Which Child Will Benefit From a Behavioral Intervention for ADHD? A Pilot Study to Predict Intervention Efficacy From Individual Reward Sensitivity.

Objective: This article aims to assess whether individual differences in reward sensitivity can be used to predict which children with attention-deficit/hyperactivity disorder (ADHD) will benefit most from behavioral interventions that include reinforcement. Methods: A 12-week behavioral intervention was offered to 21 children with ADHD and their parents. Reward sensitivity was assessed prior to the intervention using a combination of psychological and physiological measures. ADHD symptoms were assessed pre- and posttreatment using the Strengths and Weaknesses of ADHD and Normal behavior (SWAN) rating scale. Results: Lower scores on one of the questionnaire scales were associated with greater pre/posttreatment differences in ADHD symptoms. Conclusion: We found that pre/posttreatment change was associated with one measure of parent-rated reward sensitivity. Children with low impulsive negative behavior toward gaining reward improved most during treatment. This result suggests that aspects of reward-related behaviors in ADHD may be useful to predict the effectiveness of treatment.

The effectiveness of an experimental treatment when compared to care as usual depends on the type of care as usual.

In psychotherapy, effectiveness of an experimental treatment often is compared to care as usual. However, little if any attention has been paid to the heterogeneity of care as usual. The authors examined the effectiveness of manualized behavior therapy on school-aged disruptive behavior disordered (DBD) children in everyday clinical practice. A total of 77 DBD children (8-13 years) were randomly assigned to the Utrecht Coping Power Program (UCPP) condition or the care as usual condition. Care as usual consisted of family therapy (FT) or behavior therapy (BT). Decrease in parent-reported overt aggression was significantly larger in the UCPP condition than in the FT condition, but UCPP and BT did not differ significantly in this respect. The effect sizes of difference scores on other variables were more in favor of UCPP when compared to FT than to BT. The comparison of an experimental treatment to care as usual depends on the type of usual treatment.

Preventive effects of treatment of disruptive behavior disorder in middle childhood on substance use and delinquent behavior.

OBJECTIVE: Disruptive behavior disorder (DBD) is a well-known risk factor for substance abuse and delinquent behavior in adolescence. Therefore, the long-term preventive effects of treatment of DBD in middle childhood on beginning substance use and delinquency in early adolescence were investigated. METHOD: Children with DBD (8-13 years old) had been randomly assigned to manualized behavior therapy (Utrecht Coping Power Program; UCPP) or to care as usual (CU) in the Netherlands. Five years (2003-2005) after the start of treatment (1996-1999), substance use and delinquency were monitored in 61 of the initial 77 adolescents and compared with a matched healthy control group by means of self-report questionnaires. One-factor analyses of variance and Pearson's chi2 analyses were performed. RESULTS: Differences in substance use were revealed in favor of the UCPP, with more adolescents in the CU group smoking cigarettes in the last month (UCPP 17%, CU 42%; chi2 = 4.7; p < .03) and more adolescents in the CU group having ever used marijuana (UCPP 13%, CU 35%; chi2 = 4.0; p < .045). Moreover, in this respect, the UCPP fit in the range of the matched healthy control group. Both treatment groups were comparable to the matched healthy control group in delinquent behavior. CONCLUSIONS: Manualized behavior therapy for DBD in middle childhood seems to be more powerful than CU in reducing substance use in early adolescence. Both treatment conditions show a beneficial long-term preventive effect on delinquency.

Cortisol and treatment effect in children with disruptive behavior disorders: a preliminary study.

OBJECTIVE: Basal cortisol and cortisol stress responsivity are valuable biological characteristics of children with disruptive behavior disorder (DBD). In this study, the predictive value of cortisol to outcome of intervention was investigated. METHOD: Basal cortisol levels and cortisol levels under stress were studied in 22 children with DBD before the start of a psychotherapeutic treatment. The disruptive behavior of the child was assessed before treatment and after cessation (9 months later). RESULTS: Children with DBD with relatively high and low basal cortisol levels differed in the severity of problem behavior at pretreatment, with the low basal cortisol group having more severe problems. During stress, children with DBD showed either increasing or decreasing cortisol values. Although these cortisol responsivity groups were similar in the severity of behavioral problems at pretreatment, the behavioral problems of the group with high cortisol stress responsivity were significantly lower after the intervention than the behavioral problems of the group with low cortisol stress responsivity. CONCLUSIONS: In children with DBD, the basal cortisol level was related to the severity of behavioral problems at pretreatment but not to the severity of behavioral problems after treatment. The cortisol response pattern during stress was related to treatment outcome.

[Progressive paraparesis, complication of acquired pagetic synostosis of the cervical vertebrae. 2 cases]. / Paraparésie progressive, complication d'un bloc vertébral pagétique acquis de siège cervical. Deux observations.

Two cases of pagetic cervical intervertebral synostosis with spinal cord compression are reported. Computed tomography and magnetic resonance imaging enabled detailed analysis of pagetic bone structure and relationships between the fused spinal segment and spinal cord. Few similar cases have been reported and most authors have advocated conservative therapy with calcitonin and/or diphosphonates, with surgery only in cases unresponsive to pharmacotherapy.

[Remission of Lambert-Eaton syndrome over a 10-year period. Recurrence without evidence of tumor at autopsy]. / Rémission d'un syndrome de Lambert-Eaton pendant 10 ans. Récidive sans tumeur décelable a l'autopsie.

A case of Lambert-Eaton's syndrome with onset 18 months prior to detection of an epidermoid cancer of the larynx is reported. Regression of the syndrome, and its total remission over 10 years without treatment following excision of the tumor, suggested a possible relationship as a paraneoplastic disorder. However, doubt was cast on any possible link by recurrence of the Lambert-Eaton's syndrome after 10 years remission, and the satisfactory course without treatment over the next 6 years combined with failure to detect any tumor recurrence or metastases, even at autopsy. The question raised is whether this is indeed a true paraneoplastic affection or a fortuitous association of an idiopathic form of Lambert-Eaton's syndrome and an infrequent cancer which, in addition, has never been reported at the origin of the Lambert-Eaton syndrome.

[The unusual origin of an acute cephalalgia, a colloid cyst of the third ventricle (author's transl)]. / A propos d';une cause rate de céphalée paroxystique. le kyste colloïd du troisième ventricule.

An unusual acute cephalalgia might reveal a vascular or tumoral cerebral disease. The authors report a case of cephalalgia of such a type following upon a colloid cyst of the third ventricle, an exceptional but serious cause, whose symptomatology they are discussing; in this connection, they are studying the problems concerning three other cases of acute cephalalgia. In these four patients, cephalalgia is almost the only symptom. A recent unique relapsing acute cephalalgia, without appreciable previous history, should induce to perform thorough paraclinical investigations and, above all at present, a tomodensitometric test.

[Involvement of the central nervous system in Behçet's syndrome. Report of two cases (author's transl)]. / L'atteinte du système nerveux central au cours de la maladie de Behçet. A propos de deux observations.

After presenting two personal observations, the authors underline the fact that the neurological manifestations of Behçet's disease are more frequent than they were supposed to be. Their symptoms are overly manifold but have in common constant abnormality in the cerebrospinal fluid when an attack occurs. The affection is a very serious one demanding an early and well established diagnosis only to be obtained thanks to a clinical examination. Corticosteroïd therapy (1 mg/kg per day) either alone or associated with immuno-suppressive therapy may check the attack. Preventing relapses implies a non-stop treatment. Immuno-suppressive therapy seems to be the most efficient one.

[Retention of urine caused by fecaloma in the course of a Guillain-Barre syndrome (author's transl)]. / Rétention d'urines par fécalome au cours d'un syndrome de Guillain-Barre.

Sphincteral disorders are very rarely seen in a Guillain-Barre syndrome. The authors report a case of such a syndrome in a woman, in the course of which a retention of urine appeared making diagnosis more difficult. The cause actually was mechanical.