Insecure maternal attachment is associated with depression in ADHD children.

The objective of this study was to analyze the possible association between maternal attachment style and comorbidity associated with childhood ADHD. We evaluated a total of 103 children with ADHD treated at a Child and Adolescent Mental Health Centre and their mothers. Comorbidity was evaluated using the MINI-KID interview. Maternal attachment was evaluated using the Adult Attachment Questionnaire. We considered child variables that could be associated with the clinical course of ADHD, such as symptom severity, age, gender, evolution time, academic level, and current pharmacological treatment; parental variables, such as the mother's psychiatric history, current psychopathology, marital status, academic level, income, and employment, were also considered. We found an association between maternal insecure attachment and comorbid depressive disorder in childhood ADHD. An insecure maternal attachment style must be considered in the assessment and treatment of childhood ADHD with comorbid depression.

Maternal psychiatric history is associated with the symptom severity of ADHD in offspring.

Controversy exists about the role of parent psychopathology in persistence and severity of attention deficit hyperactivity disorder (ADHD) symptoms in their children. Here we aimed to analyse the potential association between the severity of ADHD symptoms in children and the presence of psychiatric and ADHD symptoms in their biological parents. Seventy-three triads of children and their parents who were in active treatment for their diagnosed ADHD were evaluated in our Child and Adolescent Mental Health Centers. The mental health of the parents was also assessed. The general psychopathology of the parents was evaluated using the Symptom Checklist-90-R (SCL-90-R), and symptoms of hyperactivity were examined using the Adult ADHD Self-Report Scale (ASRS v.1.1). The severity of symptoms in children was assessed using the ADHD Rating Scale-IV (ADHD-RS-IV). Variables that could have affected the clinical development of ADHD such as sex, evolution time, age, academic level and the presence of comorbidities were controlled. The severity of the symptoms in children with ADHD was significantly related to the psychiatric history of their mother, the younger age of the child and the presence of a comorbid conduct disorder in the child. We discussed the importance of screening for parental psychopathology in clinical practice.

[The course of attention deficit/hyperactivity disorder in an outpatient sample]. / Curso del trastorno por déficit de atención y/o hiperactividad en una muestra ambulatoria.

INTRODUCTION: Attention Deficit Hyperactivity Disorder may be a disorder of with a poor prognosis and more so when associated with psychosocial risk factors. The aim of this study is to identify clinical and psychosocial risk factors associated with poor prognosis of this disorder. PATIENTS AND METHODS: In a sample of 88 patients was followed up at our Child and Adolescent Mental Health Centres for two or more years. We classified subjects using the Clinical Global Impression Scale of Improvement following the clinical course in three categories (improved, worsened and unchanged). We performed bivariate and univariate logistic regressions to study the association between the variables and outcome. RESULTS: Worsened and unchanged groups (30% of the sample) had more psychiatric comorbidity, a higher percentage of individuals with no drug treatment, and presence of the following social risk factors: inadequate parenting, adverse social and family environment and psychosocial stress. The highest degree of association is related to the absence of drug treatment (OR=15.8, 95% CI 2.71 to 92.19, P=.002) and the presence of two comorbidities (OR=4.8, 95% CI 1.02 to 22.64, P=.047). CONCLUSIONS: In our sample of ADHD outpatients, there was a subgroup that was unchanged or worsened. Drug therapy, psychological treatment, detection and clinical management of comorbidity and some of the psychosocial risk factors can influence the course and outcome of ADHD and therefore the standard treatment of these patients needs to be considered.

Curso del trastorno por déficit de atención y/o hiperactividad en una muestra ambulatoria / The course of attention deficit/hyperactivity disorder in an outpatient sample

Introducción: El trastorno por déficit de atención y/o hiperactividad puede ser un trastorno de mal pronóstico y más cuando se asocia a algunos factores de riesgo psicosocial. Objetivo: Detectar variables clínicas y factores de riesgo psicosocial asociados al mal pronóstico del trastorno. Pacientes y métodos: En una muestra de 88 pacientes seguidos en nuestros centros de salud mental infanto-juvenil durante dos o más años, clasificamos los sujetos utilizando la escala de impresión clínica global de mejoría según evolución clínica en tres categorías (mejoría, empeoramiento y sin cambios). Realizamos análisis bivariados y regresión logística univariada para estudiar la asociación entre las variables y el desenlace clínico. Resultados: Los grupos sin cambio y empeoramiento (el 30% de la muestra) presentaban mayor comorbilidad psiquiátrica, mayor porcentaje de individuos con ausencia de tratamiento farmacológico y mayor presencia de los siguientes factores de riesgo social: crianza inadecuada, ambiente sociofamiliar adverso y estrés psicosocial. El mayor grado de asociación se relacionó con la ausencia de tratamiento farmacológico (OR=15,8; IC 95% 2,71 - 92,19, p=0,002) y con presentar dos comorbilidades (OR=4,8; IC 95% 1,02 - 22,64, p=0,047). Conclusiones: En nuestra muestra ambulatoria de TDAH hay un subgrupo que no cambia o empeora. El tratamiento farmacológico, psicológico, la detección y el manejo clínico de la comorbilidad y de algunos de los factores de riesgo psicosocial pueden influir en el curso y evolución del TDAH y por lo tanto es necesario considerarlos en el tratamiento estándar de estos pacientes(AU)

Introduction: Attention Deficit Hyperactivity Disorder may be a disorder of with a poor prognosis and more so when associated with psychosocial risk factors. The aim of this study is to identify clinical and psychosocial risk factors associated with poor prognosis of this disorder. Patients and methods: In a sample of 88 patients was followed up at our Child and Adolescent Mental Health Centres for two or more years. We classified subjects using the Clinical Global Impression Scale of Improvement following the clinical course in three categories (improved, worsened and unchanged). We performed bivariate and univariate logistic regressions to study the association between the variables and outcome. Results: Worsened and unchanged groups (30% of the sample) had more psychiatric comorbidity, a higher percentage of individuals with no drug treatment, and presence of the following social risk factors: inadequate parenting, adverse social and family environment and psychosocial stress. The highest degree of association is related to the absence of drug treatment (OR=15.8, 95% CI 2.71 to 92.19, P=.002) and the presence of two comorbidities (OR=4.8, 95% CI 1.02 to 22.64, P=.047). Conclusions: In our sample of ADHD outpatients, there was a subgroup that was unchanged or worsened. Drug therapy, psychological treatment, detection and clinical management of comorbidity and some of the psychosocial risk factors can influence the course and outcome of ADHD and therefore the standard treatment of these patients needs to be considered(AU)