Comorbidity of asthma in patients with attention-deficit/hyperactivity disorder (ADHD) aged 4-12 years in Iran: a cross-sectional study.

Attention-deficit/hyperactivity disorder (ADHD) is defined as a stable pattern of attention deficits or impulsive hyperactivity that can interfere with the functioning, growth, and development of individuals. It is believed that both the type of asthma and the medications used to treat it exacerbate the symptoms of ADHD. Methods and Materials: The present study was a cross-sectional analytical study conducted to investigate the incidence of asthma in ADHD patients aged 4-12 years who were referred to Urmia University of Medical Sciences clinics and hospitals. In this study, ADHD patients were diagnosed through a psychiatric interview and based on a paediatric asthma questionnaire (approved by asthma and allergy organizations and scientific institutions), and individuals with suspected asthma were selected. All 101 ADHD patients referred to these clinics during the specified period were examined. Five patients were excluded from the study because of lack of cooperation or incomplete information. Then, the selected subjects were divided into two age groups of less than 5 years and between 5 and 12 years. The final diagnosis of asthma was made by clinical findings and demographic questionnaire in subjects younger than 5 years, while it was made by spirometry in subjects between 5 and 12 years. Data analysis was conducted using SPSS software. Results: The mean age of the 96 samples included in the study was 7.67 years with a standard deviation of 7.214. Sixteen of them (16.7%) were under 5 years of age and eighty of them (83.3%) were between 5 and 12 years of age. Asthma was diagnosed in 7 children under 5 years of age (7.3%) and in 14 children (14.6%) between 5 and 12 years of age. A total of 21 (21.9%) were diagnosed as having asthma after screening. On the basis of these results, the frequency of asthma according to classified age was significant (P=0.020). The frequency of asthma based on sex and birth rank was also examined, and none of these factors showed a significant association with asthma. Medications taken by the ADHD patients were also examined in this study. The most commonly used medications in both groups of patients with asthma and no asthmatic patients were a combination of risperidone and atomoxetine or risperidone alone. The prevalence of asthma in the target population was also assessed in terms of parental smoking. Conclusions: According to the results of this study, the incidence of asthma in ADHD patients aged 4-12 years is high, and this case is more frequent in subjects younger than 5 years than in subjects aged 5-12 years. It should be noted that according to the results of the present study, there was no significant association between birth rank, parental smoking, ADHD medication, and the frequency of asthma.

Debate: Conduct disorder and the segregation of child mental health.

Should conduct disorder (CD) be classified as a psychiatric diagnosis? The model of CD found in current diagnostic systems is not without its flaws. The criteria for CD have often been criticised for lacking developmental sensitivity with regard to young children, and questions concerning the subtyping of the disorder and its overlap with comorbid conditions remain contentious. Compelling evidence nonetheless supports the view that this 'behaviour disorder' represents a complex mental health issue that belongs in these diagnostic systems. Most importantly, it identifies a group of children and adolescents for whom early intervention appears to be particularly critical and may serve to divert chronic trajectories of poor mental health. This debate has significant implications for science and practice and is addressed here with a particular focus on the Australian context.

The potential shared brain functional alterations between adults with ADHD and children with ADHD co-occurred with disruptive behaviors.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Many previous studies have shown that the comorbid status of disruptive behaviour disorders (DBD) was a predictor for ADHD persistence into adulthood. However, the brain mechanisms underlying such a relationship remain unclear. Thus, we aim to investigate whether the brain functional alteration in adults with ADHD could also be detected in children with ADHD co-occurring with disruptive behaviours from both quantitative and categorical dimensions. METHODS: A total of 172 children with ADHD (cADHD), 98 adults with ADHD (aADHD), 77 healthy control children (cHC) and 40 healthy control adults (aHC) were recruited. The whole-brain spontaneous fluctuations in brain activity of each participant were recorded using functional near-infrared spectroscopy (fNIRS), and the functional connectivities (FCs) were calculated. We first compared the FC differences between aADHD and aHC. Then, for the regions with significantly abnormal FCs in aADHD, we further compared these features between cADHD and cHC. In addition, the correlation between these FCs and the conduct disorder (CD)/oppositional defiant disorder (ODD) symptoms were analysed in cADHD. Moreover, to render the results readily interpretable, we compared the FC differences among ADHDCD-, subthreshold ADHDCD+ and cHC groups, and among ADHDODD-, ADHDODD+ and cHC groups. Finally, we repeated the above analysis after controlling for other comorbidities and core symptoms to diminish the potential confounding effects. RESULTS: We found that compared with aHC, aADHD showed significantly increased FCs in the VN, DMN, SMN, and DAN. The aforementioned abnormal FCs were also detected in cADHD, however, in an opposite orientation. Notably, these abnormal FCs were positively correlated with CD symptoms. Finally, the subthreshold ADHDCD+ group even exhibited a tendency of adult-like increased FCs compared with the cHC. The results held after controlling for other comorbidities and core symptoms. CONCLUSION: This study provides functional neuroimaging evidence that CD might be a risk factor for ADHD persistence into adulthood. Our work highlights the importance of differentiating ADHDCD+ from ADHD and inspiring further understanding of brain development in ADHD.

Implementation and evaluation of a curriculum on the assessment and treatment of disruptive behaviour disorders.

Disruptive behaviour disorders (DBDs)-which can include or be comorbid with disorders such as attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and disruptive mood dysregulation disorder-are commonly seen in paediatric practice. Given increases in the prescribing of atypical antipsychotics for children and youth, it is imperative that paediatric trainees in Canada receive adequate education on the optimal treatment of DBDs. We describe the development, dissemination, and evaluation of a novel paediatric resident curriculum for the assessment and treatment of DBDs in children and adolescents. Pre-post-evaluation of the curriculum showed improved knowledge in participants.

Needs for occupational assistance among young adults with ADHD to deal with executive impairments and promote occupational participation - a qualitative study.

PURPOSE: To examine perceived aspects of importance among young adults with ADHD to participate and engage in occupational activities, and to explain how support from occupational specialists can assist them to deal with executive impairments. MATERIALS AND METHODS: Individual interviews with eight young adults with attention-deficit/hyperactivity disorder. The interview guide was based on assumptions derived from the literature regarding executive functioning and issues related to participation in occupational activities, alongside the needs for social support. Interview transcripts were analysed using qualitative content analysis. RESULTS: Four categories emerged from the analysed interviews: (1) Being involved in an occupational environment fulfils a need for social contact, (2) Occupational activities must be clear and within interest (3) Self-confidence and daily routines are prerequisites for occupational participation (4) Having a lifeline providing continuous support is important. CONCLUSIONS: Routines, interest and structure in everyday life are important to engage in occupational activities. There is a need for continuous support from a trusted person to establish and maintain healthy daily routines. Occupational specialists can be a vital resource, as they possess specific knowledge on the possibilities for occupation, and additionally, they can fulfil the young adults' needs for continuous support. There is a need for studies questioning how some young adults with ADHD fulfil their work role despite executive impairments. Focusing on executive functioning can be a valuable supplement to the focus on specific diagnoses in research and practice.

Barriers and Facilitators Associated with the Management of Aggressive and Disruptive Behaviour in Children: A Qualitative Study with Pediatricians.

BACKGROUND: Aggressive and disruptive behaviours are frequently observed in children. Short-term use of antipsychotics with monitoring for adverse effects is recommended when first-line interventions fail (e.g. psychosocial therapies and psychostimulants for ADHD). This study aimed to understand the barriers and facilitators to behavioural change for the management of aggressive and disruptive behaviours by pediatricians. METHODS: This was a qualitative study with twenty community-based pediatricians. An interview guide was developed to elicit beliefs associated with practice behaviours. We used thematic content analysis with the Theoretical Domains Framework to inform knowledge translation interventions, by helping to determine what behavioural barriers and facilitators to practice exist. Key domains which influenced behaviour were identified by evaluating the frequency of beliefs across interviews, conflicting beliefs, and the strength of beliefs impacting behaviour. RESULTS: Pediatricians described evaluating the impact of aggressive and disruptive behaviours, attempting to determine their cause, and using an approach that prioritized psychosocial therapies and psychostimulants. Pediatricians reported that antipsychotics were effective but that they experienced anxiety about harms, and there was a need to accept the adverse effects as a trade-off for improved function. Discontinuing antipsychotics was problematic. Despite awareness of antipsychotic-induced movement disorders and metabolic effects, there were limitations in physician skills, knowledge and resources and social influences that were a barrier to routine implementation of recommended monitoring procedures. CONCLUSIONS: This study identifies barriers and facilitators to evidence-based practice that can be used for knowledge translation interventions to ensure a high standard of care for children prescribed antipsychotics.

CONTEXTE: Les comportements agressifs et perturbateurs sont fréquemment observés chez les enfants. L'utilisation à court terme d'antipsychotiques sous surveillance des effets indésirables est recommandée lorsque les interventions de première intention échouent (p. ex., les thérapies psychosociales et les psychostimulants pour le TDAH). La présente étude visait à comprendre les obstacles et les facilitateurs du changement de comportement pour la prise en charge du comportement agressif et perturbateur par les pédiatres. MÉTHODES: Il s'agit d'une étude qualitative menée avec 20 pédiatres communautaires. Un guide d'entrevue a été mis au point afin d'obtenir les croyances associées aux comportements de la pratique. Nous avons utilisé l'analyse du contenu thématique à l'aide du cadre des domaines théoriques pour éclairer les interventions de transmission des connaissances, en aidant à déterminer quels obstacles et facilitateurs comportementaux existent pour la pratique. Les domaines clés qui influençaient le comportement ont été identifiés en évaluant la fréquence des croyances dans les entrevues, les croyances conflictuelles et la force des croyances influant sur le comportement. RÉSULTATS: Les pédiatres ont décrit leur évaluation de l'effet des comportements agressifs et perturbateurs, ont tenté d'en déterminer la cause, et ont eu recours à une approche qui privilégiait les thérapies psychosociales et les psychostimulants. Les pédiatres ont énoncé que les antipsychotiques étaient efficaces mais qu'ils éprouvaient de l'anxiété au sujet des effets néfastes, et qu'il existait un besoin d'accepter les effets indésirables en contrepartie d'une fonction améliorée. Discontinuer les antipsychotiques était problématique. Malgré la connaissance des troubles du mouvement et des effets métaboliques induits par les antipsychotiques, il y avait des limitations des compétences, des connaissances et des ressources des médecins et des influences sociales qui faisaient obstacle à la mise en œuvre régulière des procédures de surveillance recommandées. CONCLUSIONS: Cette étude identifie les obstacles et les facilitateurs de la pratique fondée sur les données probantes qui peuvent servir aux interventions de transmission des connaissances afin d'assurer une norme élevée des soins aux enfants à qui on prescrit des antipsychotiques.

Mental health disorders and adolescent peer relationships.

RATIONALE: Mental health disorders often arise during adolescence, with disruptive behavior disorders and anxiety disorders among the most common. Given the salience of peer relationships during adolescence, and research suggesting that mental health disorders negatively impact social functioning, this study uses novel methodology from social network analysis to uncover the social processes linking disruptive behavior disorders and anxiety disorders with adolescent friendships. In particular, the study focuses on peer withdrawal, peer popularity, and peer homophily in relation to both disorders. METHODS: Data come from 15-year old students in four Scottish secondary schools (N = 602). Diagnoses of disruptive behavior disorders and anxiety disorders were produced using the Diagnostic Interview Schedule for Children, and peer relationship data were obtained through a friendship nomination survey. Exponential random graph models were used to estimate the probability of peer withdrawal, peer popularity, and peer homophily based on each disorder. RESULTS: Results demonstrated that adolescents with disruptive behavior disorders were more popular than their peers without disruptive behavior disorders (OR: 1.47, CI: 1.20, 1.87). Friendship was also more likely between two adolescents both with or both without disruptive behavior disorders (OR: 1.26, CI: 1.07, 1.47), demonstrating peer homophily. There was no evidence that anxiety disorders were related to adolescent peer relationships. CONCLUSIONS: Findings from this study suggest that disruptive behavior disorders may be socially rewarded (e.g., peer popularity) and socially clustered (e.g., homophily), whereas anxiety disorders show no such trends. Thus, intervention efforts must account for the peer social status that may be gained from engaging in disruptive behavior during this developmental period. Further, given that similarity in DBD status is associated with an increased likelihood of friendship, adolescents are likely to be surrounded by peers who reinforce their behaviors.

Feasibility and acceptability of internet-delivered parent-child interaction therapy for rural Australian families: a qualitative investigation.

INTRODUCTION: Parent-child interaction therapy (PCIT) is an evidence-based parent management training program for the treatment of childhood disruptive behaviour disorders (DBDs). In Australia, however, due to a lack of services in regional, rural and remote areas, the program is not accessible to all families who might benefit. Preliminary evidence demonstrates that telehealth technologies can be leveraged to deliver PCIT via internet (I-PCIT) to urban families. It is not known, however, to what extent I-PCIT is acceptable and effective for regional and remote families, who are traditionally underserved and face a range of stressors unique to living outside major cities. The present study represents the first qualitative investigation into the experience of I-PCIT for rural or regional Australian families. METHODS: Qualitative interviews were conducted with 10 parents who were living in regional, rural and remote areas of New South Wales (NSW), Australia, and who were referred to an I-PCIT program for treatment of DBD in a child aged 2-4 years. RESULTS: Thematic analysis yielded two pre-treatment themes: motivation for seeking treatment and barriers to previous service access. Three overarching themes were identified in post-treatment interviews: positive outcomes, valuable program components and challenges and acceptability of internet delivery. Results demonstrate that consumers from regional, rural and remote NSW view I-PCIT as an acceptable and effective treatment of childhood DBD, bolstering preliminary evidence about the utility of internet technologies to deliver the high-quality results of PCIT. While internet connection issues were a hindrance to treatment for some participants, all parents reported meaningful positive outcomes for both child and parents. CONCLUSION: The study highlights that I-PCIT effectively expands the reach of mental health services to Australian communities that previously could not access clinic-based parenting services.

Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: findings from the DTD field trial.

Background: Developmental trauma disorder (DTD) has been proposed to describe the biopsychosocial sequelae of exposure to interpersonal victimization in childhood that extend beyond the symptoms of post-traumatic stress disorder (PTSD). Objective: To characterize the psychopathology comorbid with DTD and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric disorders were identified with screening modules on the Kiddie Schedule for Affective Disorders and Schizophrenia, Present/Lifetime version (K-SADS-PL), in a multi-site sample of 236 children (7-18 years old; 50% female) referred by paediatric or mental health providers. Results: DTD (N = 80, 34%) and PTSD (N = 69, 29%) were highly comorbid and shared several DSM-IV internalizing disorder and DSM, 5th Edition (DSM-5) dysregulation disorder comorbidities. However, DTD, but not PTSD, was associated with comorbid panic disorder and disruptive behaviour disorders. On a multivariate basis including all probable DSM-IV disorders and DSM-5 dysregulation disorders, DTD was associated with separation anxiety disorder and attention deficit hyperactivity disorder after controlling for PTSD, while PTSD was associated with major depression and generalized anxiety disorder after controlling for DTD. Conclusions: DTD's comorbidities overlap with but extend beyond those of PTSD to include panic, separation anxiety, and disruptive behaviour disorders. DTD warrants further investigation as a potential diagnosis or a complex variant of PTSD in children, similar to the adult symptoms of disturbances of self-organization in the proposed International Classification of Diseases, 11th revision (ICD-11) complex post-traumatic stress disorder subtype.

Antecedentes: El Trastorno Traumático del Desarrollo ha sido propuesto para describir las secuelas psicosociales de la exposición a la victimización interpersonal en la infancia que se extiende más allá de los síntomas del trastorno de estrés postraumático (TEPT).Objetivo: Caracterizar la comorbilidad psicopatológica con el DTD y determinar si esta comorbilidad es diferente de, y se extiende más allá, de las comorbilidades del TEPT.Método: El DTD fue evaluado por medio de una entrevista estructurada, y probables trastornos psiquiátricos bajo el DSM-IV fueron identificados con los módulos de tamizaje KSADS-PL (en sus siglas en inglés), en una muestra 236 niños (de edades entre 7 y 18 años de edad; 50% mujeres) provenientes de múltiples sitios y que fueron referidos por proveedores pediátricos y de salud mental.Resultados: El DTD (N=80, 34%) y el TEPT (N = 69, 29%) fueron altamente comórbidos y compartieron comorbilidades con el trastorno internalizado del DSM-IV y el trastorno de desregulación del DSM-5. Sin embargo, el DTD, pero no el TEPT, se asoció a comorbilidad con trastorno de pánico y trastornos de la conducta disruptiva. Sobre una base multivariada incluyendo todos los probables trastornos del DSM-IV y los trastornos de desregulación del DSM-5, el DTD se asoció con el trastorno de ansiedad por separación y con el trastorno de déficit atencional con hiperactividad luego de controlar el TEPT, mientras que el TEPT se asoció con la depresión mayor y el trastorno de ansiedad generalizada luego de controlar el DTD.Conclusiones: Las comorbilidades del DTD se superponen con, pero se entienden más allá del TEPT para así incluir pánico, ansiedad de separación, y los trastornos de la conducta disruptiva. El DTD garantiza las investigaciones futuras como un potencial diagnóstico o una variante compleja del TEPT en niños, similar a los síntomas adultos de las perturbaciones en la auto-organización en el subtipo del TEPT Complejo propuesto del CIE-11.

Prenatal alcohol use as a risk for attention-deficit/hyperactivity disorder.

The objective of the study was to investigate the association between alcohol use during pregnancy and mental disorders in childhood, controlling for confounding risk factors by a longitudinal study of pregnant women and their offspring. The initial cohort comprised pregnant women attending an obstetric service. From the initial sample of 449 pregnant women, 81 mother-child pairs agreed to participate. After 12 years, mother-child pairs were assessed through self-administered questionnaires and semi-structured interviews. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was used to assess the presence of any mental disorders in the children. The mothers were assessed by the Self-Reporting Questionnaire (SRQ) and the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, data on the mother's alcohol use collected during pregnancy were analysed. A logistic regression tested the influence of alcohol consumption in all trimesters and binge drinking on the occurrence of attention-deficit/hyperactivity disorder (ADHD), controlling for covariates. Binge drinking at any time during pregnancy or low-moderate alcohol consumption in all trimesters of pregnancy was associated with a fivefold increased odds of child ADHD. The combination of both patterns of alcohol use added an increase of 19% in the variance of ADHD's occurrence. The episodic use of at least four drinks or the regular use of low-moderate alcohol doses during pregnancy was associated with significantly increased odds of subsequent child ADHD. Reducing binge drinking and regular alcohol use of pregnant women may lead to a significant decrease in their children developing ADHD.