An updated safety review of the current drugs for managing ADHD in children.

INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent condition that causes persistent problems with attention and/or hyperactivity-impulsivity and often results in significant impairment when left untreated. Medications for this disorder continue to evolve and provide new treatment options. Ongoing review of related medication safety and tolerability remains an important task for prescribers. AREAS COVERED: This manuscript provides an updated safety review of medications used to treat ADHD in children and adolescents. PubMed and OneSearch online databases were utilized to search for literature relevant to the topic of ADHD medications and safety. Clinical trials of medications used to treat ADHD, systematic reviews and meta-analyses, and articles covering specific safety issues (adverse or unfavorable events) such as cardiovascular effects, seizures, impact on growth, depression, suicidal ideation, substance use disorders, psychosis, and tics are described. EXPERT OPINION: Available pharmacologic treatments for ADHD have favorable efficacy, safety and tolerability and allow many patients to achieve significant improvement of their symptoms. Despite the availability of multiple stimulant and non-stimulant formulations, some individuals with ADHD may not tolerate available medications or attain satisfactory improvement. To satisfy unmet clinical needs, ADHD pharmaceutical research with stimulant and nonstimulant formulations targeting dopamine, norepinephrine, and novel receptors is ongoing.

Collaboration with Schools and School-Based Health Centers.

Since the early 1900s when school-based health services were first introduced, models of school-based health have evolved toward comprehensive and integrated models that include mental health. New and innovative models of Comprehensive Mental Health Systems offer a range of prevention and intervention strategies that are delivered across collaborative systems of community and school-based mental health. Studies of school-based health services indicate positive outcomes in health, mental health, and education. Child and adolescent psychiatrists can work with schools by providing direct service, consultation, and technical assistance to increase access, improve health equity, and optimize mental health outcomes for all youth.

Debate: Student mental health matters - the heightened need for school-based mental health in the era of COVID-19.

The COVID-19 pandemic has highlighted existing gaps in school-based mental health services and created new and urgent needs to address student mental health. Evidence from early in the pandemic already suggests that preexisting educational and mental health disparities have increased under the stress of the current health crisis. School mental health professionals are essential to help address anxiety, to promote social adjustment in the 'new normal', and to address trauma, grief, and loss. Schools will also need to creatively support teachers during this unprecedented time. Such efforts will require adequate funding and advocacy for the inclusion of school-based mental health supports within governmental COVID-19 aid packages.

Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors.

OBJECTIVE: The aim of this study was to examine a cohort of unaccompanied refugee minors (URMs) by means of psycholinguistic methods in order to obtain a more subtle picture of their degree of traumatization. METHODS: Twenty-eight participants were included in the Stress-Inducing Speech Task (SIST) consisting of a free association (FA) and a stress (STR) condition. Narratives were examined by means of (1) quantitative parameters (word count); (2) psycholinguistic variables (temporal junctures, TJs), narrative structure, referential activity (RA)-a measure of emotional expressivity; and (3) content analysis ratings. RESULTS: Word count was significantly lower than in age-matched norms. In the FA condition, TJs were lower, but in the STR condition, rates were comparable. RA was significantly higher in both conditions. Content analysis ratings showed that the experiences described by these youths were potentially traumatic in nature. CONCLUSIONS: This pattern of narrative shows a mixture of fulfilling the task demand, while containing an emotionally charged narrative. Narrative structure was absent in the FA condition, but preserved in the STR condition, as URMs struggled with the description of non-normative events. This indicates that these youths have not yet emotionally dealt with and fully integrated their trauma experiences.

Listening for avoidance: narrative form and defensiveness in adolescent memories.

We describe a linguistic clue to speakers' states of mind that has utility for psychotherapists and counselors, and summarize the theoretical and empirical support for using this clue in clinical practice. Specifically, we posit that the degree to which people relate stressful episodes from their lives as a chronological sequence of events is negatively associated with the extent to which they self-protectively avoid experiencing negative affect. We review relevant discussions and findings from linguistics and psychology, and then present a new study that replicates previous research. In this study of the relationship between defensive avoidance and the narrative structure of stressful memories in non-clinical adolescents, 168 high school students spoke for 10 min into a tape recorder about "your most stressful life event." Transcribed interviews were analyzed for narrative immersion, the extent to which the past is retold in chronological order, using a method adopted from Labov and Waletzky. A negative association was found between narrative immersion and avoidance (as operationalized by scores on the Marlowe Crowne Social Desirability Scale). Listening for narrative immersion in the speech of clients discussing past stressful times may therefore represent a useful tool in exploring defensive avoidance of stressful episodic memories.

Boys' and girls' responses to stress: affect and heart rate during a speech task.

PURPOSE: To examine gender differences in heart rate and reports of negative and positive affect among adolescents during a speech task. METHODS: Subjects were 133 adolescents, 73 girls and 60 boys, ages 14-18 years. Subjects were randomly assigned to speak for 10 minutes and asked either to free associate or to describe the most stressful event in their lives. Their heart rate was assessed at baseline and at 5 and 10 minutes after the task began. Self-ratings of negative and positive affect were assessed at baseline and at 10 minutes after the beginning of the task. Data were analyzed by Student's t-tests for independent samples, analyses of covariance, and Spearman rank-order correlation coefficients. RESULTS: Girls rated their negative affect significantly higher at baseline in comparison to boys. In addition, girls had a higher baseline heart rate. However, boys' increase in heart rate 5 minutes into the speech task was significantly greater than that of girls. Also, the free association task elicited significantly greater increases in heart rate compared to a task in which the adolescent described his or her most stressful life event. However, the stressful event task elicited greater negative and less positive affect. Significant relationships between change in heart rate and ratings of post-task affect were found among girls but not among boys, suggesting that the girls' ratings of their affect are more congruent with their physiological reactions to a stressful speech task. CONCLUSIONS: These results suggest that gender and task differences must be considered in assessing adolescents' stress.