Maternal choline supplementation lessens the behavioral dysfunction produced by developmental manganese exposure in a rodent model of ADHD.

Studies in children have reported associations between elevated manganese (Mn) exposure and ADHD-related symptoms of inattention, impulsivity/hyperactivity, and psychomotor impairment. Maternal choline supplementation (MCS) during pregnancy/lactation may hold promise as a protective strategy because it has been shown to lessen cognitive dysfunction caused by numerous early insults. Our objectives were to determine whether (1) developmental Mn exposure alters behavioral reactivity/emotion regulation, in addition to impairing learning, attention, impulse control, and sensorimotor function, and (2) MCS protects against these Mn-induced impairments. Pregnant Long-Evans rats were given standard diet, or a diet supplemented with additional choline throughout gestation and lactation (GD 3 - PND 21). Male offspring were exposed orally to 0 or 50 mg Mn/kg/day over PND 1-21. In adulthood, animals were tested in a series of learning, attention, impulse control, and sensorimotor tasks. Mn exposure caused lasting dysfunction in attention, reactivity to errors and reward omission, learning, and sensorimotor function, recapitulating the constellation of symptoms seen in ADHD children. MCS lessened Mn-induced attentional dysfunction and partially normalized reactivity to committing an error or not receiving an expected reward but provided no protection against Mn-induced learning or sensorimotor dysfunction. In the absence of Mn exposure, MCS produces lasting offspring benefits in learning, attention, and reactivity to errors. To conclude, developmental Mn exposure produces a constellation of deficits consistent with ADHD symptomology, and MCS offered some protection against the adverse Mn effects, adding to the evidence that maternal choline supplementation is neuroprotective for offspring and improves offspring cognitive functioning.

Is prevention of ADHD and comorbid conditions in adolescents possible?

OBJECTIVES: To examine how the concept of prevention is applicable to adolescent ADHD, which preventive interventions may be feasible, and which methods can be used to evaluate effectiveness. METHOD: Following a literature search for prevention clinical trials relevant to adolescent ADHD, selected studies are critically reviewed to identify suitable targets and promising interventions. RESULTS: There is some evidence from controlled studies that interventions delivered to prepubertal children at high risk for ADHD or diagnosed with ADHD may decrease the incidence or persistence of ADHD in adolescence. Uncontrolled follow-up of clinical samples and population studies suggest that treatment of adolescents with ADHD can decrease the risk for several negative functional outcomes in youth. A controlled trial found a specific cognitive training intervention to decrease risky driving. CONCLUSIONS: Prevention of ADHD and associated negative outcomes is possible and of high clinical relevance. Assessing prevention effects is methodologically challenging, but feasible.

The protective effect of thymoquinone or/and thymol against monosodium glutamate-induced attention-deficit/hyperactivity disorder (ADHD)-like behavior in rats: Modulation of Nrf2/HO-1, TLR4/NF-κB/NLRP3/caspase-1 and Wnt/ß-Catenin signaling pathways in rat model.

Both thymoquinone (TQ) and thymol (T) have been proved to possess a positive impact on human health. In this research, we aimed to investigate the effect of these compounds separately and together on the Attention-deficit/hyperactivity disorder (ADHD)-like behavior induced by monosodium glutamate (MSG) in rats. Forty male, Spargue Dawley rat pups (postnatal day 21), were randomly allocated into five groups: Normal saline (NS), MSG, MSG+TQ, MSG+T, and MSG+TQ+T. MSG (0.4 mg/kg/day), TQ (10 mg/kg/day) and T (30 mg/kg/day) were orally administered for 8 weeks. The behavioral tests proved that rats treated with TQ and/or T showed improved locomotor, attention and cognitive functions compared to the MSG group with more pronounced effect displayed with their combination. All treated groups showed improvement in MSG-induced aberrations in brain levels of GSH, IL-1ß, TNF-α, GFAP, glutamate, calcium, dopamine, norepinephrine, Wnt3a, ß-Catenin and BDNF. TQ and/or T treatment also enhanced the mRNA expression of Nrf2, HO-1 and Bcl2 while reducing the protein expression of TLR4, NFκB, NLRP3, caspase 1, Bax, AIF and GSK3ß as compared to the MSG group. However, the combined therapy showed more significant effects in all measured parameters. All of these findings were further confirmed by the histopathological examinations. Current results concluded that the combined therapy of TQ and T had higher protective effects than their individual supplementations against MSG-induced ADHD-like behavior in rats.

Trastorno por Déficit de Atención con Hiperactividad: Ritmo Circanual en el Mes de Nacimiento / Attention Deficit Hyperactivity Disorder: Circannual Rhythm in the Month of Birth

Estudiamos la existencia de ritmo circanual en el mes de nacimiento en participantes con trastorno de déficit de atención e hiperactividad (TDAH)y analizamos la asociación entre meses de nacimiento y TDAH. La muestra incluye 10978 participantes (1778 TDAH / 9200 no TDAH), entre 3 y18 años, reclutados mediante muestreo consecutivo de primeras consultas atendidas en salud mental entre 1992 y 2021. Los participantes conTDAH presentan un ritmo circanual significativo en los meses de nacimiento, con una acrofase en octubre. Nacer en el último cuatrimestre del añoincrementa significativamente la probabilidad de ser diagnosticado TDAH, controlando el efecto de sexo y edad. Con el transcurso de los meses delaño, existe una tendencia lineal creciente significativa de ser diagnosticado de TDAH, no observada en población general, ni en casos sin TDAH.Es necesario tener precaución en el diagnóstico y tratamiento de los niños nacidos en los últimos meses del año, que, por su mayor inmadurez encomparación con los demás niños de la clase, pudieran ser diagnosticados y tratados erróneamente como TDAH. (AU)

We studied the existence of circanual rhythm in the month of birthin participants with attention deficit hyperactivity disorder (ADHD) and analyzed the association between months of birth and ADHD. We analyzed10,978 participants (1,778 ADHD/9,200 non-ADHD), aged 3 to 18 years. A consecutive sample of first visits to mental health between 1992 and2021 is used. Participants with ADHD exhibit a significant circannual rhythm in the months of birth, with an acrophase in October. Being born in thelast quarter of the year significantly increases the probability of being diagnosed with ADHD, controlling for the effect of sex and age. As the monthsof the year go by, there is a significant increasing linear trend of being diagnosed with ADHD, which is not observed neither in general populationnor in cases without ADHD. Caution is necessary in diagnosis and treatment of children born in the last months of year, who, due to their greaterimmaturity compared to the other children in class, could be misdiagnosed and treated as ADHD. (AU)

El TDAH en la etapa preescolar: Una revisión narrativa / ADHD in Preschool: A Narrative Review

El Trastorno por Déficit de Atención (TDAH) es un trastorno del neurodesarrollo muy heterogéneo y altamente prevalente en población infanto-juvenil. La detección del TDAH en la etapa preescolar (entre los 3 y 5 años) permitiría intervenir de manera precoz, reducir sus síntomas y modificarel curso del trastorno. El presente estudio tiene como objetivo revisar de manera narrativa el concepto del TDAH en población preescolar, suscaracterísticas, los instrumentos que permiten su detección y los tratamientos disponibles. Los síntomas clínicos del TDAH en preescolares no sontan frecuentes como se ha pensado tradicionalmente y además presentan una gran validez predictiva, manteniéndose con frecuencia a lo largo delos años. La presentación del TDAH más frecuente en esta etapa es la hiperactiva/impulsiva y las presentaciones con predominancia de inatenciónaparecen con poca frecuencia. La evaluación del TDAH abarca la detección de psicopatología general que pueda ser comórbida al TDAH o bienque permita un correcto diagnóstico diferencial. Existen escalas de evaluación de síntomas de TDAH que son fiables para la detección clínica deltrastorno y deben combinarse con medidas que evalúen posibles dificultades asociadas. Las intervenciones familiares son las más frecuentementeutilizadas, no siendo recomendado el tratamiento farmacológico hasta los 6 años. Sin embargo, los resultados de efectividad de los tratamientosson poco robustos. Es necesaria una intervención preventiva precoz en la etapa preescolar con casos que presenten o estén en riesgo de presentarTDAH y no “sentarse y esperar” si bien se necesita encontrar intervenciones más efectivas. (AU)

Attention Deficit Disorder (ADHD) is a very heterogeneous and highly prevalent neurodevelopmentaldisorder in children and adolescents. The detection of ADHD in the preschool stage (between 3 and 5 years of age) would allow early intervention, reducing its symptoms and modifying the course of the disorder. The present study aims to review in a narrative way the concept of ADHD inpreschool population, its characteristics, the instruments that allow its detection and the available treatments. The clinical symptoms of ADHD inpreschoolers are not as frequent as traditionally thought and present a high predictive validity, being frequently maintained over the years. The mostcommon presentation of ADHD at this stage is hyperactive/impulsive and inattentive-dominant presentations occur infrequently. The evaluation ofADHD includes the detection of general psychopathology that may be comorbid to ADHD or that allows a correct differential diagnosis. SeveralADHD symptom assessment scales are reliable for the clinical detection of the disorder and should be combined with measures that assess possible associated difficulties. Family interventions are the most frequently used, and pharmacological treatment is not recommended until 6 years ofage. However, the results of treatment effectiveness are not very robust. Early preventive intervention is needed in the preschool stage with casesthat present or are at risk of presenting ADHD and not “sit and wait”, although more effective interventions need to be found. (AU)

State of the art and new directions of Quantitative Electroencephalography use in Differential Diagnosis of ADHD / Estado de la cuestión y uso de la electroencefalografía cuantitativa en el diagnóstico diferencial del TDAH

Advances in technology in recent years have made the use of quantitative electroencephalogram more accessible to clinicians. The incorporation ofnormative databases in QEEG studies and the possibility of detecting different electroencephalographic patterns in patients with a given pathology,despite showing an apparent symptomatology homogeneity, make it an interesting source of information. The relationship of these patterns with apossible response to treatment or with prognostic estimates would justify its inclusion as a routine test in the process of the differential diagnosisof ADHD. In this paper, we present the possible benefits of the use of QEEG in the differential diagnosis of ADHD, the different electroencephalographic patterns associated with ADHD most common in the literature, and a case showcasing the use of the technique in a patient with ADHD. (AU)

El avance de la tecnología en los últimos años ha hecho que el uso del electroencefalograma cuantitativo sea más accesible a los clínicos. La incorporación de bases de datos normativas enlos estudios de QEEG y la posibilidad de detectar diferentes patrones electroencefalográficos en pacientes con una patología determinada, a pesarde mostrar una aparente homogeneidad sintomatológica, hacen que sea una fuente de información interesante. La relación de estos patrones conuna posible respuesta a tratamientos o con estimaciones pronósticas justificarían su inclusión como prueba rutinaria en el proceso de diagnósticodiferencial del TDAH. En este trabajo se presentan los posibles beneficios del uso del QEEG en el diagnóstico diferencial del TDAH, los diferentespatrones electroencefalográficos asociados al TDAH más comunes en la literatura y un caso ilustrativo del uso de la técnica en un paciente con TDAH. (AU)

Hiperativos e desatentos à luz da Homeopatia

Dr. Antonio Carlos Resende irá fazer uma abordagem homeopática no tratamento do TDAH ( Transtorno do Déficit de Atenção e Hiperatividade), transtorno cada vez mais crescente nos tempos atuais e que foi agravada nesse tempo de pandemia! Palestrante: Dr. Antonio Carlos Silveira Rezende e participação do Dr. Marcio Ueda.

Adherence to Mediterranean diet and attention-deficit/hyperactivity disorder in children: A case control study.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. The Mediterranean diet as a plant-based diet has a beneficial effect on mental health. The present study was designed to investigate the association between adherence to Mediterranean diet and odds of ADHD in Iranian children. METHODS: This age and gender matched case-control study was conducted on 360 children 7-13 years old in Yazd, Iran. Children were categorized into new diagnosed case (n = 120) and control groups (n = 240). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV-TR) was used to diagnose ADHD. A validated food frequency questionnaire was used to measure food intake. The association of adherence to the Mediterranean with the odds ratio of ADHD examined by logistic regression. RESULTS: After adjusting for potential confounders including energy intake, parents' educational level, economic status, family history ADHD and physical activity, the children in the highest tertile of adherence to Mediterranean diet had a lower odd of ADHD (odds ratio [OR]: 0.49; 95% Confidence Interval [CI]: 0.27-0.89) compared to the children in the lowest. In addition, an association was observed between increasing trend adherence to Mediterranean diet and decrease odds of ADHD after full adjustments (P for trend <0.001). CONCLUSION: We found that higher adherence to Mediterranean diet containing vegetables, legumes, fruits and nuts, grains, and fish could decrease the odds of ADHD in primary school children. Further studies are suggested to approve our vision.

How the placenta-brain lipid axis impacts the nutritional origin of child neurodevelopmental disorders: Focus on attention deficit hyperactivity disorder and autism spectrum disorder.

Dietary fish is a rich source of omega-3 (n-3) fatty acids, and as such, is believed to have played an important role in the evolution of the human brain and its advanced cognitive function. The long chain polyunsaturated fatty acids, particularly the n-3 docosahexanoic acid (DHA), are critical for proper neurological development and function. Both low plasma DHA and obesity in pregnancy are associated with neurodevelopmental disorders such as attention deficit and hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in childhood, and n-3 supplementation has been shown to improve symptoms, as reviewed herein. The mechanisms underlying the connection between maternal obesity, n-3 fatty acid levels and offspring's neurological outcomes are poorly understood, but we review the evidence for a mediating role of the placenta in this relationship. Despite promising data that n-3 fatty acid supplementation mitigates the effect of maternal obesity on placental lipid metabolism, few clinical trials or animal studies have considered the neurological outcomes of offspring of mothers with obesity supplemented with n-3 FA in pregnancy.

Influence of Alcohol Consumption, Personality and Attention Deficit Hyperactivity Disorder on Traffic Offenders / Influencia del Consumo de Alcohol, la Personalidad y el Trastorno de Déficit de Atención e Hiperactividad en Delincuentes viales

Background: Despite the authorities’ efforts to promote responsible driving, traffic accidents are a notable cause of death in many countries. Scientific research shows that variables such as alcohol abuse and personality dimensions can contribute to explaining this social phenomenon and the rising number of traffic offences. The present study aims to explore how alcohol abuse, personality disorders and Attention Deficit Hyperactivity Disorder (ADHD) are associated with risky driving behaviour. Method: the sample included 300 subjects: the study group (199 convicted of traffic offences) and the control group (101 subjects from the general driving population). The tools used were the International Personality Disorder Scale, the Alcohol Use Disorders Identification Test and the Adult ADHD Self-Report Scale (ASRS). Results: a higher incidence of signs of paranoid, antisocial, impulsive, borderline and anxious personality traits was detected for the study group, as well as a higher prevalence of alcohol abuse. Conclusions: this research offers indications for the design of effective preventive and reinsertion interventions. It also highlights the importance of considering psychological dimensions to ensure road safety.(AU)

Antecedentes: Los accidentes de tráfico son una causa de muerte en muchos países, pese a los esfuerzos por promover una conducción responsable. La investigación sobre el problema muestra que variables como el abuso de alcohol y dimensiones de personalidad, contribuyen a explicar este fenómeno social y el aumento de la delincuencia vial. El propósito de este estudio es explorar cómo el abuso de alcohol, los trastornos de la personalidad y el Trastorno por Déficit de Atención e Hiperactividad (TDHA) se asocian a conductas de riesgo al volante. Método: Participaron 300 sujetos: un grupo de estudio (199 personas condenadas por delitos viales) y otro control (101 sujetos extraídos de la población general de conductores). Los instrumentos utilizados fueron el examen internacional de trastornos de la personalidad (IPDE), el cuestionario de identificación de trastornos por consumo de alcohol (AUDIT) y el cuestionario autoinformado de cribado del TDAH. Resultados: el grupo estudio presentó mayor incidencia de indicios de trastornos de personalidad paranoide, disocial, impulsivo, límite y ansioso; así como mayor prevalencia de abuso de alcohol. Conclusiones: El estudio ofrece claves para construir intervenciones preventivas y de reinserción eficaces, enfatizando la relevancia de dimensiones psicológicas para garantizar la seguridad en las vías públicas.(AU)

Breastmilk Feeding during the First 4 to 6 Months of Age and Childhood Disease Burden until 10 Years of Age.

BACKGROUND: Breastfeeding is recommended due to its beneficial effects on human health. However, the effect of breastfeeding on health differs, resulting in various childhood diseases. OBJECTIVE: Our purpose was to investigate the association between breastfeeding at least in the first 4 months and the subsequent development of 15 certainly defined childhood diseases until 10 years of age, the all-cause hospitalization rate and growth at 6-7 years of age. METHODS: Participants included propensity-score matched 188,052 children born between January 2008 and December 2009, who were followed up till 10 years of age. Data were taken from the National Investigation of birth Cohort in Korea study 2008 database. Risk ratios were obtained using a modified Poisson regression and weighted risk differences using binomial regression. RESULTS: Compared to formula feeding, breastfeeding was associated with decreased risks of febrile convulsion, attention deficit hyperactivity disorder and autism spectrum disorder, pneumonia, acute bronchiolitis, hypertrophic pyloric stenosis, asthma, all-cause hospitalization, overweight/obesity and short stature. Exclusive breastfeeding at 4 to 6 months of age had similar results to exclusive breastfeeding over 6 months of age. CONCLUSIONS: Breastfeeding in early infancy reduces the risk for various childhood diseases, all-cause hospitalization rate, obesity, and short stature during childhood.

Maternal exposure to pesticides during pregnancy and risk for attention-deficit/hyperactivity disorder in offspring: A protocol for systematic review and meta-analysis.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder in childhood. Studies explored the association of maternal exposure to pesticides during pregnancy with a risk of offspring developing ADHD, but have reported inconclusive results. Here, we will perform a systematic review and meta-analysis of observational studies to assess a possible association between them. METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. PubMed, Embase, Web of Science, the Cochrane Library, and the PsycINFO will be searched from inception to May 2021. Observational studies investigating the association of maternal exposure to pesticides during pregnancy with a risk of offspring developing ADHD will be considered. The Newcastle-Ottawa Scales or the scale of the Agency for Healthcare Research and Quality will be used to assess the methodological quality of the included studies according to their study design. A fixed or random-effect model will be used to synthesize data depend on the heterogeneity test. STATA version 12.0 will be used to conduct the meta-analysis. RESULTS: This study will provide a high-quality evaluation of association between maternal exposure to pesticides during pregnancy and risk for ADHD in offspring. CONCLUSION: This study will present evidence on whether maternal exposure to pesticides during pregnancy is a risk factor for ADHD in offspring.

Longer-Term Outcomes of the Incredible Years Parenting Intervention.

Conduct problems can develop into behavior disorders and put children at risk for other mental health problems. Parenting interventions have been shown to successfully reduce conduct problems and are often expected to prevent the development of broader mental health problems. Few studies have evaluated the longer-term and broader effects of these interventions. To what extent are parenting intervention effects sustained in the years after the intervention? And do effects pertain to conduct problems specifically, or do they also affect broader aspects of children's mental health? We used a randomized controlled trial to assess the longer-term (2.5 years) effects of the Incredible Years parenting intervention on children's conduct problems in an indicated prevention setting (N = 387; 79% retention rate). Using a multi-method (survey and computerized tasks) and multi-informant (parents, teachers, and children) approach, we tested whether initial effects on conduct problems were sustained, and whether Incredible Years had broader effects on children's peer problems, emotional problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, attention and inhibition deficits, and service use. Incredible Years, relative to control (no intervention), led to sustained reductions in parent-reported conduct problems (Cohen's d = 0.31), but not teacher- and child-reported conduct problems. There were no broader benefits: Incredible Years did not reduce children's peer problems, emotional problems, ADHD-symptoms, attention and inhibition deficits, or their service use. Improvements in parents' perceptions of child conduct problems sustained until 2.5 years later. Our findings do not show benefits of Incredible Years as a preventive intervention for children's broader mental health.

Risk and Protective Factors in Autism Spectrum Disorders: A Case Control Study in the Lebanese Population.

Autism spectrum disorders (ASD) are among the most common childhood neurodevelopmental disorders. Identification of risk and protective factors are necessary to improve the guidance of prevention and intervention strategies. Our study aims to determine the potential risk and protective factors in ASD in the Lebanese population. Our case-control study included 100 ASD patients and 100 healthy matched controls recruited from all the Lebanese districts. The data collected from the questionnaires was analyzed using SPSS 23.0. Independent Student T-test and Chi-Square test were carried out for the bivariate analysis of the data. In addition, the variables revealing a p-value < 0.05 were used for the multivariate logistic regression analysis. Multivitamins intake, especially omega 3 and vitamin B (Odds Ratio (OR) = 0.257; 95% Confidence Interval (CI) [0.115-0.579]), rich cereal diet (OR = 0.212; 95% CI [0.089-0.510]), and supplementation in iron during pregnancy (OR = 0.229; 95% CI [0.083-0.627]) were identified as protective factors against ASD. On the other hand, stress during pregnancy (OR = 6.339; 95% CI [2.845-14.125]), the presence of ASD patients in the family (OR = 7.878; 95% CI [1.877-33.065]) and the presence of attention deficit hyperactivity disorder (ADHD) patients in the family (OR = 6.981; 95% CI [1.362-35.789]) were associated with ASD. This study shed light on risk and protective factors associated with ASD in the Lebanese population. Further rigorous research, taking into consideration these factors, is needed to assist in early detection, prevention and subsequent intervention targeting ASD and its associated comorbidities, given that our study is not experimental and does not prove causality.

The Importance of Marine Omega-3s for Brain Development and the Prevention and Treatment of Behavior, Mood, and Other Brain Disorders.

Most of the global population is deficient in long-chain marine omega-3s. In particular, docosahexaenoic acid (DHA), a long-chain omega-3 fatty acid, is important for brain and eye development. Additionally, DHA plays a significant role in mental health throughout early childhood and even into adulthood. In the brain, DHA is important for cellular membrane fluidity, function and neurotransmitter release. Evidence indicates that a low intake of marine omega-3s increases the risk for numerous mental health issues, including Attention Deficit Hyperactivity Disorder (ADHD), autism, bipolar disorder, depression and suicidal ideation. Studies giving supplemental marine omega-3s have shown promise for improving numerous mental health conditions. This paper will review the evidence surrounding marine omega-3s and mental health conditions.

Empirically derived dietary patterns and food groups intake in relation with Attention Deficit/Hyperactivity Disorder (ADHD): A systematic review and meta-analysis.

BACKGROUND AND AIMS: Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent chronic psychiatric condition in children world wide. This study was aimed to provide an overview of food groups and dietary patterns in ADHD children as a systematic review. METHODS: The relation between dietary patterns and this disorder was also investigated through meta-analysis. Databases including Google Scholar, SCOPUS, ISI Web of science, and PubMed were searched up to June 2017. Studies on posteriori derived dietary patterns and food intakes of ADHD children were included. The achieved Relative Risks (RR) and Odds Ratio (OR) were pooled together for ADHD to compare the most and the least adherence to major dietary patterns. The heterogeneity was assessed by Cochran's Q test and I-squared methods. RESULTS: This systematic review consisted of 6 dietary patterns and 6 foods or macronutrients studies. In this regard, 6 dietary patterns studies (n: 8816) were included in the meta-analysis. The pooled analysis established that "healthy" dietary pattern significantly decreased the risk of ADHD (OR: 0·63; 95% CI: 0·41, 0·96), whereas "Western" (OR: 1.92; 95% CI: 1.13, 3.26; p:0.016) and "junk food" (OR: 1.51; 95% CI: 1.06, 2.16; p: 0.024) dietary patterns increased it. CONCLUSIONS: "Healthy" dietary pattern highly loaded with vegetables, fruits, legumes, and fish has decreased the odds of ADHD up to 37%. In addition, adherence to "junk food" pattern containing sweetened beverages and desserts as well as "Western" dietary pattern including red meat, refined grains, processed meats, and hydrogenated fat increased it.

[The prevention of externalizing disturbances]. / Prävention externaler Störungen ­ zum Stand der Forschung.

The prevention of externalizing disturbances Abstract. Objectives: Externalizing disturbances (attention deficit-hyperactivity disorders, oppositional defiant disorders, conduct disorders) in children and adolescents have a high prevalence, are stable over time, and precipitate a high individual and economic burden. Method: This review article presents the state of research based on selected current meta-analyzes and systematic reviews. Additionally, evidenced-based German-language prevention programs are discussed. Results: As in treatment, a multimodal approach to prevention is recommended which aims at reducing externalizing symptoms in specific settings. Interventions that focus on the specific environment in the family and the (pre-)school are preferable. Child-focused interventions are especially important in the context of peer-related problematic behavior because parent-based or teacher-based interventions may be less able to affect peer interactions. Conclusions: Comprehensive parent-based and (pre-)school-based preventive interventions of externalizing disturbances should be implemented. These should also include child-based approaches and additional parent-based group interventions. The effects of these interventions should be tested in large-scale studies.

Association Between Greenness Surrounding Schools and Kindergartens and Attention-Deficit/Hyperactivity Disorder in Children in China.

Importance: Few studies have investigated the association between greenness and childhood attention-deficit/hyperactivity disorder (ADHD). Objective: To evaluate the association between greenness surrounding schools or kindergartens and symptoms of ADHD in children. Design, Setting, and Participants: This population-based cross-sectional study was performed between April 2012 and January 2013 in 7 cities in northeastern China. This analysis included 59 754 children (aged 2-17 years) from 94 schools and kindergartens, who had resided in the study area for 2 years or longer. Data were analyzed from April 15, 2019, to October 10, 2019. Exposures: Greenness surrounding each child's school or kindergarten was estimated using 2 satellite image-derived vegetation indexes: the normalized difference vegetation index and the soil-adjusted vegetation index. Main Outcomes and Measures: Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) scales were used to measure ADHD symptoms (9 inattention symptoms and 9 hyperactivity-impulsivity symptoms). Parents or guardians rated the frequency of each of 18 ADHD symptoms during the preceding 6 months. Children with 6 or more symptoms of either inattention or hyperactivity-impulsivity were defined as having ADHD symptoms. Generalized linear mixed models were applied to estimate the association between greenness and ADHD symptoms. Results: The mean (SD) age of the 59 754 study participants was 10.3 (3.6) years, and 29 494 (49.4%) were girls. A total of 2566 participants (4.3%) had ADHD symptoms. Greenness levels differed substantially across schools and kindergartens. The normalized difference vegetation index within 500 m of a school or kindergarten ranged from -0.09 to 0.77. Greater greenness levels were associated with lower odds of ADHD symptoms. In covariate-adjusted models, a 0.1-unit increase in normalized difference vegetation index or soil-adjusted vegetation index within 500 m of a school or kindergarten was significantly associated with lower odds of ADHD symptoms (odds ratios, 0.87 [95% CI, 0.83-0.91] and 0.80 [95% CI, 0.74-0.86], respectively; P < .001 for both). The associations were robust in a series of sensitivity analyses. Conclusions and Relevance: These findings suggest that there may be a beneficial association between school-based greenness and ADHD symptoms in Chinese children. Future longitudinal and mechanistic studies are needed to confirm the findings of this cross-sectional analysis and further explore potential mechanisms of this association.

Training attention in children with acquired brain injury: a study protocol of a randomised controlled trial of the TALI attention training programme.

INTRODUCTION: Childhood inattention has been linked with poor academic outcomes, and increased lifetime social, occupational and psychiatric morbidity. Children with an acquired brain injury (ABI) are particularly susceptible to attention deficits and may benefit from interventions aimed at enhancing attention. The primary objective of this study is to evaluate the short-term efficacy of the TALI Train programme, compared with a placebo, on the outcome of attention in children with ABI. METHODS AND ANALYSIS: The study is a parallel, double-blind, randomised controlled trial. Participants will consist of 80 children with a diagnosis of ABI aged 4-9 years 11 months. Participants will be randomly allocated to either (1) TALI Train (intervention group), an adaptive game-based attention training programme, or (2) a non-adaptive placebo programme (control group). Both programmes are delivered on a touchscreen tablet, and children complete five 20 min sessions per week for a 5-week period at home. Assessment of selective, sustained and executive attention (primary outcomes), and behavioural attention, working memory, social skills and mathematics ability (secondary outcomes) will occur at baseline, post-training, and at 3-month and 6-month follow-up to assess immediate and long-term efficacy of TALI Train compared with placebo. Assessments will be completed at the Royal Children's Hospital in Melbourne, Australia. All assessments and analyses will be undertaken by researchers blinded to group membership. Latent growth curve modelling will be employed to examine primary and secondary outcomes. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the Royal Children's Hospital Human Research Ethics Committee (HREC) (38132) and the Monash University HREC (17446). Results will be disseminated through peer-reviewed journals, conference presentations, media outlets, the internet and various community/stakeholder activities. TRIAL REGISTRATION NUMBER: ACTRN12619000511134.

Exposure to antibiotics in the first 24 months of life and neurocognitive outcomes at 11 years of age.

RATIONALE: Antibiotics are commonly prescribed for infants. In addition to increasing concern about antibiotic resistance, there is a concern about the potential negative impact of antibiotics on the gut microbiota and health and development outcomes. OBJECTIVE: The aim of this study was to investigate the association between early life antibiotic exposure and later neurocognitive outcomes. METHODS: Participants were infants born to mothers enrolled in the probiotics study. The initial study was designed to evaluate the effect of two different probiotics on allergy outcomes in childhood. Antibiotic exposure was based on parent report and categorised according to the following timing of the first exposure: 0-6 months, 6-12 months, 12-24 months or not at all. At 11 years of age, children's neurocognitive outcomes were assessed using psychologist-administered, parent-report and self-report measures. The relationship between the timing of antibiotic exposure and neurocognitive outcomes was examined using regression models. RESULTS: Of the 474 participants initially enrolled, 342 (72%) children had a neurocognitive assessment at 11 years of age. After adjustment for mode of delivery, probiotic treatment group assignment, income and breastfeeding, children who had received antibiotics in the first 6 months of life had significantly lower overall cognitive and verbal comprehension abilities, increased risk of problems with metacognition, executive function, impulsivity, hyperactivity, attention-deficit hyperactivity disorder, anxiety and emotional problems. CONCLUSIONS: These results provide further evidence that early exposure to antibiotics may be associated with detrimental neurodevelopmental outcomes.