Comorbidity of Attention Deficit Hyperactivity Disorder and Generalized Anxiety Disorder in children and adolescents.

The aim of the study is to explore the impact of Generalized Anxiety Disorder (GAD) comorbidity in children with Attention Deficit Hyperactivity Disorder (ADHD). Six hundred children with ADHD (mean age = 9.12 years), recruited from 2013 to 2017, participated in the study. A total of 96 (16%) children with ADHD displayed a comorbidity with GAD. ADHD + GAD were compared to 504 ADHD children without GAD in terms of cognitive and psychiatric profile, ADHD subtype and family psychiatric history. The ADHD + GAD, predominantly represented from ADHD combined (72.6%), displayed higher psychiatry comorbidity, in particular with depressive disorders, and were associated with higher rates of maternal depression, of ADHD in fathers, and bipolar disorders in second degree relatives. Moreover, younger preschool-primary school age children with ADHD + GAD showed significant higher frequency of depressive disorders versus younger preschool-primary children with ADHD without GAD. ADHD + GAD comorbidity represents a more complex clinical condition compared to ADHD without GAD, characterized by the higher frequency of multiple comorbidities and by a psychiatric family with higher rates of mood and disruptive disorders.

Impact of attention-deficit/hyperactivity disorder on the lives of Italian children and adolescents: data from the European Lifetime Impairment Survey.

AIM: In Italy, attention-deficit/hyperactivity disorder (ADHD) remains under-diagnosed. The Lifetime Impairment Survey assessed impairments/symptoms of ADHD in children across six European countries. Results relating to the Italian sample are discussed here. METHODS: Parents/caregivers of children aged <20 years with ADHD (ADHD group) and without ADHD (control group) were invited to participate in an online survey. Participants answered questions relating to their eldest/only child. History of ADHD diagnosis was self-reported. Eight impairment and symptom scales and two summed scores were created to compare the ADHD and control groups; higher scores indicate greater impairment. RESULTS: In Italy, 104 parents/caregivers of children with ADHD and 105 parents/caregivers of children without ADHD participated in the survey (N.=83 and N.=84, respectively, after exclusion of participants with implausible answers). The ADHD group had higher mean (standard deviation) scores than the control group for home impairment (2.1 [0.5]) vs. 1.9 [0.4]; P<0.001), school impairment (2.8 [0.6] vs. 2.1 [0.6]; P<0.001), relationship impairment (2.3 [0.8] vs. 1.9 [0.7]; P<0.001) and comorbid symptoms (3.3 [0.7] vs. 2.5 [0.7]; P<0.001). Impairment at home and at school were correlated with each other (r=0.478; P<0.001) and with ADHD symptoms (r=0.321; P<0.001 and r=0.462; P<0.001, respectively), comorbid symptoms (r=0.231; P<0.05 and r=0.420; P<0.001), school failure (r=0.208; P<0.02 and r=0.320; P<0.001) and relationship impairments (r=0.432; P<0.01 and r=0.645; P<0.001). CONCLUSION: The daily lives of children with ADHD in Italy are significantly affected by impairments associated with ADHD. Children and adolescents with ADHD in Italy should receive prompt diagnosis and appropriate therapy.

Prevalence of severe ADHD: an epidemiological study in the Italian regions of Tuscany and Latium.

BACKGROUND: The rate with which attention deficit/hyperactivity disorder (ADHD) is diagnosed varies widely across countries, suggesting that cultural factors influence the clinical interpretation of child behaviour. This study estimated the point prevalence of severe ADHD among elementary and middle-school Italian children. METHOD: An epidemiological sample of 2016 children attending 2nd-8th grade in the Italian regions of Tuscany and Latium was selected based on census distribution of the school-age population. Teachers completed the Italian version of the ADHD Rating Scale for Teachers (SDAI). For children with at least six inattention symptoms and/or at least six hyperactivity/impulsivity symptoms rated 'very often' by the teachers, the parents completed the Italian ADHD Rating Scale for Parents (SDAG). Children with documented ADHD symptoms at both school and home received a complete psychiatric interview with the Kiddie Schedule for Affective Disorders and Schizophrenia-present and lifetime version (K-SADS-PL). RESULTS: Of the 1887 assessed children, 4.45% (95% CI 3.58-5.51) met the ADHD cut-off on teacher ratings, 1.43% (0.96-2.12) had ADHD symptoms endorsed by both teacher and parent, and 1.32% (0.87-1.97) were further confirmed by the psychiatric evaluation. The male:female ratio was 7:1. The inattentive type accounted for about half of the ADHD cases. CONCLUSIONS: When applying stringent criteria for both severity and pervasiveness of symptoms, it is estimated that about 1.3% of the Italian elementary and middle-school children suffer from severe ADHD.

Deficient Emotional Self-Regulation in ADHD Assessed Using a Unique Profile of the Child Behavior Checklist (CBCL): Replication in an Italian Study.

OBJECTIVE: A unique profile of the empirically derived Child Behavior Checklist-anxious/depressed, attention, and aggression-deficient emotional self-regulation (CBCL-AAA-DESR profile: ≥180 and ≤210) may be used to identify a sizable minority of children with ADHD with associated DESR. The main aim of this study was to replicate these findings in an Italian sample. METHOD: The sample consisted of 358 children and teenagers aged 6 to 17 years of both sexes with (n = 190) and without a diagnosis of ADHD (n = 168). RESULTS: In all, 40.0% of children with ADHD had a positive CBCL-DESR profile compared with 3.5% of controls. Receiver-operating characteristic analysis showed that the CBCL-DESR profile cut-off (sensitivity = 97.33, specificity = 79.66, criterion ≥179, ≤210) discriminated the two subsamples. CONCLUSION: The findings replicate previous results highlighting the utility of the CBCL as a means of identifying DESR in children with ADHD.

A comparison of bipolar disorders in children in Italy and the United States.

BACKGROUND: The clinical presentation of bipolar disorders, though clearly recognized in adolescents, remains controversial in younger children and across cultures. The aim of this study was to compare the clinical presentation of bipolar disorders in Italian and American children between ages 5 and 12 years. METHODS: Sixty-seven children from six outpatient programs were enrolled (Italian sample: n=40; American sample: n=28) between January 2010 and June 2011. Children and their parents were interviewed by experienced clinicians using the Washington University in St. Louis Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present, Lifetime Version (WASH-U K-SADS). RESULTS: Italian children scored significantly higher on ratings of "elevated mood" (p=0.002), whereas American children scored significantly higher on ratings of "flight of ideas" (p=0.001) and "productivity" (p=0.001). Rates of comorbidity were different between groups. LIMITATIONS: Data were acquired from several sites in Italy as compared to from a single American site. Medication and educational information were not systematically collected. Furthermore, the sample collected may only reflect characteristics of a less severely ill group of bipolar children. CONCLUSIONS: Our comparison of Italian and American children with early onset bipolar disorders found that the phenotype of bipolar spectrum disorders is largely shared across cultures, although psychiatric comorbidities differed.

Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: results from the European Lifetime Impairment Survey.

The Lifetime Impairment Survey assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children/adolescents from six European countries. Parents/caregivers of children/adolescents aged<20 years with ADHD (ADHD group; n = 535) and without ADHD (control group; n=424) participated in an online survey. History of ADHD diagnosis was self-reported. ADHD and control groups were compared using impairment and symptom scales; higher scores indicate greater impairment. Mean (SD) age at ADHD diagnosis was 7.0 (2.8) years, following consultation of 2.7 (2.6) doctors over 20.4 (23.9) months. Parents/caregivers (64%; 344/535) reported frustration with some aspect of the diagnostic procedure; 74% (222/298) were satisfied with their child's current medication. ADHD had a negative impact on children/adolescents in all aspects of life investigated. The ADHD group had a higher mean (SD) school impairment score (2.7 [0.7]) compared with the control group (2.1 [0.7]; P<0.001) and were more likely to be in the bottom of their class (P<0.001). These data provide insights into impairments associated with ADHD in childhood/adolescence, and identify areas for improvement in its management and treatment.

The head-up tilt test and the differential diagnosis between epileptic attacks and syncope. Case report.

Often patients who have undergone a false diagnosis of epileptic attack have actually been affected by syncope. One of the most common causes of such misdiagnosis is an abnormal interictal electroencephalographic (EEG) trace. The purpose of this paper is to suggest the usefulness of the head-up tilt test as a differential diagnosis between epileptic attack and syncope. Patients underwent the head-up tilt test, which was considered positive only if the syncopal symptomatology was reproduced. The subjects were patients in a neuropsychiatric clinic. Four patients with a positive anamnesis due to brief episodes of unconsciousness and to falls were assessed. All 4 patients showed an abnormal EEG with focal spikes and sharp-waves. The head-up tilt test produced a syncope in all 4 cases. In the symptomatology evoked by the test the patients and their parents recognized the exact same characteristics of those episodes for which they had sought consultation, so a diagnosis of a vasovagal syncope of 3 different types was made. The head-up tilt test proved appropriate to differentiate syncope from epileptic attacks in patients with symptoms of unconsciousness, falls and interictal EEG spikes or sharp-waves.

Dissociative disorder in children. A case study.

Dissociative disorder is well-known in adulthood but in many cases it begins in childhood where it is usually not taken into consideration, rarely diagnosed, and often mistaken with borderline disorders. In childhood dissociation is well-defined: in a dimensional way by the presence of the dissociation symptoms over 2 SD and in a categorial view by the presence of primary symptoms. We made a psychiatric assessment on a child aged 11 years and 7 months, who said he heard "voices in his head". The assessment included: Children Dissociative Checklist (CDC), Adolescent Dissociative Experience Scale (A-DES), Children Depression Inventory (CDI), Wechsler Intelligence Scales for Children-Revised (WISC-R), Strength and Difficulties Questionnaire (SDQ), Children Behaviour Check-list (CBCL), (Scale Disturbi Attenzione Genitori, parent attention deficit scale, SDAG), Parent Conners Questionnaire, free conversation, a drawing, a neurological examination, an EEG-Holter and a semistructured psychiatric interview: K-SADS PL 1.0. SDQ, CDI and CBCL showed pathological scores in every area. K-SADS PL 1.0 excluded schizophrenia and showed: attention deficit, disthymic disorder, generalized anxiety disorder, oppositive-defiant disorder and conduct disorder with rage episodes, like borderline disorder. I.Q. was 76, SDAG (total 46) and Conners (mean points 1.81) showed a high score, simulating Attention Deficit with Hyperactivity disorder (ADHD). The presence of primary symptoms, like dissociative amnesia and very high scores in CDC (23, mean score for MPD) and in A-DES (85, mean 4.2) are useful for diagnoses. Dissociative disorder also exists in childhood, but it should be differentiated from ADHD and borderline disorder.

The child's awareness of the concept of mental disease. A case study.

In international literature not many papers discuss the comprehension of the mental disease concept by children and their ability to understand its behavioral and ethical consequences. A knowledge of this domain could be very important for health professionals and practitioners who have to cope with children abused by adult relatives with psychiatric illnesses. The case study of an 8 year-old girl describes a brief child training, projected to facilitate the recovery of the child mother relationship, through the child's comprehension of the concept of mental disease. The girl was initially assessed in a child psychiatric clinic after a period of hospitalization caused by a severe physical aggression committed by the mother during an acute schizophrenic episode (an attempt of homicide and suicide). Post Traumatic Stress Disorder (PTSD) and other psychopathologies were absent in the child. The training project included: 1) the achievement of a confidential relationship between the girl and the doctor, 2) the child's comprehension of the general concept of illness, 3) the child's comprehension of the concept of mental illness and the absence of responsibility relative to the bizarre and aggressive behavior of the psychiatric patient. After 2 months of child training, the girl showed a partial but sufficient comprehension of the concept of mental illness. Hence, the girl successfully restored her relationship with the mother, without developing any psychopathological effects. This result was confirmed after one year.

Headache in pediatric and neuropsychiatric primary care. A pilot study.

BACKGROUND: To evaluate the prevalence of headache in primary health care for children (child neuropsychiatry and pediatric primary care), detecting possible differences among areas, showing the number of patients with headache with a clinical significance that had not been communicated to a physician and studying the clinical features of cases. METHODS: A questionnaire is administered to all consecutive patients of 3 child neuropsychiatrists of a primary health care unit during a period of 20 days and of 2 family pediatricians during a period of 10 days. Data are collected on 259 children, between 5 and 14 years. RESULTS: 17.76% of examined children have recurrent headache. The percentage is significantly different (p < 0.05) in neuropsychiatry (22.78%) and pediatrics (9.90%). 63.04% of parents with children affected by headache have never reported the disease to a physician and 28.26% of affected children should follow a preventive therapy, but do not. Among all children, 6.56% have migraine and 8.49% have a tension-type headache, according to ICD-10 criteria. CONCLUSIONS: The higher frequency of headache in child neuropsychiatric primary care is probably due to a comorbidity with psychiatric diseases. The high number of non-reported cases of headache is in agreement with data reported in the literature about adults and suggests that it is important to ask standard questions about headache in the course of the anamnesis in all primary health care for children.