Transdiagnostic feasibility trial of internet-based parenting intervention to reduce child behavioural difficulties associated with congenital and neonatal neurodevelopmental risk: introducing I-InTERACT-North.

OBJECTIVE: We examined feasibility and acceptability of an adapted telepsychological parent-child intervention to improve parenting skills and reduce emotional and behavioural difficulties in Canadian families of children at-risk for poor neurodevelopment given congenital or neonatal conditions. Preliminary program efficacy outcomes are also described. METHODS: Twenty-two families of children between the ages of 3-8 years with histories of neonatal stroke, hypoxic ischemic encephalopathy (HIE) and serious congenital and neonatal conditions [(congenital heart disease (CHD) or prematurity)] consented to participate in an adapted telepsychological parenting skills training program (I-InTERACT-North). The program helps parents develop positive parenting skills to improve parenting competence and child behaviour through 7 online psychoeducational modules completed independently and 7 videoconference sessions with a therapist. Videoconference sessions include live coaching to support application of skills. Feasibility (i.e., number of participants eligible, consented, refused), adherence (i.e., completion time, retention rates), acceptability (i.e., website experience questionnaire, therapist and parent semi-structured interviews), and preliminary efficacy (i.e., observational coding of parenting skill, self-reported parent competence, parent-reported child behaviour) data were collected. RESULTS: Nineteen of the 22 families (86%) enrolled completed the program in an average of 10 weeks (range: 6-17 weeks). Parents and therapists reported high overall satisfaction with the program (100%), including acceptability of both the online modules (95%) and the videoconference sessions (95%). Parenting confidence (d = 0.45), parenting skill (d = 0 .64), and child behaviour (d = 0.50) significantly improved over the course of the intervention. CONCLUSIONS: Findings provide preliminary evidence for the feasibility, acceptability, and efficacy of I-InTERACT-North for parents of children with neonatal brain injury.

Epilepsy, Attention-Deficit/Hyperactivity Disorder and Methylphenidate: Critical Examination of Guiding Evidence.

OBJECTIVE: Attention-Deficit/Hyperactivity Disorder (ADHD) and epilepsy are commonly comorbid; yet in the psychiatric literature, there is a remarkable paucity of guiding evidence regarding the safety and efficacy of treatment using methylphenidate (MPH) in this population. The objective of this review is to critically appraise evidence regarding the treatment of ADHD in the context of seizure disorders in order to better inform management considerations and practices. METHOD: A comprehensive search of the Central, Embase, Medline, and Web of Science databases identified 349 references. After a thorough review, only nine relevant references contributing new information and providing reliable and interpretable data were identified; seven were prospective studies (two double-blind placebo controlled trials, five open-label trials) and two were retrospective reviews. Prospective studies were then reviewed in detail, critically appraised, and interpreted. RESULTS: All studies reported no increase in seizure rates in a majority of participants after exposure to MPH. MPH was effective in treating ADHD symptoms. However, the following major limitations to the studies impede drawing confident conclusions: small sample sizes, lack of uniformity regarding seizure type and severity, seizure-free period pre-stimulant treatment, and low baseline seizure rates. CONCLUSIONS: Given the academic, social, emotional, and functional impact of untreated ADHD, a watchful approach to the use of MPH in children with stable epilepsy who are impaired by ADHD symptoms is justified.

OBJECTIF: Le trouble du déficit d'attention avec hyperactivité (TDAH) et l'épilepsie sont fréquemment comorbides; et pourtant, dans la littérature psychiatrique, il y a une remarquable rareté de données probantes directrices concernant l'innocuité et l'efficacité du traitement par méthylphénidate (MPH) dans cette population. L'objectif de cette revue est d'évaluer de façon critique les données probantes sur le traitement du TDAH dans le contexte des troubles convulsifs afin de mieux éclairer les considérations et pratiques de prise en charge. MÉTHODE: Une recherche exhaustive des bases de données Central, Embase, Medline, et Web of Science a identifié 349 références. Après un examen minutieux, seulement neuf références pertinentes apportant une information nouvelle et offrant des données fiables et interprétables ont été relevées; sept étaient des études prospectives (deux essais à double insu contrôlés contre placebo, cinq essais ouverts) et deux étaient des revues rétrospectives. Les études prospectives ont ensuite été examinées en détail, ont fait l'objet d'une évaluation critique, et ont été interprétées. RÉSULTATS: Toutes les études n'indiquaient aucune hausse des taux de crises d'épilepsie chez une majorité de participants après une exposition au MPH. Le MPH était efficace pour traiter les symptômes du TDAH. Toutefois, les limitations majeures suivantes des études empêchent de tirer des conclusions en toute confiance : petites tailles d'échantillons, absence d'uniformité à propos du type et de la gravité des crises, période sans crise avant le traitement par stimulant, et faibles taux de crises au départ. CONCLUSIONS: Étant donné l'effet scolaire, social, émotionnel et fonctionnel du TDAH non traité, une approche vigilante de l'utilisation du MPH chez les enfants dont l'épilepsie est stable et qui sont aux prises avec les symptômes du TDAH est justifiée.