Parent-Child Inpatient Treatment in Child and Adolescent Mental Healthcare: Predictors of Child Outcomes.

Family inpatient units in child and adolescent mental health (CAMH) services engage all admitted family members in the treatment of children's symptoms. Studies demonstrated improvements in child and family functioning following family inpatient treatment, but evidence regarding predictors of treatment outcome is lacking. We analyzed data of families (n = 66) who received a four-week inpatient treatment for families with severe parent-child interaction problems. Hierarchical linear regression analyses revealed that parents who recalled harsher parenting practices of their own fathers reported greater improvements in their children's externalizing and internalizing problems. Greater improvements in externalizing problems were further predicted by lower parental educational level, less adverse impacts of stressful life events, and less internalizing child problems prior to admission. We therefore conclude that family inpatient treatment was particularly effective for children in families with lower parental education and a history of harsh parenting.

Predicting delinquent behavior in young adults with a childhood diagnosis of ADHD: results from the Cologne Adaptive Multimodal Treatment (CAMT) Study.

The aim of this study was to investigate which factors predict lifetime reports of delinquent behavior in young adults who had received adaptive multimodal treatment of attention-deficit/hyperactivity disorder (ADHD) starting at ages 6-10 years. Participants were reassessed 13-24 years (M = 17.6, SD = 1.8) after they had received individualized ADHD treatment in the Cologne Adaptive Multimodal Treatment Study (CAMT). Their behavior was classified as non-delinquent (n = 34) or delinquent (n = 25) based on self-reports regarding the number of police contacts, offenses, and convictions at follow-up. Childhood variables assessed at post-intervention (e.g., externalizing child behavior problems, intelligence, and parenting behavior) that were significantly associated with group membership were entered as possible predictors of delinquency in a Chi-squared automatic interaction detector (CHAID) analysis. Delinquent behavior during adolescence and adulthood was best predicted by (a) meeting the symptom count diagnostic criteria for conduct disorder (CD) according to parent ratings, in combination with a nonverbal intelligence of IQ ≤ 106 at post-intervention, and (b) delinquent behavior problems (teacher rating) at post-intervention. The predictor variables specified in the CHAID analysis classified 81% of the participants correctly. The results support the hypothesis that a childhood diagnosis of ADHD is only predictive of delinquent behavior if it is accompanied by early conduct behavior problems. Low nonverbal intelligence was found to be an additional risk factor. These findings underline the importance of providing behavioral interventions that focus on externalizing behavior problems to children with ADHD and comorbid conduct problems.

Prediction of Educational Attainment and Occupational Functioning in Young Adults With a Childhood Diagnosis of ADHD: Results from the Cologne Adaptive Multimodal Treatment (CAMT) Study.

OBJECTIVE: This longitudinal study examined early predictors of educational attainment and occupational functioning in adults with a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD). METHOD: Participants (n = 70) of the Cologne Adaptive Multimodal Treatment (CAMT) Study were diagnosed with ADHD and received adaptive multimodal ADHD treatment during childhood. They were then followed through adolescence into adulthood. RESULTS: Hierarchical regression analysis revealed that poor reading skill and externalizing behaviors in childhood were early predictors of educational and occupational difficulties in adulthood. The use of stimulant medication in childhood predicted lower high school achievement, probably because medication use was confounded by indication. The regression models improved when intelligence scores and/or externalizing behaviors, especially delinquency, assessed in adolescence were considered as additional predictors. CONCLUSION: Children with ADHD, who continue to show reading difficulties and externalizing behavior problems after initial treatment, are at risk for educational and occupational difficulties and may need additional support.

Does parent management training reduce behavioural and emotional problems in children with intellectual disability? A randomised controlled trial.

BACKGROUND: Children with intellectual disability (ID) are more likely to develop behavioural and emotional problems. However, specific interventions for the treatment of these problems in children with ID have rarely been evaluated. Parent management training (PMT) has been shown to be effective in reducing behavioural and emotional problems for other mental disorders. Therefore, we developed and evaluated a special PMT intervention for parents of children with ID. METHODS: The PMT was developed based on existing programs for children with other mental disorders. The effects of the PMT were analysed in a randomised controlled trial (intervention group: n = 21; waitlist control group: n = 21). The primary outcome was behavioural and emotional problems of children as rated by parents. Additionally, effects on parent-rated family burden and positive and negative parenting were assessed. OUTCOME: For the primary outcome, a statistically significant reduction of behavioural and emotional problems of the children emerged, with moderate effects for disruptive/ antisocial behaviour and anxiety. Family burden was reduced as a trend, with a small effect size. There was a significant increase in positive parenting and no effect on negative parenting.

Children with Attention-Deficit/Hyperactivity Disorder Grown Up: An 18-Year Follow-Up after Multimodal Treatment.

OBJECTIVE: ADHD treatment has positive effects on behavioral symptoms and psychosocial functioning, but studies that follow children treated for ADHD into adulthood are rare. METHOD: This follow-up study assessed symptom severity and functional outcomes of adults (n = 70) who had received individualized ADHD treatment in the Cologne Adaptive Multimodal Treatment (CAMT) Study at ages 6 to 10 years. RESULTS: Despite symptomatic improvement, participants reported poorer educational and occupational outcomes than expected (e.g., currently unemployed: 17%). They had also been in contact with the justice system more often than expected (e.g., lifetime convictions: 33%) and were impaired on health-related outcomes (e.g., substance use problems: 15%). Several social outcomes were favorable (e.g., long-term relationship/married: 63%). CONCLUSION: Compared to the general population or norm samples, CAMT participants had a higher relative risk (RR) of functional impairments, demonstrating the need for continued support for a substantial proportion of the young adults.

Efficacy of Omega-3/Omega-6 Fatty Acids in Preschool Children at Risk of ADHD: A Randomized Placebo-Controlled Trial.

Objective: To evaluate the efficacy of an Omega-3/Omega-6 fatty acid supplement in preschool children at risk for ADHD. Method: Forty preschool children with elevated levels of ADHD symptoms were randomly assigned to either a verum or a placebo group. Children in the verum group received a 4-month treatment with Omega-3/Omega-6 fatty acids. Outcome measures comprised parent- and teacher-rated ADHD symptoms, which were the primary outcome variables, internalizing and externalizing problems, and intellectual abilities. Results: Intention-to-treat analyses of covariance, controlling for age and baseline data, revealed effects on parent- and teacher-rated ADHD symptoms (primary outcomes; parent ratings: F = 4.51, df = 1, p = .04, d = 0.63; teacher ratings: F = 4.67, df = 1, p = .04, d = 0.70), parent-rated internalizing symptoms (F = 8.47, df = 1, p < .01, d = 0.63), and parent- and teacher-rated externalizing symptoms (parent ratings: F = 4.58, df = 1, p = .04, d = 0.54; teacher ratings: F = 5.99, df = 1, p = .02, d = 0.79). Analyses involving only cases with available data yielded significant moderate effects on teacher-rated inattention symptoms (F = 4.60, df = 1, p = .04, d = 0.79) and parent-rated internalizing problems (F = 6.04, df = 1, p = .02, d = 0.57). Conclusion: The intention-to-treat analyses provide some evidence for positive effects of Omega-3/Omega-6 fatty acids. However, the results require replication in larger samples to allow for firm conclusions for practice.

Long-Term Course After Adaptive Multimodal Treatment for Children With ADHD: An 8-Year Follow-Up.

Objective: This study reassessed adolescents and young adults (15-22 years old) who received individually tailored multimodal treatment for ADHD (behavior therapy and/or stimulant medication) during childhood 6 to 12 years after treatment (M = 8.8 years, SD = 1.6). Method: All participants (N = 75) provided information about their social functioning. Most parents (83%) completed behavior rating scales. Results: Participants demonstrated significant improvement in behavior during the follow-up period with effect sizes on ADHD symptoms of d = 1.2 and 68% of the former patients in the normal range at follow-up. Participants reported elevated rates of grade retention (51%), school dropout (13%), special education service use (17%), school change (47%), and conviction (16%), but few were unemployed (4%). Conclusion: This study provides evidence that the effects of individually tailored multimodal treatment for ADHD in childhood are maintained into adolescence and young adulthood. No hints could be found that continued medication results in a more favorable long-term outcome.

[Family relations and behavioral-emotional problems in adolescents - an analysis with the adolescent version of the Family Relations Test for Children and Adolescents]. / Familienbeziehungen und psychische Auffälligkeiten im Jugendalter ­ eine Analyse mit der Jugendlichenfassung des Family Relations Test für Kinder und Jugendliche.

Family relations and behavioral-emotional problems in adolescents - an analysis with the adolescent version of the Family Relations Test for Children and Adolescents Abstract. OBJECTIVES: So far hardly any instruments are available for the German-speaking countries, covering family relations from the perspective of young people reliably. Moreover, the relationship between family relations from the perspective of young people and behavioral problems has been rarely investigated. METHOD: Based on the Family Relations Test, which has been developed originally for children, the Family Relations Test for Children and Adolescents was developed in order to assess the family relations from the perspective of adolescents (94 items, 44 % newly developed). A clinical sample (n = 152) and a field sample (n = 132) was tested with this instrument and additionally behavioural problems of the adolescents were rated by the parents and the adolescents. RESULTS: The two-factor solution of the principal component analysis resulted in a clear distinction between two factors describing positive and negative family relations. The internal consistencies (Cronbach's Alpha) of the scales describing positive and negative relations are between .91 and .93. On these total scores young people from the clinic sample describe overall stronger negative relations in their families compared to young people in the field sample. Within the clinic sample moderate correlations between the extent of mental problems of young people rated by themselves and their parents could be found. CONCLUSIONS: Positive and negative relationships of young people to the individual family members and to all members of the family as a whole can be assessed reliably and factorially valid. As expected, significant correlations between negative family relations and mental problems could be found. The adolescent version of the Family Relations Test for Children and Adolescents proves to be a useful tool, to assess family relationships from the perspective of young people and thus to identify possible factors maintaining mental disorders of young people.

Efficacy and Safety of Omega-3/6 Fatty Acids, Methylphenidate, and a Combined Treatment in Children With ADHD.

OBJECTIVE: To compare efficacy of Omega-3/6 fatty acids (Equazen eye q™) with methylphenidate (MPH) and combined MPH + Omega-3/6 in children with ADHD. METHOD: Participants ( N = 90) were randomized to Omega-3/6, long-acting MPH, or combination for 12 months. ADHD symptoms were assessed using the ADHD Rating Scale and Clinical Global Impressions-Severity (CGI-S) scale. RESULTS: ADHD symptoms decreased in all treatment arms. Although significant differences favoring Omega + MPH over Omega-3/6 alone were found for ADHD Total and Hyperactivity-Impulsivity subscales, results on the Inattention subscale were similar. CGI-S scores decreased slowly and consistently with Omega-3/6, compared with a rapid decrease and subsequent slight increase in the MPH-containing arms. Adverse events were numerically less frequent with Omega-3/6 or MPH + Omega-3/6 than MPH alone. CONCLUSION: The tested combination of Omega-3/6 fatty acids had similar effects to MPH, whereas the MPH + Omega combination appeared to have some tolerability benefits over MPH.

Parent-child inpatient treatment for children with behavioural and emotional disorders: a multilevel analysis of within-subjects effects.

BACKGROUND: The importance of parental involvement in child treatment is well-established. Several child psychiatric clinics have, therefore, set up inpatient family units where children and parents are both actively involved in the treatment. Unfortunately, evidence supporting the benefits of these units is sparse. METHODS: We evaluated the effectiveness of inpatient treatment for families with severe parent-child interaction problems in a child psychiatric setting. Consecutive admissions to the parent-child ward (N = 66) were studied. A within-subjects design was used with four assessment points (baseline, admission, discharge, four-week follow-up). Outcome measures were 1) parent and teacher ratings of child behaviour, and 2) parent self-ratings of parenting practices, parental strains and parental mental health. Data were analyzed using multilevel modelling for longitudinal data (piecewise growth curve models). RESULTS: All parent-rated measures improved significantly during the four-week treatment period (d = 0.4 - 1.3). These improvements were significantly greater than those observed during the four-week pre-admission period. In addition, benefits were maintained during the four-week follow-up period. Only parents' self-efficacy in managing their child's behaviour showed continued improvement during follow-up. Teacher ratings of children's disruptive behaviour at school were stable during the pre-admission period and showed significant improvements at follow-up (d = 0.3 - 0.4). CONCLUSIONS: We conclude that parent-child inpatient treatment has positive effects on child and parent behaviour and mental health, and can therefore be recommended for children with behavioural and emotional disorders and severe parent-child interaction problems.