Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD.

Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.

Can children and adolescents with ADHD use attention to maintain verbal information in working memory?

Children and adolescents with attentional-deficit/hyperactivity disorder (ADHD) present deficits in working memory (WM), but accounts for this phenomenon are still lacking. In this study, we used two variations of a complex-span task to test whether a specific WM mechanism, attentional refreshing, causes these deficits. Attentional refreshing is a maintenance strategy based on the sequential switch of attention between maintaining and processing information in WM. Its use is evidenced by a decrease in recall performance proportional to the distraction of attention away from the memoranda. In this study, we designed two experiments requiring children and adolescents with ADHD symptoms to maintain sequences of letters for subsequent recall, while performing a distracting task. In Experiment 1, the distracting task consisted of reading digits aloud. In Experiment 2, it consisted in making spatial judgements. The pace of the distracting tasks was varied to manipulate the level of attentional distraction. We observed that recall in ADHD participants was higher in the distracting conditions that give attention more opportunity to refresh letters. Moreover, ADHD participants had a similar recall performance to their age-matched typically developing peers. This study shows first evidence that individuals with ADHD can use attention to maintain verbal information in WM and calls for more research to understand their WM development.

Optimizing the Assessment of Parental Burnout: A Multi-informant and Multimethod Approach to Determine Cutoffs for the Parental Burnout Inventory and the Parental Burnout Assessment.

Parental burnout (PB) is a chronic stress-related condition resulting from long-lasting exposure to overwhelming parenting stress. Previous studies showing the seriousness of this condition stressed the urgent need to provide researchers and practitioners with effective assessment tools. Validated PB measures are the Parental Burnout Inventory (PBI) and the Parental Burnout Assessment (PBA). The good psychometric properties of these instruments have been replicated across different samples and countries, but thresholds for identifying impairing PB levels (i.e., cutoff scores) have not yet been established. The present study aims to fill this gap by adopting a multi-informant and multimethod approach to a sample of 192 burned-out and control parents. PBI and PBA cutoffs were derived from the combination of several PB indicators, based on a preregistered analysis strategy. Results identified a score of 74.6 (95% confidence interval (CI) = [69.48-79.68]) for the PBI and 86.3 (95% CI = [79.49-93.03]) for the PBA as indicators of the most severe PB levels.

When not teaming up puts parents at risk: Coparenting and parental burnout in dual-parent heterosexual families in Switzerland.

Parental burnout refers to loss of energy and pleasure in the parental role. It is predictive of psychopathological outcomes in parents and dysfunctional parenting behaviors. Support of parental duties is central to alleviation of parental burden and prevention of burnout. Coparenting is the concept related to interparental mutual support in rearing a child. However, the links between coparenting and parental burnout have yet to be assessed. We thus aimed in this study to assess which dimensions of coparenting are linked with parental burnout. A total of 306 participants from the French-speaking part of Switzerland (120 fathers, 186 mothers) completed online questionnaires about parental burnout, their coparental relationship, and sociodemographic characteristics. We performed hierarchical regressions, entering sociodemographic characteristics in a first block and coparenting dimensions in a second block. Results showed that (i) a higher number of children and having younger children are linked to higher burnout; (ii) coparenting exposure to conflict is related to higher burnout, whereas endorsement of the partner's parenting is related to lower burnout; and (iii) no interaction effect occurs between sociodemographic characteristics and coparenting variables. Coparenting thus significantly contributes to the occurrence of burnout syndrome. Working on the coparental relationship preventively in parental educational programs or at a relational systemic level in therapy may help prevent burnout. Treating one parent only may not be sufficient to alleviate burnout, as negative coparenting could counter the effect of individual therapy.

Attentional Orienting in Working Memory in Children with ADHD.

Children with attentional-deficit/hyperactivity disorder (ADHD) have impairments in working memory (WM) functioning. Impaired orienting of visual attention during encoding and/or maintenance is hypothesized as the cause of poor performance in visuospatial WM in 10-to-16-year-olds. We used a color-recognition task with valid location cues before encoding (pre-cues) and during maintenance (retro-cues). If ADHD children have an orienting deficit during these processing stages, they should not benefit from the cues. We observed strong pre- and retro-cueing benefits both for ADHD and typically developing controls, with no differences between the groups. This strengthens findings showing that ADHD is not characterized by deficits in orienting attention and provides evidence of retro-cue benefits in this population.

Parental Burnout Around the Globe: a 42-Country Study.

High levels of stress in the parenting domain can lead to parental burnout, a condition that has severe consequences for both parents and children. It is not yet clear, however, whether parental burnout varies by culture, and if so, why it might do so. In this study, we examined the prevalence of parental burnout in 42 countries (17,409 parents; 71% mothers; Mage = 39.20) and showed that the prevalence of parental burnout varies dramatically across countries. Analyses of cultural values revealed that individualistic cultures, in particular, displayed a noticeably higher prevalence and mean level of parental burnout. Indeed, individualism plays a larger role in parental burnout than either economic inequalities across countries, or any other individual and family characteristic examined so far, including the number and age of children and the number of hours spent with them. These results suggest that cultural values in Western countries may put parents under heightened levels of stress. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-020-00028-4.

When Fathers Feel Socially Constrained to Assume a Role: A Negative Predictor of the Coparental Relationship in Switzerland.

Role distribution is a central issue for parents in the transition to parenthood, but little is known about the motivations in fathers to assume a specific role. Differences in work-family balance in each parent may be motivated by an individual choice mutually shared by both partners; however, in many couples, the parents may feel forced to adopt a traditional role distribution, either for financial reasons, or to comply with social expectations about what men and women should do when they are parents. This feeling of being socially constrained to adopt a role distribution that is not congruent with intrinsic motivations can generate dissatisfaction and may jeopardize the development of the interparental relationship. Coparenting refers to the emotional and instrumental support parents bring to each other in their parental tasks. It has been shown to be central in family functioning and a powerful predictor of children's emotional and cognitive development. In this study, we aimed to assess the extent to which different motivations for role distribution in fathers are predictive of the quality of the coparental relationship. A convenience sample of 144 fathers from the French-speaking part of Switzerland completed online questionnaires about their motivations, coparental relationship, and sociodemographic characteristics. Results showed that the reasons for role distribution were mainly economical, practical, and in order to meet personal expectations. Multivariate general linear modeling showed that role distribution that is constrained to meet social expectations and age were predictive of a less cohesive coparental relationship, whereas a deliberate choice in role distribution was linked to a more cohesive coparental relationship.

Attention Networks in ADHD Adults after Working Memory Training with a Dual n-Back Task.

Patients affected by Attention-Deficit/Hyperactivity Disorder (ADHD) are characterized by impaired executive functioning and/or attention deficits. Our study aim is to determine whether the outcomes measured by the Attention Network Task (ANT), i.e., the reaction times (RTs) to specific target and cue conditions and alerting, orienting, and conflict (or executive control) effects are affected by cognitive training with a Dual n-back task. We considered three groups of young adult participants: ADHD patients without medication (ADHD), ADHD with medication (MADHD), and age/education-matched controls. Working memory training consisted of a daily practice of 20 blocks of Dual n-back task (approximately 30 min per day) for 20 days within one month. Participants of each group were randomly assigned into two subgroups, the first one with an adaptive mode of difficulty (adaptive training), while the second was blocked at the level 1 during the whole training phase (1-back task, baseline training). Alerting and orienting effects were not modified by working memory training. The dimensional analysis showed that after baseline training, the lesser the severity of the hyperactive-impulsive symptoms, the larger the improvement of reaction times on trials with high executive control/conflict demand (i.e., what is called Conflict Effect), irrespective of the participants' group. In the categorical analysis, we observed the improvement in such Conflict Effect after the adaptive training in adult ADHD patients irrespective of their medication, but not in controls. The ex-Gaussian analysis of RT and RT variability showed that the improvement in the Conflict Effect correlated with a decrease in the proportion of extreme slow responses. The Dual n-back task in the adaptive mode offers as a promising candidate for a cognitive remediation of adult ADHD patients without pharmaceutical medication.

Early Attentional Modulation by Working Memory Training in Young Adult ADHD Patients during a Risky Decision-Making Task.

Background: Working memory (WM) deficits and impaired decision making are among the characteristic symptoms of patients affected by attention deficit/hyperactivity disorder (ADHD). The inattention associated with the disorder is likely to be due to functional deficits of the neural networks inhibiting irrelevant sensory input. In the presence of unnecessary information, a good decisional process is impaired and ADHD patients tend to take risky decisions. This study is aimed to test the hypothesis that the level of difficulty of a WM training (WMT) is affecting the top-down modulation of the attentional processes in a probabilistic gambling task. Methods: Event-related potentials (ERP) triggered by the choice of the amount wagered in the gambling task were recorded, before and after WMT with a the dual n-back task, in young ADHD adults and matched controls. For each group of participants, randomly assigned individuals were requested to perform WMT with a fixed baseline level of difficulty. The remaining participants were trained with a performance-dependent adaptive n-level of difficulty. Results: We compared the ERP recordings before and after 20 days of WMT in each subgroup. The analysis was focused on the time windows with at least three recording sites showing differences before and after training, after Bonferroni correction ( p < 0.05 ). In ADHD, the P1 wave component was selectively affected at frontal sites and its shape was recovered close to controls' only after adaptive training. In controls, the strongest contrast was observed at parietal level with a left hemispheric dominance at latencies near 900 ms, more after baseline than after adaptive training. Conclusion: Partial restoration of early selective attentional processes in ADHD patients might occur after WMT with a high cognitive load. Modified frontal sites' activities might constitute a neural marker of this effect in a gambling task. In controls, conversely, an increase in late parietal negativity might rather be a marker of an increase in transfer effects to fluid intelligence.

Validation of the French Version of Conners' Parent Rating Scale-Revised, Short Version (CPRS-R:S): Scale Measurement Invariance by Sex and Age.

Objective: ADHD is one of the most frequent neurodevelopmental disorders. In addition to clinical assessment, its diagnosis requires the use of validated and reliable behavior questionnaires such as the Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S). Though various French versions of the CPRS-R:S have been already put to use in clinical practice and research, only a few have undergone a stringent validation process. After a previous validation of the factorial structure of Lausanne French version, we sought here for the analysis of its invariance across sex and age. Method: This validation step was carried out in a rather homogeneous French population of 365 boys and 374 girls from a single school. Two-age classes were considered: children (boys and girls) aged 9 to 11 years (n = 258) and adolescents aged 12 to 15 years (n = 481). Results: Regarding age, dimension Oppositional showed a strong invariance whereas dimensions Hyperactivity and Cognitive problems/Inattention showed a partially strong invariance. Regarding sex, dimensions Oppositional and Hyperactivity showed a partially strong invariance whereas dimension Cognitive problems/Inattention showed a partially weak invariance. The distribution of the CPRS-R:S scores is given by sex and age class. Conclusion: The Lausanne French version of the CPRS-R:S, already validated regarding its factorial structure, internal consistency, and reliability, is here validated regarding its invariance across sex and age. Caution should be taken in using dimension Cognitive problems/Inattention in comparisons between boys and girls.

Cognitive Working Memory Training (CWMT) in adolescents suffering from Attention-Deficit/Hyperactivity Disorder (ADHD): A controlled trial taking into account concomitant medication effects.

Although, cognitive working memory training (CWMT) has been reported to enhance working memory functioning in youths with attention-deficit/ hyperactivity disorder (ADHD), few studies take into account the concomitant effects of medication. Sixty adolescents aged from 11 to 15 years were randomly assigned to CWMT treatment, whereas medication was either continued or not introduced (no randomization performed). Results revealed beneficial effects of CWMT on the different components of working memory (WM), namely the phonological loop, the visuospatial sketchpad and the central executive. In particular, CWMT allowed participants to obtain a level of performance similar to the typically-developing adolescents for the phonological loop (i.e., forward digit span) as well as for the visuospatial sketchpad (i.e., board span). For the central executive (i.e., backward digit span) the concomitant effects of CWMT and medication allows participants to obtain the performance level of the typically-developing adolescents. Although, no transfers were observed with respect to other cognitive functions, in medicated patients with ADHD, CWMT reduced hyperactivity / impulsivity symptoms at 2-month follow-up. The present study gives evidence of the efficacy of CWMT to enhance WM performance, as well as, to reduce symptoms. The overall results highlight the usefulness of multimodal interventions.

Event-Related Potentials during a Gambling Task in Young Adults with Attention-Deficit/Hyperactivity Disorder.

Attention-deficit hyperactivity disorder (ADHD) is characterized by deficits in executive functions and decision making during childhood and adolescence. Contradictory results exist whether altered event-related potentials (ERPs) in adults are associated with the tendency of ADHD patients toward risky behavior. Clinically diagnosed ADHD patients (n = 18) and healthy controls (n = 18), aged between 18 and 29 (median 22 Yo), were screened with the Conners' Adult ADHD Rating Scales and assessed by the Mini-International Neuropsychiatric Interview, adult ADHD Self-Report Scale, and by the 60-item HEXACO Personality Inventory. The characteristic personality traits of ADHD patients were the high level of impulsiveness associated with lower values of agreeableness. All participants performed a probability gambling task (PGT) with two frequencies of the feedback information of the outcome. For each trial, ERPs were triggered by the self-paced trial onset and by the gamble selection. After trial onset, N2-P3a ERP component associated with the attentional load peaked earlier in the ADHD group than in controls. An N500 component related to the feedback frequency condition after trial onset and an N400-like component after gamble selection suggest a large affective stake of the decision making and an emphasized post-decisional evaluation of the choice made by the ADHD participants. By combining ERPs, related to the emotions associated with the feedback frequency condition, and behavioral analyses during completion of PGT, this study provides new findings on the neural dynamics that differentiate controls and young ADHD adults. In the patients' group, we raise the hypothesis that the activity of frontocentral and centroparietal neural circuits drive the decision-making processes dictated by an impaired cognitive workload followed by the build-up of large emotional feelings generated by the conflict toward the outcome of the gambling choice. Our results can be used for new investigations aimed at studying the fine spatiotemporal distribution of cortical activity, and the neural circuits that underly the generation of that activity, associated with the behavioral deficits characteristic of ADHD.

The Zappel-Philipp a historical example of ADHD Clinics.

In his book "Die Geschichte von dem Zappel-Philipp," the German psychiatrist Heinrich Hoffmann (1809-1894) offers a clinical vignette which raises the question of the description of a disobedient child or presenting hyperactivity symptoms. This article describes the historical context and the biographical aspects related to this interesting approach to describing a psychiatric syndrome to children and adults. It also underlines the importance of a global approach of ADHD that considers the familial environment and situational context of symptoms.

Validation of the French Version of Conners' Parent Rating Scale Revised, Short Version: Factorial Structure and Reliability.

OBJECTIVE: Attention-deficit hyperactivity disorder is one of the most frequent neurodevelopmental disorders. Its diagnosis requires reference questionnaires such as the Conners' Parent Rating Scale (CPRS). Presently, in French-speaking countries, a few translations of the revised short CPRS have been put to use without previous formal validation. We sought here for the validation of a French version (Lausanne, Switzerland) of the revised short CPRS regarding construct validity, internal consistency, and item reliability in a sample of French schoolchildren. METHOD: The study involved 795 children and adolescents aged 9 to 19 years from a single school. The factorial structure and item reliability were assessed with a confirmatory factor analysis for ordered categorical variables. The dimension internal consistency was assessed with Guttman's lambda 6 coefficient. RESULTS: The results confirmed the original and strong 3-dimensional factorial structure (Oppositional, Cognitive Problems/Inattention, and Hyperactivity), showed satisfactory item reliability, and indicated a good dimension internal consistency (Guttman's lambda 6 coefficient: 0.87, 0.90, and 0.82, respectively, to the 3 dimensions). CONCLUSIONS: Thus, the Lausanne French version of the revised short CPRS may be considered validated regarding construct validity and item and dimension reliability; it can be now more confidently used in clinical practice.

The concept of instability: a French perspective on the concept of ADHD.

Historical references to the emergence of the current concept of ADHD typically cite descriptions from medical textbooks by Weikard (1775) and Crichton (An inquiry into the nature and origin of mental derangement: Comprehending a concise system of the physiology and pathology of the human mind and a history of the passion and their affects. Cardell Jr and Davies, Londres, 1798) on attention disorders, poems of Hoffman on hyperactive and impulsive behaviors (Der Struwwelpeter. Frankfurt am Main, Literarische Anstalt, 1843), as well as the work of Still (Lancet 1:1008-1012, 1077-1082, 1163-1168, 1902a, Lancet 159(4102):1008-1013, 1902b, Lancet 159(4103):1077-1082, 1902c, Lancet 159(4104):1163-1168, 1902d) on impulsive behaviors and defective moral regulation of behavior. The notion of "instability" developed by French physicians between 1887 and 1910 is rarely mentioned and often ignored. Writings from this period show that in France, the emergence of the concept of ADHD according to modern terminology comes from the notion of "mental instability" introduced in the 1890s under the leadership of Désiré-Magloire Bourneville at the Hospital Bicêtre in Paris, based on his observations of children and adolescents who had been labeled "abnormal" and placed in medical and educational institutions. In the early twentieth century, elaborating on the observations of Bourneville, Jean Phillipe and Georges Paul-Boncour showed the presence of a subgroup of "unstable" children who suffered from a disease entity in its own right within the population of "abnormal" schoolchildren (the terminology of the time). This new pathological entity included symptoms of hyperactivity, impulsivity and inattention, corresponding to today's classic triad of ADHD symptoms. While noting the lack of behavioral inhibition, clinical descriptions of Bourneville, Philip and Paul-Boncour also considered the notion of "moral disorder" which at that time played an important role in psychopathology. This resulted in some degree of confusion between impulsive symptoms and major behavioral disturbances often associated with ADHD.

Hyperactivity and attention problems in a Swiss sample of school-aged children: effects of school achievement, child gender, and informants.

OBJECTIVE: The sensitivity and tolerance regarding ADHD symptoms obviously differ from one culture to another and according to the informants (parents, teachers, or children). This stimulates the comparison of data across informants and countries. METHOD: Parents and teachers of more than 1,000 school-aged Swiss children (5 to 17 years old) fill in Conners's questionnaires on ADHD. Children who are older than 10 years old also fill in a self-report questionnaire. Results are compared to data from a North American sample. RESULTS: Swiss parents and teachers tend to report more ADHD symptoms than American parents and teachers as far as the oldest groups of children are concerned. Interactions are evidenced between school achievement, child gender, and informants. A relatively low rate of agreement between informants is found. CONCLUSION: These results strengthen the importance to take into account all informants in the pediatric and the child psychiatry clinic, as well as in the epidemiological studies.

Assessing attachment cognitions and their associations with depression in youth with eating or drug misuse disorders.

The study investigates associations between attachment cognitions and depression symptoms in 71 15-25-year-olds, 26 of whom have eating disorders, and 20 of whom are drug misusers. Attachment cognitions were measured with the CaMir Q-sort, which provides indexes for secure, avoidant, and preoccupied attachment, as well as scores on 13 dimensions. The BDI-13 was used to measure depressive symptomatology. Consistent with the literature, BDI scores were associated with cognitions of preoccupied attachment. They were also related to cognitions of avoidant attachment, confirming Bowlby's theory on defensive exclusion. For participants with eating disorders, depressive symptomatology was related to preoccupation and parental interference, whereas for drug misusers, it was negatively related to security, preoccupation, parental support, and lack of parental concern. These findings help understand how attachment cognitions may participate in depressive symptomatology, namely in youth whose behavior problems may be associated with specific attachment experiences.