Prenatal diet and children's trajectories of hyperactivity-inattention and conduct problems from 3 to 8 years: the EDEN mother-child cohort.

BACKGROUND: Evidence shows that diet contributes substantially to lifelong physical and mental health. Although dietary exposure during gestation and early postnatal life is critical, human epidemiological data are limited regarding its link with children's subsequent externalizing issues. The aim of this study was to investigate the role of maternal diet during pregnancy in offspring's symptoms of hyperactivity-inattention and conduct problems from ages 3 to 8 years. METHODS: We used data of 1,242 mother-child pairs from a French cohort followed up from pregnancy until the children were 8 years of age. Dietary patterns (DP) of the mother during pregnancy were assessed with food frequency questionnaires. Children's externalizing behavior was assessed with the Strength and Difficulties Questionnaire at ages 3, 5, and 8 years, from which trajectories of hyperactivity-inattention symptoms and conduct problems were derived. We conducted multivariable logistic models to study associations adjusted for a range of potential confounders. RESULTS: Results showed significant relationships between maternal 'low Healthy diet' (adjusted Odds Ratio (aOR) = 1.61; IC 95%: 1.09-2.37) and 'high Western diet' (aOR = 1.67; IC 95%: 1.13-2.47) during pregnancy and children's trajectories of high symptoms of hyperactivity-inattention. The associations took into account relevant confounders such as DP of the children at age 2 years, maternal stress and depression, gestational diabetes, and socioeconomic variables. CONCLUSIONS: Maternal diet during pregnancy was independently associated with children's hyperactivity-inattention symptoms but not with conduct problems. Early prevention addressing lifestyle should specifically target diet in pregnant women.

Clinical and social factors associated with attention-deficit hyperactivity disorder medication use: population-based longitudinal study.

BACKGROUND: The impact of longitudinal psychiatric comorbidity, parenting and social characteristics on attention-deficit hyperactivity disorder (ADHD) medication use is still poorly understood. AIMS: To assess the baseline and longitudinal influences of behavioural and environmental factors on ADHD medication use. METHOD: Survival regressions with time-dependent covariates were used to model data from a population-based longitudinal birth cohort. The sample (n = 1920) was assessed from age 5 months to 10 years. Measures of children's psychiatric symptoms, parenting practices and social characteristics available at baseline and during follow-up were used to identify individual and family-level features associated with subsequent use of ADHD medication. RESULTS: Use of ADHD medication ranged from 0.2 to 8.6% between ages 3.5 to 10 years. Hyperactivity-inattention was the strongest predictor of medication use (hazard ratio (HR) = 2.75, 95% CI 2.35-3.22). Among all social variables examined, low maternal education increased the likelihood of medication use (HR = 2.09, 95% CI 1.38-3.18) whereas immigrant status lowered this likelihood (HR = 0.40, 95% CI 0.17-0.92). CONCLUSIONS: Beyond ADHD symptoms, the likelihood of receiving ADHD medication is predicted by social variables and not by psychiatric comorbidity or by parenting. This emphasises the need to improve global interventions by offering the same therapeutic opportunities (including medication) as those received by the rest of the population to some subgroups (i.e. immigrants) and by diminishing possible unnecessary prescriptions.

Attention problems in childhood and adult substance use.

OBJECTIVE: To assess the link between childhood attention problems (AP) and substance use 18 years later. STUDY DESIGN: This cohort study was conducted in a community sample of 1103 French youths followed from 1991 to 2009. Exposures and covariates were childhood behavioral problems (based on parental report at baseline), early substance use, school difficulties, and family adversity. Outcome measures were regular tobacco smoking, alcohol problems, problematic cannabis use, and lifetime cocaine use (based on youth reports at follow-up). RESULTS: Individuals with high levels of childhood AP had higher rates of substance use (regular tobacco smoking, alcohol problems, problematic cannabis use, and lifetime cocaine use). However, when taking into account other childhood behavioral problems, early substance use, school difficulties, and family adversity, childhood AP were related only to regular tobacco smoking and lifetime cocaine use. Early cannabis exposure was the strongest risk factor for all substance use problems. CONCLUSION: This longitudinal community-based study shows that, except for tobacco and cocaine, the association between childhood AP and substance use is confounded by a range of early risk factors. Early cannabis exposure plays a central role in later substance use.

Childhood attention problems and socioeconomic status in adulthood: 18-year follow-up.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) has been associated with socioeconomic difficulties later in life. Little research in this area has been based on longitudinal and community studies. AIMS: To examine the relationship between childhood attention problems and socioeconomic status 18 years later. METHOD: Using a French community sample of 1103 youths followed from 1991 to 2009, we tested associations between childhood attention problems and socioeconomic status between ages 22 and 35 years, adjusting for potential childhood and family confounders. RESULTS: Individuals with high levels of childhood attention problems were three times more likely to experience subsequent socioeconomic disadvantage than those with low levels of attention problems (odds ratio 3.44, 95% CI 1.72-6.92). This association remained statistically significant even after adjusting for childhood externalising problems, low family income, parental divorce and parental alcohol problems. CONCLUSIONS: This longitudinal community-based study shows an association between childhood attention problems and socioeconomic disadvantage in adulthood. Taking into account ADHD and associated difficulties could help reduce the long-term socioeconomic burden of the disorder.

Disruptive behaviors and early sexual intercourse: The GAZEL Youth Study.

Sexual health-risk behaviors in disruptive children are poorly understood. In a longitudinal population-based sample, event-time analyses showed that subjects with high levels of conduct disorder symptoms, particularly in combination with simultaneously high levels of hyperactivity-inattention symptoms, exhibited the highest risk for earlier sexual activity compared to controls, suggesting the need for prevention.

Objective Level of Alertness and Inhibitory Control Predict Highway Driving Impairment in Adults With ADHD.

Objective: It remains unclear whether daytime impairments in ADHD patients are better explained by an altered level of alertness and/or by cognitive deficits. The aim of this study was to determine the respective contribution of these factors on driving performance in ADHD adults. Method: ADHD adults (n = 39) and healthy controls (n = 18) underwent a nocturnal polysomnography (PSG) followed by a Maintenance of Wakefulness Test (MWT), a simulated driving task, and a neuropsychological evaluation. Results: ADHD patients had shorter mean sleep latency on the MWT and worse driving performance than controls. They also made more errors on attention and executive functioning tests. Logistic regression analyses showed that inhibition deficits and objective daytime sleepiness predicted highway driving performance in ADHD. Conclusion: Our study shows that not only inhibitory control deficits but also pathological level of alertness independently contribute to highway driving impairment in ADHD patients, providing a better understanding of the pathophysiological mechanisms involved in ADHD.

Hyperactivity-inattention symptoms in childhood and substance use in adolescence: the youth gazel cohort.

BACKGROUND: This study addresses in both genders the relationship between childhood Hyperactivity-inattention symptoms and subsequent adolescent substance use, while controlling for psychiatric comorbidity, temperament and environmental risk factors. METHODS: 916 subjects (421 males, 495 females) aged 7-18 were recruited from the general population and surveyed in 1991 and 1999. Child psychopathology and substance use patterns were evaluated through parent and adolescent self-reports. Multivariate modeling was performed to assess the effects of childhood Hyperactivity-inattention symptoms and other risk factors on adolescent substance use. RESULTS: In males, Hyperactivity-inattention symptoms alone accounted for the risk of subsequent regular cannabis smoking (OR=3.14, p=0.03) and subsequent lifetime use of other drugs including stimulants, opiates, inhalants and sedatives (OR=2.72, p=0.02). In females, Hyperactivity-inattention symptoms did not independently increase the liability to later substance use. In males, the temperament trait activity was a significant predictor of subsequent regular cannabis smoking (OR=2.32, p=0.04). CONCLUSIONS: This survey points to a possible specific link between Hyperactivity-inattention symptoms and subsequent cannabis use and experimentation of harder drugs in males.

Emotional reactivity: Beware its involvement in traffic accidents.

BACKGROUND: Reducing risk attributable to traffic accidents is a public health challenge. Research into risk factors in the area is now moving towards identification of the psychological factors involved, particularly emotional states. The aim of this study was to evaluate the link between emotional reactivity and responsibility in road traffic accidents. We hypothesized that the more one's emotional reactivity is disturbed, the greater the likelihood of being responsible for a traffic accident. METHODS: This case-control study was based on a sample of 955 drivers injured in a motor vehicle crash. Responsibility levels were determined with a standardized method adapted from the quantitative Robertson and Drummer crash responsibility instrument. Emotional reactivity was assessed with the MATHYS. RESULTS: Hierarchical cluster analysis discriminated four distinctive driver's emotional reactivity profiles: basic emotional reactivity (54%), mild emotional hyper-reactivity (29%), emotional hyper-reactivity (11%) and emotional hypo-reactivity (6%). Drivers who demonstrated emotional hypo-reactivity had a 2.3-fold greater risk of being responsible for a traffic accident than those with basic emotional reactivity. CONCLUSION: Drivers' responsibility in traffic accidents depends on their emotional status. The latter can change the ability of drivers, modifying their behavior and thus increasing their propensity to exhibit risk behavior and to cause traffic accidents.

The Semiology of Motor Disorders in Autism Spectrum Disorders as Highlighted from a Standardized Neuro-Psychomotor Assessment.

BACKGROUND: Altered motor performance has been described in Autism Spectrum Disorders (ASD) with disturbances in walking; posture, coordination, or arm movements, but some individuals with ASD show no impairment of motor skills. The neuro-developmental processes that underpin the performance of neuro-psychomotor functions have not been widely explored, nor is it clear whether there are neuro-psychomotor functions specifically affected in ASD. Our objective was to focus on the semiology of motor disorders among children with ASD using a neuro-developmental assessment tool. METHOD: Thirty-four children with ASD, with or without intellectual deficit (ID) were recruited in a child psychiatry department and Autism Resource Centers. Initial standard evaluations for diagnosis (psychiatric; psychological; psychomotor) were supplemented by a standardized assessment battery for neuro-developmental psychomotor functions (NP-MOT). RESULTS: The results of some NP-MOT tests differed between children with ASD with ID and those without. However, on the NP-MOT battery, neither of the two groups did well in the bi-manual and finger praxia tests (36 and 52% respectively failed). Manual and digital gnosopraxia showed some deficit (63 and 62% respectively failed). Postural deficits were found in tests for both static equilibrium (64%) and dynamic (52%). There were also difficulties in coordination between the upper and lower limbs in 58% of children. We found 75% failure in motor skills on the M-ABC test. Concerning muscular tone, significant laxity was observed in distal parts of the body (feet and hands), but hypertonia was observed in the proximal muscles of the lower limbs (reduced heel-ear angle). DISCUSSION: The results of manual and digital gnosopraxia tests point to a planning deficit in children with autism. A gesture programming deficit is also highlighted by the poor results in manual praxis, and by failures in the M-ABC tests despite prior training of the child. However, concerning global motor function, a significant difference was observed between children with and without ID. Our findings suggest a semiology of tone deregulation between proximal versus distal muscles, indeterminate tonic laterality, postural control deficit (proprioceptive), impairment of inter-hemispheric coordination (corpus callosum), and neurological soft signs such asdysdiadochokinesia, which leads us to hypothesize a general impairment of motor functions.

Prenatal Caffeine Exposure and Child IQ at Age 5.5 Years: The EDEN Mother-Child Cohort.

BACKGROUND: Evidence from animal studies suggests maternal caffeine intake during pregnancy has detrimental effects on subsequent brain development in offspring. However, human data in this area are limited. The aim of this study was to assess whether caffeine intake by women during pregnancy is associated with impaired cognitive development in offspring at age 5.5 years. METHODS: Multivariate modeling was conducted using data of 1083 mother-child pairs from a population-based birth cohort in France followed from pregnancy to age 5.5 years of the children. Measures included an estimate of maternal caffeine intake during pregnancy, children's IQ at age 5.5, and individual and family characteristics. RESULTS: Prenatal caffeine exposure was common in the sample (91%) with 12% displaying an intake ≥200 mg/day (high). Multivariable modeling showed a significant negative relationship between caffeine intake and children's IQ at 5.5 years (-.94 [95% confidence interval = -1.70, -.17] full IQ unit per 100 mg daily caffeine intake). In particular, children of mothers consuming ≥200 mg/day were more likely to have borderline or lower IQ compared with children of mothers consuming <100 mg/day (13.5% vs. 7.3%; odds ratio = 2.30, 95% confidence interval = 1.13, 4.69). CONCLUSIONS: We found an association between caffeine intake during pregnancy and impaired cognitive development in offspring, a result in line with animal data. More epidemiologic and biologically grounded research is needed to determine whether this association is causal. This finding suggests that conservative guidelines regarding the maximum caffeine intake recommended in pregnancy (i.e., 200 mg/day) should be maintained.

Video game performances are preserved in ADHD children compared with controls.

OBJECTIVE: Although ADHD and excessive video game playing have received some attention, few studies have explored the performances of ADHD children when playing video games. The authors hypothesized that performances of ADHD children would be as good as those of control children in motivating video games tasks but not in the Continuous Performance Test II (CPT II). METHOD: The sample consisted of 26 ADHD children and 16 control children. Performances of ADHD and control children were compared on three commercially available games, on the repetition of every game, and on the CPT II. RESULTS: ADHD children had lower performances on the CPT II than did controls, but they exhibited equivalent performances to controls when playing video games at both sessions and on all three games. CONCLUSION: When playing video games, ADHD children present no difference in inhibitory performances compared with control children. This demonstrates that cognitive difficulties in ADHD are task dependent.

The increased risk of road crashes in attention deficit hyperactivity disorder (ADHD) adult drivers: driven by distraction? Results from a responsibility case-control study.

BACKGROUND AND OBJECTIVE: Both distractions (external and internal) and attention-deficit/hyperactivity disorder (ADHD) are serious risk factors for traffic crashes and injuries. However, it is still unknown if ADHD (a chronic condition) modifies the effect of distractions (irregular hazards) on traffic crashes. The objective of this study was to assess the effects of distractions and ADHD on traffic crash responsibility. METHODS: A responsibility case-control study was conducted in the adult emergency department of Bordeaux University Hospital, France. Subjects were recruited among drivers injured in a motor vehicle crash between April 2010 and August 2011. Responsibility levels were estimated using a standardized method. Frequencies of exposures were compared between drivers responsible and drivers not responsible for the crash. Independent risk factors were identified using a multivariate logistic regression including test interactions between distractions and ADHD. RESULTS: A total of 777 subjects were included in the analysis. Factors associated with responsibility were distraction induced by an external event (adjusted OR (aOR) = 1.47; 95% confidence interval (CI) [1.06-2.05]), distraction induced by an internal thought (aOR = 2.38; CI: [1.50-3.77]) and ADHD (aOR = 2.18 CI: [1.22-3.88]). The combined effect of ADHD and external distractions was strongly associated with responsibility for the crash (aOR = 5.79 CI: [2.06-16.32]). Interaction assessment showed that the attributable proportion due to the interaction among participants with both exposures was 68%. DISCUSSION: Adults with ADHD are a population at higher risk of being responsible for a road traffic crash when exposed to external distractions. This result reinforces the need to diagnose adult ADHD and to include road safety awareness messages delivered by the physician. Developing advanced driver assistance systems devoted to the management of attention lapses is also increasingly relevant for these drivers.

Distraction and driving: results from a case-control responsibility study of traffic crash injured drivers interviewed at the emergency room.

BACKGROUND: Use of cellular phones has been shown to be associated with crashes but many external distractions remain to be studied. OBJECTIVE: To assess the risk associated with diversion of attention due to unexpected events or secondary tasks at the wheel. DESIGN: Responsibility case-control study. SETTING: Adult emergency department of the Bordeaux University Hospital (France) from April 2010 to August 2011. PARTICIPANTS: 955 injured drivers presenting as a result of motor vehicle crash. MAIN OUTCOME MEASURES: The main outcome variable was responsibility for the crash. Exposures were external distraction, alcohol use, psychotropic medicine use, and sleep deprivation. Potential confounders were sociodemographic and crash characteristics. RESULTS: Beyond classical risk factor found to be associated with responsibility, results showed that distracting events inside the vehicle (picking up an object), distraction due to driver activity (smoking) and distracting events occurring outside were associated with an increased probability of being at fault. These distraction-related factors accounted for 8% of injurious road crashes. LIMITATIONS: Retrospective responsibility self-assessment. CONCLUSIONS: Diverted attention may carry more risk than expected. Our results are supporting recent research efforts to detect periods of driving vulnerability related to inattention.

Impact of time on task on ADHD patient's performances in a virtual classroom.

BACKGROUND: Use of virtual reality tool is interesting for the evaluation of Attention Deficit/Hyperactivity Disorder (ADHD) patients. The virtual environment offers the opportunity to administer controlled task like the typical neuropsychological tools, but in an environment much more like standard classroom. Previous studies showed that a virtual classroom was able to distinguish performances of children with and without ADHD, but the evolution of performances over time has not been explored. The aim of this work was to study time on task effects on performances of ADHD children compared to controls in a virtual classroom (VC). METHODS: 36 boys aged from 7 to 10 years completed the virtual classroom task. We compared the performance of the children diagnosed with ADHD with those of the control children. We also compared attentional performances recorded in the virtual classroom with measures of the Continuous Performance Test (CPT II). RESULTS: Our results showed that patients differ from control subjects in term of time effect on performances. If controls sustained performances over time in the virtual reality task, ADHD patients showed a significant performance decrement over time. Performances at the VC correlated with CPT II measures. CONCLUSION: ADHD children are vulnerable to a time on task effect on performances which could explain part of their difficulties. Virtual reality is a reliable method to test ADHD children ability to sustain performances over time.

Mind wandering and driving: responsibility case-control study.

OBJECTIVE: To assess the association between mind wandering (thinking unrelated to the task at hand) and the risk of being responsible for a motor vehicle crash. DESIGN: Responsibility case-control study. SETTING: Adult emergency department of a university hospital in France, April 2010 to August 2011. PARTICIPANTS: 955 drivers injured in a motor vehicle crash. MAIN OUTCOME MEASURES: Responsibility for the crash, mind wandering, external distraction, negative affect, alcohol use, psychotropic drug use, and sleep deprivation. Potential confounders were sociodemographic and crash characteristics. RESULTS: Intense mind wandering (highly disrupting/distracting content) was associated with responsibility for a traffic crash (17% (78 of 453 crashes in which the driver was thought to be responsible) v 9% (43 of 502 crashes in which the driver was not thought to be responsible); adjusted odds ratio 2.12, 95% confidence interval 1.37 to 3.28). CONCLUSIONS: Mind wandering while driving, by decoupling attention from visual and auditory perceptions, can jeopardise the ability of the driver to incorporate information from the environment, thereby threatening safety on the roads.

Socio-behavioral characteristics of children with Rubinstein-Taybi syndrome.

Research regarding the behavioral aspects of children with Rubinstein-Taybi syndrome (RTS) has suggested some possible behavioral patterns including autistic features. Caregivers of 39 children (mean age = 8.4 years) with RTS (49% showing abnormality in CREBBP gene) and 39 children (mean age = 8.6 years) matched on developmental level, age and gender were administered the Child Behavior Checklist and the Children's Social Behavior Questionnaire. Children with RTS did not exhibit higher internalizing (affective and anxiety symptoms) or externalizing (disruptive symptoms) behavioral problems than expected for their age/developmental range. However, they displayed some specific behaviors: short attention span, motor stereotypies, poor coordination, and overweight. The presence of an identified CREBBP gene abnormality was possibly related to the motor difficulties through impaired motor skills learning.

Síntomas psiquiátricos asociados al consumo de pasta base de cocaína en niños y adolescentes: un estudio exploratorio en Montevideo, Uruguay / Psychiatric symptoms associated with cocaine paste consumption in children and adolescents: an exploratory study in Montevideo, Uruguay

Introducción: Desde principios de los años 2000, el consumo de Pasta Base de Cocaína (PBC) se hizo objeto de preocupación para los clínicos y los actores de Sanidad Pública en Uruguay. A pesar de la importancia del fenómeno existen muy pocos estudios sobre las condiciones psiquiátricas asociadas al consumo de PBC, especialmente en población pediátrica, siendo esta la más vulnerable y la que puede beneficiar de intervenciones precoces eficaces. El objetivo de este trabajo era determinar la asociación entre problemas psiquiátricos y consumo de PBC en niños y adolescentes hospitalizados. Método: Realizamos un estudio observacional comparativo, entre 2008 y 2010, en una población que consultaba en las urgencias del hospital pediátrico de Montevideo (Uruguay). Un grupo consumidor de PBC (N = 20) fue comparado con un grupo no consumidor de sustancias psicoactivas (N = 20) con el Child Behavior Checklist (CBCL) que mide los problemas emocionales y conductuales del joven. Resultados: El grupo consumidor de PBC mostraba niveles significativamente superiores de problemas externalizados e internalizados, particularmente comportamientos oposicionistas. Conclusiones: El consumo de PBC se asocia a niveles mayores de problemas psiquiátricos en los jóvenes. Actuar precozmente para prevenir el consumo de PBC y tratar los problemas externalizados en los consumidores parece esencial para mejorar la salud de los jóvenes en Uruguay.

ntroduction: Since the years 2000, the consumption of Cocaine Paste (CP) has become an important issue for clinicians and public health actors in Uruguay. In spite of the importance of the phenomenon few studies have focused on psychiatric conditions associated with CP consumption, especially in the paediatric population yet the most vulnerable and the one that could benefit from early effective interventions. The aim of this work was to determine the association between psychiatric problems and CP consumption in inpatients youths. Methods: We conducted an observational and comparative study between 2008 and 2010, in a paediatric population consulting in the child psychiatric emergency room of Montevideo (Uruguay). A group consuming CP (N = 20) was compared to a group not consuming psychoactive substances (N = 20) with the Child Behavior Checklist (CBCL). Results: The group consuming CP showed significantly higher levels of externalizing and internalizing problems, particularly oppositional behaviors. Conclusions: CP consumption is associated with higher levels of psychiatric symptoms in youths. Early interventions to prevent CP consumption and treat externalizing problems is of utmost importance to improve the health of youths in Uruguay.