep and health outcome measures. Episodic sleep complaints, in the first or in the second wave and chronic sleep complaints, in both waves were recorded. Outcomes in Wave 4 included physical symptoms, difficulties in activities of daily living and low quality of life. RESULTS: Logistic regressions examined whether episodic and chronic sleep complaints at W1 and W2 predict W4 health outcomes. Chronic sleep complaints predicted worse outcomes, compared to no sleep difficulties and to episodic sleep complaints, even after adjusting for demographic characteristics and previous levels of health. CONCLUSION: Sleep complaints and mainly chronic sleep complaints are related to elevated risk of future health and functional problems. Caregivers are encouraged to address sleep complaints and provide their older patients with help before sleep complaints become persistent.

The effect of exposure to missile attacks on posttraumatic stress disorder symptoms as a function of perceived media control and locus of control.

Exposure is one of the most robust predictors of post-traumatic stress disorder (PTSD) symptoms in warfare situations. Yet, while many are sensitive to exposure, others do not develop PTSD. In the current study, we address how perceived media control along with external locus of control moderate effects of exposure on PTSD symptoms among 1268 individuals exposed to missile attacks (mean age=36.97). We expected that the coupling of low perceived media control, whereby one feels poor control over media consumption (an inability to stop), especially when irrelevant and non-informative (e.g., involuntarily viewing the same terror incident shown repeatedly in a looped fashion) along with a self-perception of external locus of control, will render participants highly vulnerable to exposure. As expected, results suggest that effects of exposure on PTSD are not automatic, rather, the coupling of both low media control along with believing that life event are controlled by external factors exacerbates effects of exposure. These findings bear practical implications, as both media control and locus of control can be modified by therapeutic interventions, rendering one less vulnerable to the detrimental effects of traumatic exposure.

Psychological effects following the Iran nuclear deal: Iranian nuclear threat salience moderates the relationship between PTSD symptoms and sleep problems.

Following the July-14th, 2015 Iranian agreement, we examined if preoccupation with the threat of a nuclear Iran moderates the relationship between posttraumatic stress disorder (PTSD) symptoms and reported sleep problems in individuals exposed to the 2014 Israel-Gaza conflict. While sleep problems were evident in individuals suffering from PTSD symptoms, they were especially pronounced when PTSD symptoms were coupled with increased Iranian nuclear threat salience. Preoccupation with future national threats may increase PTSD-related sleep problems. Therefore, it may be useful if such threats are accounted for in interventions aiming to ameliorate trauma-related sleep problems arising in the context of security situation.

Beating their chests: University students with ADHD demonstrate greater attentional abilities on an inattentional blindness paradigm.

OBJECTIVE: Adults diagnosed with attentional deficit disorder (ADHD) are easily distracted in many tasks. Yet ADHD performance on inattentional blindness (IB) tasks has not been examined. Such investigation may aid in discriminating between 3 ADHD models: the neurological model, the perceptual load theory, and the "hunter versus farmer" hypothesis. METHOD: Distractibility was assessed in ADHD and non-ADHD college students using the MOXO task that involves detection of a single attended stimulus that repeatedly appears in the same place and in the well-known IB "gorilla" video which involves tracking of a stimulus moving at a fast pace in a dynamic, complex manner. RESULTS: ADHD college students showed increased distractibility in the MOXO task. By contrast, they performed better than controls in the attended channel of the IB task, while they were also better at noticing the unattended stimuli and thus exhibiting little-to-no inattentional blindness. CONCLUSIONS: As no attentional tradeoffs were evident in the IB task, it appears that the results are most consistent with the "hunter versus farmer" hypothesis, which postulates that ADHD individuals have an alternative cognitive style which is less equipped to deal with detection of repeated stimuli while comprising advantages in the tracking of stimuli moving in a fast dynamic manner.