ABSTRACT
PURPOSE: Disruptive behavioral disorders (DBDs) are common among children/adolescents in sub-Saharan Africa. A 16-week manualized multiple family group (MFG) intervention called Amaka Amasanyufu designed to reduce DBDs among school-going children/adolescents in low-resource communities in Uganda was efficacious in reducing symptoms of poor mental health relative to usual care in the short-term (4 months post-intervention-initiation). We examined whether intervention effects are sustained 6 months postintervention. METHODS: We used longitudinal data from 636 children positive for DBDs: (1) Control condition, 10 schools, n = 243; (2) MFG delivered via parent peers (MFG-PP), eight schools, n = 194 and; (3) MFG delivered via community healthcare workers (MFG-CHW), eight schools, n = 199 from the SMART Africa-Uganda study (2016-2022). All participants were blinded. We estimated three-level linear mixed-effects models and pairwise comparisons at 6 months postintervention and time-within-group effects to evaluate the impact on Oppositional Defiant Disorder (ODD), impaired functioning, depressive symptoms, and self-concept. RESULTS: At 6 months postintervention, children in MFG-PP and MFG-CHW groups had significantly lower means for ODD (mean difference [MD] = -1.08 and -1.35) impaired functioning (MD = -1.19 and -1.16), and depressive symptoms (MD = -1.06 and -0.83), than controls and higher means for self-concept (MD = 3.81 and 5.14). Most outcomes improved at 6 months compared to baseline. There were no differences between the two intervention groups. DISCUSSION: The Amaka Amasanyufu intervention had sustained effects in reducing ODD, impaired functioning, and depressive symptoms and improving self-concept relative to usual care at 6 months postintervention. Our findings strengthen the evidence that the intervention effectively reduces DBDs and impaired functioning among young people in resource-limited settings and was sustained over time.
Subject(s)
Child Behavior Disorders , Mental Health , Humans , Child , Adolescent , Uganda , Child BehaviorABSTRACT
Background: The large proportion of coronavirus disease 2019 (COVID-19) patients has been associated with a large number of neu-ropsychiatric manifestations. Despite the high prevalence of COVID-19, few studies have examined such manifestations, especially in children and adolescents. Objective(s): This study investigated neuropsychiatric manifestations in hospitalized children and adolescents admitted for COVID-19 infection in Iran. Method(s): This prospective observational study included admitted children and adolescents (4-18 years old) diagnosed with COVID-19 infection, pediatric neurologists, child and adolescent psychiatrists, and infectious disease specialists, and assessed 375 infected patients during August and December 2021. Result(s): Of the 375 patients, 176 (47%) were female, with a mean age of 9.0 +/- 3.39 years. Psychiatric and neurological manifestations were reported in 58 (15.5%) and 58 (15.5%) patients, respectively. The most prevalent psychiatric disorders were separation anxiety disorder (SAD) (5.1%), major depressive disorder (MDD) (3.5%), generalized anxiety disorder (GAD) (2.7%), insomnia (2.4%), and op-positional defiant disorder (ODD) (2.4%). Regarding neurological complications, seizures were the most prevalent (13.1%), followed by encephalitis (1.9%), transverse myelitis (0.3%), acute ischemic stroke (0.3%), and Guillain-Barre syndrome (0.3%). There was no significant relationship between the duration of COVID-19 infection (P = 0.54) and ICU admission (P = 0.44) with the emergence of psychiatric symptoms. Conclusion(s): The most prevalent neurologic and psychiatric complications among children and adolescents with COVID-19 infection were seizures and the symptoms of anxiety/mood disorders, respectively.Copyright © 2023, Author(s).
ABSTRACT
Factors associated with continued driving during shelter in place orders have been examined in a community sample of typically developing teen drivers, but not in teens diagnosed with Attention/Deficit-Hyperactivity Disorder (ADHD). Our objective was to examine psychosocial factors that predicted risky driving during shelter in place orders in teens with ADHD, which is important since teens with ADHD are at particular risk for poor driving outcomes. The present study is also novel in that it uses naturalistic data of risky driving rather than self-report of continued driving. Naturalistic in-car data from 56 ADHD participants (M age = 16.875 years, SD = 0.955;55.400 % were male) enrolled in an on-going study were used in the present study. Teens had an average of 26.915 months (SD = 14.343) of driving experience. Risky driving was defined as experiencing an event exceeding 0.600 g-force during the first month of COVID-19 pandemic shelter in place ordinances in Ohio, Kentucky, and Indiana, USA. A hierarchical logistic regression with a post-COVID driving event as the dependent variable was conducted. Baseline ratings of ADHD and oppositional defiant disorder/conduct disorder (ODD/CD) severity were entered in the first step of the model, while anxiety severity and parent behaviors regarding teen driving safety (monitoring and limit setting) were entered in the second step of the model. The first step of the model reached statistical significance (χ2(2, 54) = 7.577, p =.023), with only greater symptoms of ODD/CD significantly predicting a post-COVID driving event (B = 0.144, p =.020). With each point increase in ODD/CD symptoms, there was a 15.5 % increase in the probability of experiencing a high g-force event during COVID-19 restrictions. The model was no longer significant at step 2 when anxiety severity and parent behaviors were added to the model (χ2(3, 55) = 10.97p =.052). We conclude that ODD/CD symptom severity was the strongest predictor of risky driving during COVID-19 restrictions within a sample of teen drivers with ADHD. Study implications may be beneficial for clinicians who work with families of teens with ADHD;suggestions for strategies mitigating this risk are discussed. These findings also have implications for which teens with ADHD may be less positively impacted by other government mitigation strategies such as Graduated Drivers Licensing (GDL) regulations. © 2022
ABSTRACT
Factors associated with continued driving during shelter in place orders have been examined in a community sample of typically developing teen drivers, but not in teens diagnosed with Attention/Deficit-Hyperactivity Disorder (ADHD). Our objective was to examine psychosocial factors that predicted risky drivingduring shelter in place orders in teens with ADHD, which is important since teens with ADHD are at particular risk for poor driving outcomes. The present study is also novel in that it uses naturalistic data of risky driving rather than self-report of continued driving. Naturalistic in-car data from 56 ADHD participants (M age =16.875 years,SD= 0.955;55.400% were male) enrolled in an on-going study were used in the present study. Teens had an average of 26.915 months (SD = 14.343) of driving experience. Risky driving was defined as experiencing an event exceeding 0.600 g-force during the first month of COVID-19 pandemic shelter in place ordinances in Ohio, Kentucky, and Indiana, USA. A hierarchical logistic regression with a post-COVID driving event as the dependent variable was conducted. Baseline ratings of ADHD and oppositional defiant disorder/conduct disorder (ODD/CD) severity were entered in the first step of the model, while anxiety severity and parent behaviors regarding teen driving safety (monitoring and limit setting) were entered in the second step of the model. The first step of the model reached statistical significance (χ2(2, 54) =7.577, p = .023), with only greater symptoms of ODD/CD significantly predicting a post-COVID driving event (B = .144, p = .020). With each point increase in ODD/CD symptoms, there was a 15.5% increase in the probability of experiencing a high g-force event during COVID-19 restrictions. The model was no longer significant at step 2 when anxiety severity and parent behaviors were added to the model (χ2(3, 55) =10.97 p = .052).We conclude that ODD/CD symptom severity was the strongest predictor of risky driving during COVID-19 restrictions within a sample of teen drivers with ADHD. Study implications may be beneficial for clinicians who work with families of teenswith ADHD;suggestions for strategies mitigating this risk are discussed. These findings also have implications for which teens with ADHD may be less positively impacted by other government mitigation strategies such as Graduated Drivers Licensing (GDL) regulations.
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Background: Due to the COVID-19 pandemic children were deprived of in-person attendance at school and experienced social isolation. The impact of these social-distancing measures on pediatric mental health is only now being unraveled. We conducted a descriptive review of psychiatric diagnoses at a pediatric outpatient practice in a Southern Illinois rural community. We compared the trends of pediatric psychiatric diagnosis before and following the COVID pandemic. Methods: Pediatric Group LLC has multiple office locations in Rural Southern Illinois catering to about 10,000 pediatric patients staffed by pediatric providers and a clinical psychologist. The pediatric population has remained stable during the period. The care providers and practices have remained unchanged over the past four years. We did a retrospective review of electronic health records from January 2019 through June 2021. Using ICD10 diagnostic codes, we analyzed the top 100 diagnoses made at the pediatric practice. Diagnoses were broadly classified into psychiatric and non-psychiatric categories. Psychiatric illnesses included anxiety, attention deficit hypersensitivity disorder (ADHD), conduct disorders, mood disorders, sleep disorders, and other psychiatric illnesses such as post-traumatic stress disorder (PTSD). Descriptive comparisons were made between pre-COVID (2019) and post-COVID (2021) periods. Results: Compared to a baseline of 5044 encounters in 2019 (pre-COVID), attendance was 9% lower (4680) in 2020. Attendance dropped by 14% (2206) in the first half of 2020, increasing by 11% (2474) to reach preCOVID levels in the second half of 2020. The attendances continued to increase in the first half of 2021, reaching 43% higher (3614) numbers compared to pre-COVID levels. Compared to 2019 and 2020, an increase in all psychiatric diagnoses was seen in our offices in the year 2021. Further analysis of the year 2021 showed significant increases in Anxiety and Depressive disorders, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation disorder (DMDD), and Major Depressive disorders (MDD) that almost doubled the statistics from the pre-COVID period. Sleep disorders and Post Traumatic Distress Disorder (PTSD) visits increased by far more than 150 percent. (Table 1) Conclusion: A steady increase in pediatric psychiatric illness has been noted in the second half of 2020 and first half of 2021 following COVID pandemic. We observed an increase by over two times with almost all the psychiatric disorders in 2021. The overall increase in the incidence of various pediatric psychiatric illnesses is concerning. We believe that the absence of in-school attendance may have played a significant role.
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Background: The objective of the current study was to assess how the coronavirus disease 2019 pandemic has affected mental health services compared to the same period of the year before the pandemic. Methods: The data in the study were retrieved from the databases of the computer systems of the hospitals. All referrals in the child psychiatry outpatient clinic between March 1 and June 30, 2019, and between March 1 and June 30, 2020, constituted the sample. Results: Of the 3110 referrals, 2246 were cases and 864 were repeating examinations. Of the 2246 cases, 70.5% (n = 1583) were admitted in 2019, while 29.5% (n = 663) were admitted in 2020. Of the cases who referred in 2019, 37.3% (n = 590) were female, while this rate was 43.9% (n = 291) in 2020. The mean age of 2019 cases was found to be 9.51 ± 4.17, while the mean age of 2020 cases was found to be 10.39 ± 4.06. While attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, depressive disorder, panic disorder, school refusal, and sleep disorder rates increased significantly, specific learning disorders and mental retardation rates were found to be on the decrease in 2020. In 2019, 47.6% (n = 754) of the cases were followed with medication, and in 2020, this rate increased to 63.2% (n = 419). Conclusion: Pandemic conditions affected the content of public hospital psychiatry referrals significantly. It can be thought that the significant decrease in the number of referrals may be the result of citizens obeying the prohibitions and the fear of disease transmission in families with the onset of the pandemic that precedes the existing psychiatric problems of children.
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Adolescent athletes with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) experience unique challenges that impact their sport performance, such as making errors due to poor concentration. The current multiple-baseline across behaviors case trial (i.e., positive assertion and negative assertion) is an evaluation of The Optimum Performance Program in Sports in an adolescent athlete diagnosed with ADHD and ODD. Intervention skill sets were targeted sequentially in a virtual format to safeguard against COVID-19 contraction. A battery of psychological measures was administered at baseline, post-intervention, and 1-month follow-up. Results indicated negative and positive assertion skills improved, but only when targeted, and severity of ADHD and ODD symptom severity, general mental health symptoms, and factors interfering with sport performance decreased from pre- to post-intervention and these improvements were maintained at 1-month follow-up. Similar improvements occurred in relationships with coaches, teammates, and family. Treatment integrity and consumer satisfaction were high.