Callous-Unemotional Traits and Face-Emotion Recognition as Mediators in Conduct Problems of Children With ADHD.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk for conduct problems (CP), as well as with callous-unemotional traits (CUt) and lower accuracy in face emotional recognition (FER). It is unclear, however, whether CUt and low accuracy in FER contribute to the risk for CP in ADHD. The present study investigated the possibility of such contribution. METHODS: This pilot study's participants included 31 children aged 7-17 years, diagnosed with ADHD, and treated in a psychiatric outpatient clinic. The parents rated their children on the ADHD Rating Scale, Inventory of Callous-Unemotional Traits, and the Child Behavior Checklist-Conduct Problems scale. Participants completed the Hebrew version of the children's Reading the Mind in the Eyes Test (cRMET)-a Theory of Mind measure. A bootstrapped multiple mediator model was used, adjusting for age and gender. RESULTS: ADHD symptoms were associated with CP. This association was not mediated by CUt or cRMET. CUt was associated with CP independent of ADHD symptom severity. CONCLUSIONS: ADHD symptoms and CUt both should be considered when assessing risk for CP and devising a treatment plan, in children with ADHD. Current results did not confirm the hypothesis that cRMET and CUt mediate between ADHD symptoms and CP. More studies employing larger samples, longitudinal design, and other emotion recognition measures are needed.

Mood and Proneness to Boredom Are Associated with Poorer Continuous Performance Test Results, Which May Improve with Methylphenidate Treatment, in Attention-Deficit/Hyperactivity Disorder.

Objectives: This study aimed to evaluate the relationship between baseline test of variables of attention (TOVA) performance, attention-deficit/hyperactivity disorder (ADHD) symptom severity, mood symptoms, proneness to boredom in children with ADHD, and to assess the responses of the various scales to methylphenidate treatment. Methods: Thirty-three children and adolescents with ADHD, aged 7-18 years, were assessed at baseline with TOVA and treated for 3 months thereafter with methylphenidate. The ADHD Rating Scale (ADHD-RS), Short Boredom Proneness Scale (SBPS), Children's Depression Inventory (CDI) scale, and CDI-academic and social subscale (CDI-AS) were administered to all participants at baseline and after 3 months of methylphenidate (MPH) treatment. Results: The baseline TOVA reaction time (RT) and RT variability parameters correlated with baseline SBPS and CDI-AS scores as well as with baseline total CDI scores. Significant improvements were found in ADHD-RS, SBPS, and CDI-AS scores after MPH treatment. The alteration in ADHD-RS correlated with parallel changes in SBPS and CDI-AS scores. Conclusions: Mood and proneness to boredom correlate with poor attention-span in children with ADHD. Improvement in ADHD levels after MPH treatment correlates with a parallel decrease in mood symptoms related to academic achievement and social functioning.

Possible Age-Related Progression of Attentional Impairment in ADHD and Its Attenuation by Past Diagnosis and Treatment.

Objective: The aim of the study is to evaluate attentional impairment in different age groups with ADHD. Method: In all, 58 children, 73 adolescents, and 104 adults with ADHD were evaluated using the Test of Variables of Attention (TOVA). Subjects with comorbidities or psychotropic treatment were not included. Results: Considering Response Time Variability (RTV), adults were 10.6 and 4.0 times more likely to be severely impaired (standard score < 40) than children and adolescents, respectively. Adults were twice as likely as adolescents to be very impaired (standard score< 70) in Omissions. Considering d' (decrement of attentional performance over time), all severely impaired participants were adults. Age predicted impairment in Attention Performance Index (API), RTV, and d', but not Omissions or Commissions. Past treatment with stimulants predicted less impairment in d', past diagnosis predicted less impairment in RTV, and each predicted less impairment in Omissions and API. Conclusion: Adults had more attentional impairment than children and adolescents. Past diagnosis and treatment were associated with less ADHD-related attentional impairment.

The Placebo Response in Adult ADHD as Objectively Assessed by the TOVA Continuous Performance Test.

Objective: We compared the placebo response (PR) as measured by the Test of Variables of Attention (TOVA) and the Conners' Adult ADHD Rating Scale (CAARS) scores. Method: A retrospective data analysis from a double-blind placebo-controlled study of metadoxine-ER in adults with ADHD. An additional database was used for comparison to TOVA response after methylphenidate challenge (TOVA-MPH-R). Results: PR was highest when calculated from the TOVA-Attention Composite Score (ACS). The PR showed significantly fewer variables improving concomitantly compared with MPH-R. The most prominent correlation between the CAARS-PR and the TOVA-PR was in the Omissions score (p = .032), which was age-dependent (b = .0007, p <.001). Discussion: TOVA-PR has an index-specific profile compared with CAARS-PR and TOVA-MPH-R. The partial correlation of TOVA-PR with CAARS-PR suggests that a composite score of TOVA specific indices and CAARS could have a synergic impact to improve the reliability of the response assessment in adult ADHD.

Management of anxiety disorders in children with attention-deficit hyperactivity disorder: a narrative review.

Anxiety disorders are common comorbidities of attention deficit/hyperactivity disorder (ADHD) and conversely, ADHD is prevalent among anxious youths. A variety of treatments, both psychopharmacological and nonpsychopharmacological, are used to manage combined ADHD/anxiety disorder. This article aims to review the literature on the treatment of ADHD with comorbid anxiety disorders, and make evidence-based recommendations for clinical practice. In most cases, when ADHD is the primary condition, stimulants are the first-line of treatment, frequently resulting not only in improvement in ADHD symptoms but also alleviating the symptoms of the comorbid anxiety disorder. Stimulant treatment is relatively safe and well-tolerated in ADHD with comorbid anxiety disorder. When the stimulant administration does not attenuate the severity of the comorbid anxiety disorder, a treatment that targets specifically the anxiety disorder should be added. This recommendation, however, might be challenged by the impressive efficacy of atomoxetine for both the ADHD and anxiety disorder symptoms. Adjunctive cognitive-behavior therapy for anxiety disorder symptoms is strongly recommended and is considered superior to medication alone. Other options include adding pharmacological treatment for the anxiety symptoms. In moderate and severe cases of comorbid Ads, selective serotonin reuptake inhibitors can be added to the stimulants, with the required caution.

Levels of Proneness to Boredom in Children with Attention-Deficit/Hyperactivity Disorder On and Off Methylphenidate Treatment.

Objective: To evaluate the relationship between attention-deficit/hyperactivity disorder (ADHD) severity and propensity for boredom in children with ADHD, both on and off methylphenidate (MPH). Methods: A group of children and adolescents with ADHD (n = 30), aged 7-18 years, were assessed using the Parent-Reported-ADHD Rating Scale-5 (PR-ADHD-RS-5) and Short Boredom Proneness Scale (SBPS), at baseline, after 3 months of MPH treatment, and again after 3 weeks of MPH treatment discontinuation. Results: Significant correlation was found at baseline between PR-ADHD-RS-5 and SBPS scores [n = 30, r = 0.40 (95% confidence interval {CI} = 0.048-0.67), p = 0.027]. Both ADHD and boredom levels decreased significantly after 3 months of MPH treatment. Significant correlation was found between the reductions in PR-ADHD-RS-5 and SBPS scores at this time [n = 30, r = 0.39 (95% CI = 0.035-0.66), p = 0.045]. MPH discontinuation for 3 weeks resulted in mild but statistically significant increases in ADHD and SBPS levels. No significant correlation was detected between the changes in PR-ADHD-RS-5 and SBPS scores after 3 weeks of MPH discontinuation. Conclusions: Three months of MPH treatment resulted in parallel improvement in ADHD severity and in the level of proneness to boredom (PtB), whereas discontinuation of MPH administration is associated with increases in the two parameters, causing them to approach pretreatment levels. Clinicians and parents should be aware of the possibility of increased PtB in children with ADHD who discontinue MPH treatment. Structured daily activity and continuation of MPH treatment may preserve the beneficial effects of MPH on academic and leisure activities and may prevent aggravation of subjective boredom sensations that could lead to risky sensation-seeking behaviors and overuse of electronic devices.

Poor performance of the 'child Reading the Mind in the Eyes Test' correlates with poorer social-emotional functioning in children with attention-deficit/hyperactivity disorder.

The performance of the 'child Reading the Mind in the Eyes Test' (cRMET), a measure of Theory of Mind (ToM), was assessed in children with attention-deficit/hyperactivity disorder (ADHD) with relation to social-emotional functioning and ADHD severity. The impact of a single dose of methylphenidate on cRMET performance was evaluated. A group of 25 children aged 7-17 years diagnosed with ADHD were assessed at baseline by cRMET, the Strengths and Difficulties Questionnaire (SDQ) and the ADHD-rating scale. cRMET assessment was repeated after administration of a single dose of methylphenidate. Significant correlation was found between the age of the participant and baseline cRMET levels (r = 0.56; P = 0.0037). Significant correlation was found between poorer cRMET performance and worse socioemotional functioning, as reflected by higher baseline SDQ scores (r = -0.39, P = 0.048). No significant correlations were found at baseline between cRMET scores and ADHD severity. No significant improvement in cRMET was detected following administration of a single methylphenidate dose. Poor baseline ToM functioning is associated with lower social-emotional functioning. The ToM functioning improves with age in children with ADHD, but is not affected by a single methylphenidate administration.

Adherence to antidepressant medications is associated with reduced premature mortality in patients with cancer: A nationwide cohort study.

BACKGROUND: Depression and anxiety are common in cancer and antidepressants (AD) are efficacious treatment. The relationship between AD adherence and mortality in cancer is unclear. This study aimed to evaluate the association between adherence to AD and all-cause mortality in a population-based cohort of patients with cancer. MATERIALS AND METHODS: We conducted a 4-year historical prospective cohort study including 42,075 patients with cancer who purchased AD at least once during the study period. Adherence to AD was modeled as nonadherence (<20%), poor (20-50%), moderate (50-80%), and good (>80%) adherence. We conducted multivariable survival analyses adjusted for demographic and clinical variables that may affect mortality. RESULTS: During 1,051,489 person-years at risk follow-up, the adjusted hazard ratios (HR) for mortality were 0.89 (95% confidence interval [CI]: 0.83-0.95), 0.77 (95% CI: 0.66-0.72), and 0.80 (95% CI: 0.76-0.85) for the poor, moderate, and good adherence groups, respectively, compared to the nonadherent group. Analysis of the entire sample and a subgroup with depression, for cancer subtypes, revealed similar patterns for breast, colon, lung, and prostate cancers, but not for melanoma patients. Multivariate predictors of premature mortality included male gender (HR 1.48 [95% CI: 1.42-1.55]), current/past smoking status (HR 1.1, [95% CI: 1.04-1.15]; P < .0001), low socioeconomic status (HR 1.1, [95% CI: 1.03-1.17]; P < .0001) and more physical comorbidities. CONCLUSIONS: The present study is the first to demonstrate that higher adherence to AD is associated with a decrease of all-cause mortality in a large nationwide cohort of cancer patients. Our data add to the pressing need to encourage adherence to AD among cancer patients.

Apparent lack of practice effects in the Test of Variables of Attention (TOVA) in adult ADHD.

The test of variables of attention (TOVA) is a continuous performance test commonly used as an aid for diagnosis of ADHD and assessment of treatment response. It has been studied and standardized in both children and adults. As a repetitive measurement of treatment efficacy, used both in research and in the clinic, it's important to disprove a practice effect. A retrospective cohort analysis was done, using only the placebo-arm participants from two different randomized, multicenter, double-blind clinical trials on the efficacy of a non-stimulant (metadoxine-XR). In order to reveal the practice effects, only the participants that showed no placebo effect (< 25% improvement), in the Conners' Adult ADHD Rating Scale-investigator rated (CAARS-Inv), the gold standard, were included. Demographic data, CAARS-Inv baseline and TOVA results during each visit were recorded and analyzed. Ninety-one participants from two studies were pooled (2014 n = 24, 2016 n = 67). They did not differ significantly in any demographic parameter, most side effect frequencies, and CAARS-Inv baseline scores. The baseline TOVA performances demonstrated similarity in the degree of inattention, variability, impulsivity, and response time. The TOVA scores were not altered significantly between visits, as assessed by repeated-measures analysis of variance. No significant differences were detected between the TOVA baseline-to-endpoint scores as assessed by paired t test. No practice effects were detected, in both clinical trials, suggesting that the results of the TOVA are likely to represent genuine changes in attentional performance. Further studies are needed to replicate these findings.

High pretreatment cognitive impulsivity predicts response of oppositional symptoms to methylphenidate in patients with attention-deficit hyperactivity disorder/oppositional defiant disorder.

The aim of this study was to compare impulsivity levels, as assessed by a continuous performance test (CPT), and the correlations between baseline CPT performance and response to methylphenidate (MPH), as assessed by the conjunctive CPT (CCPT), in children with only Diagnostic and Statistical Manual of Mental Disorders, 5th ed. attention-deficit hyperactivity disorder with no oppositional defiant disorder (ADHD/noODD) or with comorbid ODD (ADHD/ODD). Fifty-three children and adolescents were included in the study (ADHD/noODD group, n = 25, 12 women/13 men and ADHD/ODD group, n = 28, eight females/20 males). Attention was assessed at baseline using CCPT. ADHD and ODD severities were assessed at baseline and following a 12-week MPH treatment using the ADHD-rating scale (ADHD-RS) completed by the parent and by a teacher and the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-ODD (K-SADS-ODD) completed by the treating psychiatrist. Higher baseline commission-errors rates (P = 0.0031) in ADHD-RS/parent-child, ADHD-RS/teacher, and K-SADS-ODD scores were detected in ADHD/ODD compared with the ADHD/noODD. Significant improvements in ADHD-RS/parent-child, ADHD-RS/teacher, and K-SADS-ODD scores were achieved following MPH treatment in both groups. Significant correlations were found between baseline CCPT commission-error rates and improvement in ADHD-RS-teacher in ADHD/noODD, but not in ADHD/ODD. Among the ADHD/ODD, but not the ADHD/noODD, a significant correlation was found between baseline CCPT commission-error rates and improvement in K-SADS-ODD. Baseline cognitive impulsivity (as measured by the CCPT) can predict response of ODD to MPH treatment in ADHD/ODD patients.

Demographic and Clinical Predictors of Hospitalization in Preschoolers With ADHD.

Objective: This chart review study characterized demographic and clinical indicators of the need for hospitalization in preschoolers with ADHD. Method: Medical records of preschoolers with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) ADHD during 2009-2012 were systematically reviewed. The cohort included 111 children (aged 5.13 ± 0.55 years, 77.47% boys). The demographic and clinical variables of hospitalized at a day-care unit (n = 30) and nonhospitalized (n = 81) preschoolers were compared. Results: Hospitalized preschoolers were younger (p < .0001), had higher rates of unmarried mothers (p < .001), and a higher number of comorbidities. The number of inattentive/hyperactivity-impulsivity symptoms was similar in both groups. Neurodevelopmental comorbidity (p < .0001), but not externalized (p = .82) or internalized (p = .20) psychopathology, was significantly higher in the hospitalized group. Conclusion: ADHD severity in preschoolers tends to be associated with younger age, specific parenthood constellations, and a high rate of neurodevelopmental, but not other, comorbidities. These findings emphasize the importance of the neurodevelopmental context in planning ADHD interventions at preschool age.

Cannabidiol as a suggested candidate for treatment of autism spectrum disorder.

Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social communication, restricted and repetitive patterns of behavior, interests, or activities and often intellectual disabilities. ASD has a number of prevalent co-morbidities, such as sleep disorders, attention deficit/hyperactivity disorder and epilepsy. No effective treatment for the core symptoms of ASD is currently available. There is increasing interest in cannabinoids, especially cannabidiol (CBD), as monotherapy or add-on treatment for the core symptoms and co-morbidities of ASD. In this review we summarize the available pre-clinical and clinical data regarding the safety and effectiveness of medical cannabis, including CBD, in young ASD patients. Cannabidiol seems to be a candidate for the treatment of ASD. At present, however, there are no convincing pre-clinical or clinical data showing efficacy and safety of cannabinoid treatment in ASD patients.

The effect of methylphenidate treatment on psychopathic behavior of patients having attention-deficit hyperactivity disorder with and without oppositional defiant disorder.

To evaluate the effect of 3 months of methylphenidate (MPH) treatment on psychopathic behavior in children having attention-deficit hyperactivity disorder (ADHD) with and without comorbid oppositional defiant disorder (ODD). Twenty-seven children with Diagnostic and Statistical Manual of Mental Disorders, fifth ed., ADHD (13 female/14 male; aged 13.3±2.2 years old) were compared to an age/sex matched ADHD/ODD group (N=27, eight female/19 male; aged 11.8±1.9 years). The attention-deficit hyperactivity disorder rating scale (ADHD-RS) and the California Child Q-Set (CCQ) were used in both groups before MPH treatment (0.8-1.2 mg/kg/day) and 3 months thereafter. Significant reduction in the ADHD-RS scores was detected following MPH treatment in both the ADHD/ODD group and in the ADHD group (P<0.0011 and P=0.0012, respectively). Reduction in the CCQ scores was obtained in the ADHD/ODD group (P=0.0001) but not in in the ADHD group (P=0.18). A correlation was found between the reductions in the ADHD-RS and CCQ scores following MPH treatment in the ADHD/ODD group (Spearman's r=0.43, P=0.024). MPH treatment in children with ADHD/ODD was associated with reduction in psychopathic scores, and the reduction correlated with a corresponding improvement in their ADHD severity.

The Impact of Prolonged, Selective, Serotonin Reuptake Inhibitor Treatment on Serum Lipid and Glucose Levels in Children and Adolescents: A Preliminary Prospective Study.

OBJECTIVES: Treatment with selective serotonin reuptake inhibitors (SSRIs) is common and is considered safe and effective in the treatment of anxiety and depressive disorders in pediatric populations. SSRI administration, however, is associated with adverse metabolic effects. The aim of this preliminary study was to evaluate the possible influence of a 6-month SSRI treatment on metabolic parameters in children and adolescents with depressive and/or anxiety disorders. METHODS: Metabolic parameters (glucose, cholesterol, triglycerides, low-density lipoprotein [LDL], and high-density lipoprotein [HDL]) were monitored in 22 children and adolescents (16 boys and 6 girls, aged 8-18 years) at baseline and after 6 months of SSRI treatment for depression and/or anxiety. RESULTS: Six months of SSRI treatment did not affect serum glucose, cholesterol, or triglycerides significantly, but a tendency (p = 0.06) toward elevation in serum LDL accompanied by a parallel reduction in HDL levels was detected. CONCLUSION: It appears that the 6-month SSRI treatment is metabolically safe in children and adolescents and does not affect the glucose or lipid profile. Long-term large-scale studies in pediatric populations focusing on the possible impact of long-term SSRI treatment (>6 months) on metabolic parameters are warranted.

Effectiveness of parental training, methylphenidate treatment, and their combination on academic achievements and behavior at school of children with attention-deficit hyperactivity disorder.

This study aimed to compare the effectiveness of parental training (PT), methylphenidate treatment (MPH), and the combination of PT and MPH treatment (PT/MPH) on school achievements in children with attention-deficit hyperactivity disorder (ADHD). Twenty eight ADHD patients (age: 10.1±1.11 years) were divided into three groups: (a) PT (N=10), (b) PT/MPH (N=8), and (c) MPH alone (N=10). Their grades in academics and conduct, from their school reports before and after treatment (6 months), were coded as achievement scores. No significant differences in baseline academic and conduct scores were found between the groups (F=0.033, d.f.=2, P=0.97 and F=0.024, d.f.=2, P=0.98, respectively). No significant changes before versus after treatment were detected in academic (3.83±0.93 vs. 3.85±0.88, paired t=0.086, d.f.=9, P=0.93, NS) or conduct (3.90±1.10 vs. 4.10±1.00, paired t=1.50, d.f.=9, P=0.17, NS) scores in the PT group. The same was true for the PT/MPH group (academic scores: 3.75±0.98 vs. 4.05±0.83, d.f.=7, t=0.927, P=0.38; conduct scores: 3.85±0.83 vs. 4.12±0.83, d.f.=7, t=0.79, P=0.45). Only the MPH group showed significant improvements in those scores (academic scores: 3/73±0.85 vs. 4/44±0.48, d.f.=9, t=3.33, P=0.0088; conduct scores: 3.80±0.70 vs. 4.60±0.70, d.f.=9, t=3.2, P=0.011). Methylphenidate alone is superior to either parental training or parental training/methylphenidate in improving academics and conduct at school.

The effect of methylphenidate treatment on suspiciousness in children with ADHD alone or comorbid with ODD.

OBJECTIVE: To assess the level of the suspiciousness in children with attention deficit/hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD) in comparison to ADHD alone and the response of suspiciousness symptoms to methylphenidate (MPH) treatment. METHODS: In this open-label comparative study, children with DSM-IV-TR ADHD, aged 8-18 years, with (N = 30) or without (N = 30) ODD received MPH treatment for 12 weeks. The severity of ODD symptoms was assessed by the Kiddie-Schedule for Affective Disorders and Schizophrenia. The severity of ADHD symptoms was assessed by the ADHD-Rating-Scale-IV and suspiciousness was assessed at baseline and at endpoint by a scale designed especially for assessment of suspiciousness and named Suspiciousness Rating Scale (SRS). RESULTS: Significant reductions in SRS scores were detected in both groups following MPH treatment (before and after: p = .0012 and p = .0273, respectively). Only in the ADHD/ODD group a significant correlation was found between the rate of improvement in ADHD, as assessed by the ADHD-RS, and the reduction in suspiciousness, as assessed by the SRS (Spearman r = 0.48, p = .0066). CONCLUSIONS: In addition to the beneficial effect of MPH treatment on ADHD and ODD symptoms it also diminishes suspiciousness. However, due to the small sample size further studies are needed to confirm the present results.

The effect of methylphenidate on anxiety and depression symptoms in patients with Asperger syndrome and comorbid attention deficit/hyperactivity disorder.

The objective of this study was to assess the response of anxiety and depression symptoms to methylphenidate (MPH) treatment in patients with Asperger syndrome (AS) combined with attention deficit/hyperactivity disorder (ADHD). A group of 12 patients with AS/ADHD, aged 8-18 years, received 12 weeks of MPH treatment. The severities of ADHD, anxiety, and depression symptoms were assessed by means of the ADHD Rating Scale (ADHD-RS), Screen for Child Anxiety Related Emotional Disorders, and the Children's Depression Inventory. The severity of ADHD and depression symptoms was reduced significantly (P<0.0003 and P=0.046, respectively). No improvement in total anxiety symptoms was found, but a significant reduction was obtained in the school-related subscale of the Screen for Child Anxiety Related Emotional Disorders (P=0.0054). A positive correlation was found between the reductions in ADHD-RS and Children's Depression Inventory scores (r=0.59, P=0.039). MPH treatment may be safe, tolerable, and effective in alleviating depression and school-related anxiety symptoms in patients with AS and ADHD.

The Possible Effect of Methylphenidate Treatment on Empathy in Children Diagnosed with Attention-Deficit/Hyperactivity Disorder, Both With and Without Comorbid Oppositional Defiant Disorder.

OBJECTIVE: To assess the Empathizing Quotient (EQ) of patients diagnosed with attention-deficit/hyperactivity disorder (ADHD) only or comorbid with oppositional defiant disorder (ODD) and compare the two groups' responses to methylphenidate (MPH) treatment. METHODS: Fifty-two children (8-18 years) diagnosed with ADHD, 26 of whom were also diagnosed with comorbid ODD (ADHD/ODD), were treated with MPH for 12 weeks. The level of EQ was assessed with the Children's version of the Empathizing Quotient (EQ-C) and the severity of ADHD symptoms with the ADHD Rating Scale (ADHD-RS). Assessments were done at baseline and at end point. RESULTS: A significant increase in EQ scores was obtained in both groups following MPH treatment (p = 0.003 for ADHD/ODD; p = 0.002 for ADHD). Significant correlation was found in the ADHD group between the changes in ADHD-RS and those in EQ, following MPH treatment (p = 0.015), but not in the ADHD/ODD group (p = 0.48). CONCLUSIONS: A correlation exists between MPH-related improvement in ADHD symptoms and between more empathy in children with ADHD not comorbid with ODD.

No Superiority of Treatment With Osmotic Controlled-Release Oral Delivery System-Methylphenidate Over Short/Medium-Acting Methylphenidate Preparations in the Rate and Timing of Injuries in Children With Attention-Deficit/Hyperactivity Disorder.

OBJECTIVES: Methylphenidate (MPH) treatment in patients with attention-deficit/hyperactivity disorder (ADHD) is reported to reduce the risk for injuries. In the present study, the rate and timing of injuries were compared among the various MPH preparations (4 and 6-8 vs 12 hour-acting) in children with ADHD. METHODS: This real-world retrospective study covered the years 2011 to 2013. Participants included 2042 youngsters (aged 4-18 years, 13.01 ± 3.2 years; 71.8% males and 28.2% females) diagnosed with ADHD according to the International Statistical Classification of Diseases, 10th Revision criteria and treated with various MPH preparations. They were divided into 2 groups by their treatment preparation as follows: MPH-immediate release (MPH-IR)-4 hour-acting pooled with MPH-slow release/long-acting (MPH-SR/LA)- 6 to 8 hour-acting versus osmotic controlled-release oral delivery system-MPH (OROS-MPH; Concerta)-12 hour-acting that consisted of pooling of OROS-MPH only and OROS-MPH combined with the other MPH preparations. The monthly rates of injury, specifically, late injury (occurrence between 4:00 p.m. to midnight) and for multiple injuries, the time interval between injuries, were assessed. RESULTS: No significant differences in monthly rate of nonfatal injuries were found between OROS-MPH with or without 4/6 to 8 hour-acting MPH-formulations versus only 4/6 to 8 hour-acting MPH-preparations (P = 0.53). Neither were differences found in the between-injury time interval (P = 0.83) or in late-injury-rates (P = 0.37) between those groups. CONCLUSIONS: This real-world-naturalistic study in the community demonstrates that, in ADHD pediatric populations, OROS-MPH preparation is not superior to short/medium-acting (4/6-8 hours) MPH preparations regarding the rate and timing of injuries.

Involvement and Warmth of Fathers with Mental Illness: The Role of the Caregiving System, Parental Self-Efficacy, Social Support and Child Characteristics.

This study compares the levels and predictors of paternal warmth and involvement of 69 fathers with serious mental illness (SMI) and 69 matched non-clinical (NC) fathers in Israel. Findings show that the NC fathers were more involved with their children, whereas the SMI fathers reported more warmth and perceived their children as less difficult. The interactions that were found in the regression analyses highlight the differences between the two groups. Among the SMI fathers, but not the NC fathers, higher paternal self-efficacy was associated with increased father involvement, and lower family support was associated with decreased warmth.