Validation and bifactor structure of the French Adult ADHD Symptoms Rating Scale v1.1 (ASRS).

BACKGROUND: Three scoring methods for the widely available Adult ADHD Symptoms Rating Scale v1.1 (ASRS) have been proposed to screen for ADHD, but these three methods have rarely been compared against formal clinical diagnoses. We aimed to validate the French version of the ASRS against a clinical interview using DSM-IV and DSM-5 diagnostic algorithms. METHODS: One hundred five adults from a convenience sample were evaluated with the ASRS and the DIVA 2.0, using both DSM-IV and DSM-5 criteria. We used Confirmatory Factor Analysis to investigate the underlying structure of the ASRS. Sensitivity, specificity, and classification accuracy were compared between the rating algorithms of the ASRS. RESULTS: The full score method had worse predictive performance than the Screener and the 2-stage scoring method. All characteristics of the three scoring methods for the ASRS were worse when applying DSM-5 criteria. The best-fitting structure was a bi-factor model with a general ADHD factor and three specific factors. CONCLUSIONS: ADHD was best conceived as a one-dimensional construct. The 2-stage scoring method superseded the Screener with comparable sensitivity and specificity.

Retrospective diagnosis of childhood ADHD using the Wender Utah Rating Scale.

OBJECTIVE: An external validation of the Wender Utah Rating Scale (WURS) against a clinical assessment is lacking, especially for French-speaking populations. METHOD: Participants completed three subsets of the WURS-61 and were assessed for ADHD using the DIVA 2.0 semi-structured interview. Exploratory factor analyses were performed. Logistic regression models and Receiver-Operating Curves were used to determine the cut-off scores that predicted childhood ADHD with best accuracy. RESULTS: One hundred three adults were included. Three factors were extracted for the WURS-25 and WURS-K, and four for the WURS-29. Cut-off scores are 44, 24 and 42, respectively. When considering DSM-5 rather than DSM-IV criteria, these values changed to 44, 36 and 44, respectively. More than 83% of the participants had been correctly classified. CONCLUSION: All three subsets of the WURS-61 retrospectively predict the presence of ADHD in childhood. This result might prove to be useful in screening and research procedures.

[Barriers to access to care evaluation scale (bace-3) psychometric properties of the french version in a naturalistic ambulatory psychiatric community setting]. / Les barrières à l'accès aux soins : validation de la BACE-3 française.

OBJECTIVES: To translate into French and validate the BACE-3 scale (Barriers to Care Evaluation) and describe the barriers to access to care in mental health settings. METHODS: The instrument was translated into French with its author's authorisation and her supervision. Three outpatient consultation centres and two day hospitals in the same geographical region were involved. We included patients aged between 18 and 6years under regular follow-up with psychiatrists and diagnosed with a psychotic disorder, a bipolar disorder, a mood disorder, a personality disorder, an anxiety disorder or a somatoform disorder, all according to ICD-10 criteria. To be included subjects further had to have sought some health care support in the last twelve months or be be regularly treated in a continuous way at the time of inclusion. RESULTS: One hundred twenty-one patients were successively included during a regular consultation. The exploratory factor analysis of the 30-item BACE-3 yielded to a method factor (items that could only be answered by patients with a family and/or at work were recoded) and two clinically meaningful factors were named, Stigmatisation and Cognitive Bias and Denial. We found that the first factor was nicely in line with the factors we had extracted from the Internalized Stigma Mental Illness (ISMI) scale in the same sample. This provided an external validation of the BACE but it was difficult to conclude any further given the limited size of our sample. CONCLUSIONS: Barriers to care need to be addressed by clinicians. Internal and external validity properties of the BACE-3 scale show it can be used in French-speaking populations of outpatients suffering from mental health problems.

[How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak?] / Comment les enfants et adolescents avec le trouble déficit d'attention/hyperactivité (TDAH) vivent-ils le confinement durant la pandémie COVID-19 ?

OBJECTIVES: During the COVID-19 pandemic, the French government has decided a general lockdown. This unprecedented situation has raised concerns about children's and adolescent's mental health. Children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) may find this context of restrained activity particularly tricky. The objectives of our study are to gather information about the well-being and global life conditions of children and adolescents with ADHD during the COVID-19 outbreak in France. METHODS: We designed a survey including both open-ended questions and questionnaire items for parents of children and adolescents with ADHD. Parents responded to the following open-ended questions: 1) "How is your child doing since the lockdown?" 2) "How is life at home since the lockdown?" 3) "If you had a remote service provision with a mental health professional (e.g. by telephone or video technology), please share your thoughts and any suggestions with us" 4) "Please share any other items that you think are important about ADHD symptoms of your child and the lockdown situation". This survey was posted on social media on the 6th of April and disseminated by French ADHD-parent and patient organizations. The present article reports the descriptive, qualitative and textometrical analyses of the survey. RESULTS: Between day 20 and 30 of lockdown, 538 parents responded to the survey, and we included 533 responses in the final analysis. The vast majority of responders were women 95 % (95 % CI 93,50; 97,18) with children whose mean age was 10,5 (95 % CI 7.58; 13.44). Since the lockdown, 34.71 % (95 % CI 30.70; 38.94) of children experienced a worsening in well-being, 34.33 % (95 % CI 30.34; 38.56) showed no significant changes and 30.96 % (95 % CI 27.09; 35.10) were doing better according to their parents. The thematic analysis showed that an improvement of their children's anxiety was one of the main topics addressed by parents. This improvement related to less school-related strain and flexible schedules that respected their children's rhythm. Improved self-esteem was another topic that parents linked with a lesser exposure of their children to negative feed-back. Parents repeatedly reported both inattention and hyperactivity/impulsivity. However, optimal lockdown life conditions seemed to compensate for the impact of ADHD symptoms (e.g. sufficient space at home, presence of a garden). Some parents reported worsening of general well-being in their children, and this manifested as oppositional/defiant attitudes and emotional outbursts. Parents also cited sleep problems and anxiety in this context. As regards everyday life during lock-down, at-home schooling was another major topic-parents described that their children struggled to complete school-related tasks and that teachers seemed to have forgotten about academic accommodations. The lockdown situation seems to have raised parents' awareness of the role of inattention and ADHD symptoms in their children's learning difficulties. Due to potential selection biases, the results of our survey may not be generalizable to all children and adolescents with ADHD. The main strengths of this rapid survey-based study lies in the reactivity of the participants and the quality and diversity of their responses to the open-ended questions. CONCLUSIONS: According to their parents, most children and adolescents with ADHD experience stability or improvement of their well-being. An improvement in school-related anxiety and the flexible adjustment to the children's' rhythms as well as parents' increased awareness of the difficulties their children experience are among the key topics in parents' descriptions.

[Pharmacological management of anxiety in patients suffering from schizophrenia]. / Prise en charge médicamenteuse de l'anxiété chez le patient souffrant de schizophrénie.

INTRODUCTION: Anxiety is a major and frequent symptom of schizophrenia, which is associated with an increased risk of relapse, impaired functioning, lower quality of life and increased incidence of suicide attempts. Despite its clinical relevance, anxiety in schizophrenia remains poorly understood. In the prodromic phase, anxiety indicates a progression towards psychotic decompensation. After a first episode, it is an indicator of relapse. LITERATURE FINDINGS: Two approaches have been used to investigate anxiety in schizophrenia: (i) categorical approach (comorbidity of schizophrenia and anxiety disorders) and (ii) dimensional approach (anxiety as a major symptom of the "dysphoric" dimension). Clinical categorical studies reported an increased frequency of comorbidity between schizophrenia and obsessive-compulsive disorder, panic disorder, social phobia, post-traumatic stress disorder, generalized anxiety disorder, agoraphobia, and specific phobia. The dimensional approach proposes that five different factors contribute to the structure of the Positive and Negative Syndrome Scale (PANSS), with anxiety as a major symptom of the "dysphoria" dimension. Concerning diagnosis, it is unclear whether psychotic and neurotic anxiety differs in nature or intensity. Nevertheless, both are frequently opposed. DISCUSSION: Psychotic anxiety is intense, profound and hermetic. In contrast to neurotic anxiety, it is associated with psychomotor disturbances, such as agitation and sideration. There is no specific tool to evaluate anxiety in schizophrenia. The dimensional approach usually runs an evaluation using items or factors extracted from the most widely-used scales, i.e. PANSS or Brief Psychiatric Rating Scale (BPRS) or from anxiety scales developed in non-schizophrenic populations, such as the Hamilton Anxiety Scale (HAMA). Recently, we developed a specific scale for hetero-evaluation (Échelle Anxiété Schizophrénie [EAS scale]). The EAS scale was recently validated and the study of its sensitivity is ongoing. THERAPEUTICAL ISSUES: Several studies have examined the effects of antipsychotics on the anxious/depressive cluster extracted from the PANSS, and some other studies have specifically evaluated the effect of antipsychotics on depressive symptoms using the Montgomery and Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS), but to our knowledge, no study has reported the effect of antipsychotics or other treatment on anxiety when using a schizophrenia-specific scale. There are no specific guideline treatments for anxiety in schizophrenia. Among phenothiazines, cyamemazine is frequently prescribed in France, because of its potent anxiolytic activity and good neurological tolerance. Some authors have suggested a specific treatment with benzodiazepines. However, benzodiazepines should be used with caution, due to undesirable actions such as dependence, rebound and potentiation of certain lateral effects.

Updated European Consensus Statement on diagnosis and treatment of adult ADHD.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Reliability of the Spanish version of the Composite Scale of Morningness.

AIM: The aim of this study was to examine the reliability of the Spanish version of Composite Scale of Morningness (CSM) and its ability to measure the circadian typology. SUBJECTS AND METHODS: Voluntary and unpaid psychology students (N= 391; 132 men and 259 women), aged between 17 and 33, completed the questionnaire between the months of September and December. RESULTS: The total score was independent of age and gender, with a close to normal distribution and a non-significant negative skewness. The internal consistency was high (Cronbach's alpha= 0.87) and factor analysis extracted three factors labeled Time of Retiring (items 2 and 7), Activity Planning (items 8, 9, and 13) and Morning Affect (items 3-6, and 10-12). With the 10th and 90th percentiles as cut-off scores, scorers below 22 (N= 40; 10.2%) are classified as evening-types and scorers above 39 as morning-types (N= 28; 7.2%). CONCLUSION: The Spanish questionnaire shares most of the good psychometric properties of other versions of the CSM, and thus can be used for Spanish-speaking student samples. Nevertheless, further studies of normative data in workers and aged subjects are needed in order to validate CSM.

[Morningness-Eveningness for Children Scale: psychometric properties and month of birth effect]. / L'échelle de matinalité pour enfants et adolescents: propriétés psychométriques et effet du mois de naissance.

There is strong evidence that individuals can be arranged on a continuum from Eveningness to Morningness reflecting their preferred time range for different activities. This preference, which mostly reflects the phase of the circadian pacemaker, is determined in part by mutations on the CLOCK gene, and by environmental factors such as the month of birth. It has been suggested that eveningness might be a susceptibility factor for depressive disorders. Two self-rated questionnaires are available (the Morningness-Eveningness Questionnaire, MEQ, and the Composite Scale for Morningness) and have been adapted for use with youngsters: the Junior-MEQ and the Morningness-Eveningness Scale for Children (MESC), respectively. Most studies concern adult samples, but it is accepted that puberty is associated with a phase delay in the circadian pacemaker die a shift towards eveningness) occuring around age 12 in both genders. In this study, we examined the psychometric properties of the French version of the MESC in 3 independent samples of adolescents (total n = 392) recruited in the community or during hospitalization in paediatric department, most of them after they attempted suicide. A three-way ANCOVA showed no gender or age effect but rather a strong group effect: hospitalized adolescents scored about 3 points below the community samples (ie towards an eveningness tendency). In each sample, the internal consistency for this 10-item measure was satisfactory (mean alpha = 0.76) and the same two-factor structure was found (Morningness and Planification) as shown by procrustes rotations. As expected, there was a negative correlation between the MESC scores and reported times of rising, of going to bed, of best intellectual and physical performances, but no correlation with the number of minutes of sleep needed. The test-retest stability was acceptable within a 8-month delay although the sample size was limited (n = 20). In line with literature data, we found a modest negative correlation about -0.20 in 2 of the samples with two depression measures (MADRS and CES-D). Finally, we assessed the effect of the month of birth on the MESC total score by a non-linear regression adjusted for age and gender that included a one-cycle cosinus function. We found that birth in March-April was associated with eveningness while birth in September-October was associated with morningness. The peak and nadir occur two months before those found in a large sample of young adults. However, this result could not be replicated in the sample of hospitalized adolescents suggesting that the effect might have been smoothed by a "pathological" factor. Reasons for this descrepancy and implications for developmental psychiatry are discussed. More precisely, we postulate a relationship between morningness and impulsivity-related personality traits. In conclusion, the MESC is a psychometrically sound instrument in need of further validity assessment.

[A new patient focused scale for measuring quality of life in schizophrenic patients: the Schizophrenia Quality of Life Scale (SOL)]. / Création et validation d'un autoquestionnaire mesurant la qualité de vie de patients souffrant de schizophrénie: l'échelle schizophrenia quality of life (SOL).

UNLABELLED: RATIONALE/OBJECTIVE: Quality of Life (QOL) has been recognized as an important measure of the outcome of patients by clinicians and policy makers in Mental Health. The emerging consensus in the health field that personal values and the patient's preferences are important in monitoring the quality of medical care outcomes makes it even more important to assess the patient's perspectives. Unfortunately, there is little consensus about what constitutes QOL or how to measure it, particularly in psychotic patients. The objective of this study is to report the stages of development and validation of a QOL questionnaire based on issues pertinent to patients with schizophrenia. METHOD: During a first phase, identical pattern were identified among interviews (conducted by psychologists) of schizophrenic patients (DSM IV, n = 100), mental health staff (n = 20) and families (n = 20). The data gathered in the first phase were discussed and organized, by 25 experts, into a structure that made up the skeleton of the scale (133 items, 17 factors). Based on a prospective epidemiological study conducted with 337 French psychiatrists, a validation analysis of structural and psychometric proprieties was performed. Finally reliability of the scale was assessed by a second test/retest (D0, D7) study (n = 100). RESULTS: A total of 686 schizophrenic, schizophreniform or schizoaffective patients (DSM IV) were included. Internal consistency analysis identified 14 factors (74 items), all with a Cronbach's alpha of at least 0.75: professional life (0.95), affective and sexual life (0.92), illness knowledge (0.90), relationship (0.92), life satisfaction, (0.87), coping with drugs (0.79), drugs impact on the body (0.87), daily life (0.83), family relationship (0.81), future (0.88), security feeling (0.84), leisure (0.87), money management (0.76) and autonomy (0.75). Construct validity was confirmed (Pearson test) using established clinical (Brief Psychiatry Rating Scale and Clinical Global Improvement), social (Psychological Aptitude Rating Scale) and generic quality of life (Functional Status questionnaire) measures, correlation coefficient was significant for all factors but 2 in the BPRS (illness knowledge and coping with drugs) and 3 in the CGI (illness knowledge, coping with drugs and life satisfaction). Lastly, test/retest indicated high reliability for each factor (p < 0.001), the lower correlation coefficient (r) was 0.526. CONCLUSIONS: The Schizophrenia Quality Of Life-scale (SOL), based on a patient's point of view approach, is an efficient, multidimensional instrument designed for the measurement of the consequences of schizophrenia on individuals' lives.

Whole blood serotonin content, tryptophan concentrations, and impulsivity in anorexia nervosa.

BACKGROUND: We hypothesized that anorectics with or without bulimic features would differ on impulsivity and indices of central serotoninergic function (high impulsivity being correlated with reduced serotoninergic function). METHODS: For all patients impulsivity rating scales and questionnaires detailing severity of eating disorder were assessed, and whole blood serotonin concentration (5-HT), free and total tryptophan (TT) concentrations, and large neutral amino acids (LNAA) were assayed. RESULTS: Nineteen patients with anorexia nervosa were included, 10 presented associated bulimic features and nine did not. Twelve healthy matched controls were also included. Our hypothesis was not verified. However, tryptophan concentration and the ratio of tryptophan concentration to LNAA allow us to separate controls from anorectics, whereas 5-HT concentration does not. Two significant and positive correlations were found: between impulsivity and anxiety in the total anorectic population, and between anxiety and serotonin in the impulsive group. CONCLUSIONS: All measured peripheral biologic indices except 5-HT concentration may be of interest in this pathology. Impulsivity and anxiety seem to be two personality components involved in anorexia nervosa. This study lead us to the necessity of redefining impulsivity in anorexia nervosa.

Relationship between impulsivity and platelet serotonin content in adolescents.

The relationship between impulsivity and serotonin function was explored in impulsive and non-depressed adolescents. Platelet serotonin content was chosen as a peripheral indicator of central serotonin function. Impulsivity was assessed with a questionnaire. All measures were performed once a week over a 6-week period for all subjects. Subjects comprised eight adolescent inpatients who were hospitalized as a result of their impulsive acts and eight healthy age- and sex-matched control subjects. Mean platelet serotonin concentration was significantly higher in the impulsive group than in the control group. Platelet serotonin concentration was positively correlated with the intensity of impulsivity in the patient group.

Psychometric properties of the French version of the composite scale of morningness in adults.

The objective of this study was to provide a reliable instrument to measure morningness for upcoming studies in French samples, using the Composite Scale of Morningness (CSM), which has been translated into French. Nursing students (n = 356) completed the questionnaire between February and March 1997. The total score obtained was independent of age and gender, and normally distributed. The reliability was high (Cronbach's alpha = 0.85), and factorial analysis confirmed the unidimensionality of the scale. Evening-type subjects are thought to score under 31, and morning-type subjects are thought to score above 44. As an external validation, morningness was associated, on weekdays and weekends, with early rising times and bedtimes and early peak times of physical and mental performance. In conclusion, we found that the English and the French versions of the Composite Scale of Morningness gave identical results. The scale is reliable and can be used for French-speaking adult samples. Nevertheless, normative data and other external validity criteria are needed.

The composite scale of morningness: further psychometric properties and temporal stability.

OBJECT: To assess the temporal stability of the French version of the Composite Scale of Morningness (CSM), and to replicate our previous findings in an independent sample in order to confirm the good internal properties of this instrument. METHOD: Sixty nursing students (11 males and 49 females) filled out the Composite Scale of Morningness on two occasions over a 13-month period. RESULTS: The scale's reliability is high: Cronbach's alpha = 0.874 in males and 0.904 in females. The CSM total scores are normally distributed and independent of gender. They do not differ between occasions, and are highly correlated: r = +0.885 in males and r = +0.930 in females. CONCLUSION: The French version of the CSM is stable over time and psychometrically reliable. These are the characteristics of a personality trait. Further studies should explore its personality, biological and genetic correlates.

[Neurocognitive subtypes of schizophrenia according to performance at verbal fluency tasks]. / Différenciation de sous-types de troubles schizophréniques en fonction des performances au test de fluence verbale.

UNLABELLED: There is a general agreement that schizophrenia is an heterogeneous disorder and cognitive performances could be an interesting feature in order to allow a better description of specific subtypes. The aim of this study was: 1) to describe clinical and neuropsychological performances of 45 DSM IV schizophrenic patients divided in two groups according to their performances in verbal fluency task; 2) to compare each group with the performances of healthy subjects matched for sex, age and education. METHOD: The differentiation criteria was the total number of words generated during 3 formal and 3 semantic fluency tasks. Data were analysed using a disjoint clustering procedure with Euclidean distance. A two cluster solution was considered optimal. Cluster S1 includes 21 schizophrenic subjects defined as low performer (range: 40-83, mean 66.7). Cluster S2 includes 24 schizophrenic subjects (range: 87-158, mean 102.8). All schizophrenic patients were clinically evaluated with SANS, SAPS and a psychosocial aptitude rating scale (PARS). Patients and controls were assessed with the following battery: verbal fluency, Trail making test A & B, Stroop test, Brown Peterson paradigm for evaluation of working memory. RESULTS: Patients with low verbal fluency had significantly higher scores at the SANS and PARS. Furthermore, the low performers (cluster S1) were differentiated from those with better performances (cluster S2) by significantly poorer results in all neuropsychological tests. Comparison with healthy subjects indicated that cluster S1 patients also had significantly poorer results in all neuropsychological tests. Relative to their 24 controls cluster S2 patients performances was lower in all measures excepted in one subscore of the Stroop test and in the number of cluster produced. This later result could indicate that some capacities for willed intention were preserved in this group and that the alteration in verbal fluency performances were better explained by impairment of the other cognitive processes. DISCUSSION: These findings point out that: 1) use of performance in cognitive executive task such as verbal fluency is a possible criteria in order to separate different types of schizophrenic patients; 2) in the two groups of schizophrenic subjects, various processes defects underline cognitive performances indicating the presence of different neurobiological dysfunctioning.

[Attention-deficit/hyperactivity disorder in childhood/adolescence and impairments associated with daily life: French data from the European Lifetime Impairment Survey]. / Retentissements au quotidien du trouble déficit de l'attention/hyperactivité durant l'enfance et l'adolescence : données françaises issues de l'enquête européenne LIS.

Attention-deficit/hyperactivity disorder (ADHD) has a 3-5 % prevalence in Europe and North America. It is associated with functional impairment and can have a negative impact on social and family relationships and daily living. The experiences of children/adolescents with ADHD in Europe, as reported by parents/caregivers who completed the online Lifetime Impairment Survey (LIS), were evaluated. The LIS was conducted in France, Germany, Italy, Spain, the Netherlands, and the UK to assess the extent to which the daily lives of children/adolescents (aged<20 years) with ADHD are affected by their disorder as reported by parents/caregivers. Participants to the survey were recruited by email from the GfK Global Online Panel, which consisted of a database of 487,533 members (including 85,512 members in France). The control group comprised parents/caregivers of children/adolescents without ADHD. Treatment for ADHD, as perceived by parents/caregivers of children/adolescents with ADHD, was also reviewed. Data from France are described here. In France, 157 (79 with ADHD, 78 without ADHD) parents/caregivers completed the LIS. Median age at diagnosis was 6.0 years (mean [SD], 6.4 [3.18] years) as reported by parents/caregivers; pharmacological treatment was prescribed for 46.8 % (37/79) of children/adolescents with ADHD. Compared with the control group, ADHD was associated with significantly greater impairment across all domains studied (P<0.001), except problems in home life. General impairment scale data demonstrated that more parents/caregivers of children/adolescents in the ADHD group than the control group thought that experiences during childhood/adolescence and unhappy memories would have a negative impact on their child in adult life (29-32 % vs 9-12 %, respectively). Issues that affected school/education were associated with perceived greater impairment in the ADHD group than the control group. Several limitations should be taken into account when reviewing these data, including the lack of questionnaire validation (although developed by expert consensus). In addition, the survey was conducted online and, as such, was more likely to recruit individuals who were well-educated, computer-literate, and willing to participate in the survey. Survey participants may also have had greater awareness of ADHD and the associated symptoms and impairment, and greater motivation to seek diagnosis or treatment, than the general population. Furthermore, diagnosis of ADHD and history of diagnosis were parent-/caregiver-reported and the results may have been influenced by recall bias or subjective reporting given that the survey did not directly assess the opinions of the children/adolescents with the disorder. These data provide insights into the negative impact that ADHD imposes on all aspects of life for children/adolescents in France with the disorder. Moreover, ADHD is believed to have a negative impact later in the patient's life. Further progress is needed in France and across Europe to provide a more effective and consistent approach to the treatment of patients with ADHD and to meet the expectations regarding management and treatment for the families concerned.

[A survey on attention deficit hyperactivity disorder]. / Enquête sur le trouble déficit de l'attention avec hyperactivité auprès de pédiatres libéraux.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder described in international classifications and thought to affect about 5% of school-aged children and 3% of adults in the general population. In France, most clinicians are not formally trained in assessing and treating ADHD, leading to underdiagnosis of the disorder. ADHD impacts all the aspects of these children's daily life (school performance, family and social life) and later their adult life. We invited all the private-practice pediatricians in the east of the Provence-Alpes-Côte d'Azur region (southeast France) to participate in a survey: 57 out of 81 accepted. The results show that their knowledge on ADHD could be improved, and that their a priori conception of the etiology of the disorder (neurodevelopmental syndrome versus societal syndrome) guides their clinical approach. We recommend pediatricians be trained to improve screening, diagnosis, and ADHD treatment monitoring in children. This recommendation might also apply to general practitioners for children and parents/adults.

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.

Time-stability of the "Functional Remission of General Schizophrenia" (FROGS) scale.

Functional remission in schizophrenia is an important treatment goal, particularly for patients who have achieved symptomatic remission. The Functional Remission of General Schizophrenia (FROGS) scale has recently been developed, with the FROGS total score being reported as reliable in a cross-sectional study, with an exploratory factor analysis showing three oblique meaningful factors. As such an instrument should have a stable structure over time, but also be able to detect improvement of functioning with time, we have further analysed the validity of the FROGS scale, specifically assessing time-stability. We re-evaluated the initial patient sample around 1.5 years after the first evaluation (mean=17.1 months, standard deviation=1.9), restricting the analyses to patients who were still being followed-up and in clinical remission (n=140 patients). The mean (standard deviation) FROGS total score was 75.82 (10.85) at the second evaluation, showing a significant improvement with time (3.84; P<0.0001 versus the first evaluation). The internal consistency/reliability of the FROGS scale was still very high (Cronbach's α=0.919). Significant improvements between the first and second evaluations were also apparent for all the individual items in the FROGS scale (P<0.01) as well as for the subscores for the three extracted factors (P<0.0001). Statistically significant correlations were observed between the FROGS scale and other indices, including the Global Assessment of Functioning (r=0.58; P<0.0001). These results provide further evidence of the solid psychometric properties of the FROGS scale.

Morningness-eveningness preference and sensation seeking.

The aim of this study was to explore the relationship between circadian preference and sensation seeking. To this aim 1041 university students (408 males and 633 females), ranging in age between 18 and 30 years, filled the reduced version of the Morningness-Eveningness Questionnaire (MEQr) and the Sensation Seeking Scale-Form V (SSS-V). Males scored higher than females in SSS-V total score and all subscales, except experience seeking (ES). As regards circadian preference, evening types scored higher than morning types in SSS-V total score and all subscales, except boredom susceptibility (BS) where they significantly differed only from intermediate types. On the whole our results highlight a significant relationship between circadian preference and sensation seeking.