Extreme pathological avoidance behaviour in children with autism.

Requests for pathological demand avoidance (PDA) diagnoses have increased over recent years. However, PDA remains controversial. It was first coined by Elisabeth Newson who hypothesised that PDA differed from autism in specific areas. This case report presents two boys from different families whose parents have suggested PDA as the core problem. But both boys were diagnosed with autism and when reviewing their history, it became clear that they had been subjected to great stress for years as they had not been supported sufficiently at school. PDA may be the resulting behaviour of this.

Extreme pathological avoidance behaviour in children with autism.

Requests for pathological demand avoidance (PDA) diagnoses have increased over recent years. However, PDA remains controversial. It was first coined by Elisabeth Newson who hypothesised that PDA differed from autism in specific areas. This case report presents two boys from different families whose parents have suggested PDA as the core problem. But both boys were diagnosed with autism and when reviewing their history, it became clear that they had been subjected to great stress for years as they had not been supported sufficiently at school. PDA may be the resulting behaviour of this.

[ADHD in adults is still overlooked].

It is well known that ADHD extends into adulthood, but if left untreated, has consequences in a range of areas. In this case report, a young man is described who, since childhood, has tried to draw attention to his problems with attention management. He smoked 60 cigarettes a day to deal with inner turmoil and restlessness. His medical history, interview with DIVA 2.0 and testing with CPT-3 point to significant problems in executive functions. Initiating medical treatment improves his level of function markedly. The clinician must uncover potential use of coping strategies when screening for ADHD.

[Alice in Wonderland-syndrome may be confused with anxiety].

This case report describes a seven-year-old girl with autism and nightly "anxiety" attacks. A diagnosis of Alice in Wonderland syndrome (AIWS) presumably associated to migraine was made, and the girl was successfully treated with lamotrigine. Effective treatment of the AIWS depends on correct diagnosis. Symptoms are bizarre and affect the senses of vision, sensation, touch and hearing, as well as one's own body image. AIWS is associated with epilepsy, migraine, certain infectious diseases and rarely cerebral tumours.

Childhood ADHD and treatment outcome: the role of maternal functioning.

BACKGROUND: Relatively little is known about the role of maternal functioning in terms of attention deficit hyperactivity disorder (ADHD) symptoms, attachment style and resilience as predictive factors for treatment outcome when offspring are diagnosed with ADHD. OBJECTIVE: To investigate whether maternal functioning is associated with treatment outcome in children with ADHD. METHODS: The study formed part of a larger naturalistic observational study of children with ADHD. A battery of self-report measures was used to assess selected factors in maternal functioning at the point of referral (baseline data); adult ADHD-symptoms, adult attachment style and adult resilience. Associations between these domains and child treatment response were subsequently examined in a 1-year follow up. RESULTS: Maternal ADHD-symptoms and degree of resilience were significantly correlated to symptom reduction in offspring diagnosed with ADHD. However, the association between maternal attachment style and child treatment response as measured by the ADHD-RS did not reach statistical significance. CONCLUSION: To our knowledge, this is the first study to consider potential protective factors along with risk factors in maternal functioning and the impact on child treatment outcome. The study contributes to our knowledge of the potential role of maternal functioning in treatment outcome for children with ADHD.

Association Between Insecure Attachment and ADHD: Environmental Mediating Factors.

OBJECTIVE: Psychological theories have postulated an association between insecure attachment and ADHD. The objective of this study is to investigate possible association between insecure attachment and ADHD in children and adults. METHOD: Review of literature was performed using the PsycINFO, Medline, and EMBASE databases. RESULTS: Twenty-nine studies were included in the review. Overall, the studies showed that parental attachment problems and environmental mediating factors were significantly associated with childhood ADHD. Adults with ADHD had a much higher incidence of insecure attachment styles than reported in the general population. CONCLUSION: There seems to be a clear association between ADHD and insecure attachment. It is likely that early intervention in the form of parent training and pharmacological treatment may prevent development of attachment problems. But such studies have not been carried out. Furthermore, adults with ADHD might need treatment for their lack of attachment competences as well. More research on this topic is much needed.

CLINICAL EXPERIENCE OF LONG-TERM TREATMENT WITH ARIPIPRAZOLE (ABILIFY) IN CHILDREN AND ADOLESCENTS AT THE CHILD AND ADOLESCENT PSYCHIATRIC CLINIC 1 IN ROSKILDE, DENMARK.

The aim of this paper is to share the clinical experience of the treatment of aripiprazole (Abilify) in children and adolescents. The authors have done a cross-sectional study about Abilify's treatment in children and adolescents with severe conduct problems (high impulsivity, aggression, outward reaction, physical cross-border behavior), high restlessness with ADHD, psychotic and psychosis-like symptoms with autistic disorders, psychosis, and intensive tics with Tourette's syndrome. The authors studied and described patients at the Child and Adolescent Psychiatric Clinic 1 in Roskilde, Denmark, who were treated with Abilify and were patients of the clinic in June 2013. The target group consisted of 33 patients, aged 9-18 years, which were in Abilify treatment during this time. Indications for the treatment and effectiveness of Abilify, Abilify's common doses used in children and adolescents, and the most common adverse effects of Abilify are presented. Abilify was found to be effective, well tolerated and safe for children and adolescents. The dose depends on the complexity of diagnosis (higher doses used in cases of complex diagnosis), on the age (higher doses used in older children, but only in the case of noncomplex diagnoses). Statistical analysis shows that in cases of complex diagnoses, dosage does not depend on age but depends on other factors. It also shows that the effect of treatment is better for those who did not gain weight.

Attachment Competences in Children With ADHD During the Social-Skills Training and Attachment (SOSTRA) Randomized Clinical Trial.

OBJECTIVE: To investigate the effects of social-skills training and a parental training program on children with ADHD as measured by the children's attachment competences. METHOD: The SOSTRA trial is a randomized, parallel-group, outcome-assessor-blinded, superiority trial evaluating 8 weeks social-skills training and parental training plus standard treatment versus standard treatment alone for 8- to 12-year old children with ADHD. RESULTS: There were no significant differences in attachment competences at 6 months between the experimental (n = 25) and the control (n = 22) groups (odds ratio = 1.06, 95% confidence interval = [0.31, 3.58], p = .91). In total, 17 children (36%) changed their entry status, 1 (2%) from secure to insecure attachment, while 16 (34%) changed from insecure to secure attachment. CONCLUSION: The experimental treatment does not seem to affect attachment competences compared with standard treatment alone. Children in the SOSTRA trial improved their attachment competences significantly at 6-month follow-up.