Search Results (39)

Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) in children is a developmental disorder that has been rapidly increasing worldwide. Its core symptoms, which include inattention, impulsivity, and hyperactivity, are often accompanied by emotional and behavioral problems such as depression and aggression. These factors can significantly impair a child’s development and functioning, making effective therapeutic intervention essential. This non-randomized controlled trial with parallel-group design examined the intervention effects of a 10-week school group sandplay therapy (SGST) program on internalizing and externalizing problems in children at risk for ADHD. Methods: This non-randomized controlled trial involved 101 fifth- and sixth-grade students (ages 11–12) from an elementary school in a mixed urban–rural area. Participants were divided into a control group (n = 47) and an intervention group (n = 54). The intervention group participated in a 10-session SGST program held once a week, while the control group received no intervention. The Korean Youth Self-Report (K-YSR) was used to evaluate the effects of the intervention, and a Repeated Measures ANOVA (RM-ANOVA) was conducted to analyze the program’s effectiveness. Results: The results revealed significant interaction effects between group and time in the SGST intervention group for several K-YSR subscales. The intervention group showed statistically significant differences in the areas of anxiety/depression (p < 0.04; η² = 0.043), somatic symptoms (p < 0.04; η² = 0.040), social immaturity (p < 0.01; η² = 0.061), and rule-breaking behavior (p < 0.04; η² = 0.044). Conclusions: SGST was found to be associated with improving not only internalizing problems like anxiety/depression, somatic symptoms in children at risk for ADHD but also externalizing problem like rule-breaking behavior and social problem like social immaturity. These findings demonstrate that school sand play therapy can be used as a non-pharmaceutical intervention for school-age children at risk of ADHD, and suggest that it can also be useful in an educational context. Full article

Evidence suggests that autistic children spend less time engaging in social interactions than their neurotypical peers which can negatively impact their wellbeing. Researchers, educators, and parents must consider how we address this. A possible facilitator of autistic children’s social skills and a protective factor for their psychological health is the role of pets and the human–pet bond. The study examined parental reports of autistic children’s attachment to their pet (dog or cat), positive and negative behaviours with that pet, and how this relates to prosocial behaviour, peer problems, and psychological health (emotional difficulties, conduct problems, hyperactivity/inattention). Sixty-five parents with an autistic child completed quantitative measures to assess these variables. Participants also completed qualitative questions aimed at understanding their perceptions of the impact of pets on their child. A regression analysis showed that children’s positive behaviour towards the pet predicted their prosocial behaviour (β = 0.40 p = 0.006). No other regression models were statistically significant. A thematic analysis of the qualitative responses highlighted four themes in relation to parents’ perceptions of the positive impacts of pets on their child. These were (1) Anxiety, Emotion Regulation, and Sleep; (2) Understanding of Self and Other; (3) Communication, Friendships, and Social Interactions; and (4) Comfort and Psychological Health. One theme was identified in relation to the negative impact of pets: (5) Pet-Related Anxiety and Concerns. The findings have implications which can inform guidelines to help parents make decisions about pet ownership and how to foster meaningful relationships between autistic children and their pets. Full article

Introduction: In 2019, an updated version of the Diagnostic Interview for ADHD in Adults (DIVA-5) was developed based on DSM-5 criteria, currently validated in Korean and Farsi. The aim of this study is to validate the DIVA-5 Italian version. Methods: 132 subjects in the Adult ADHD Screening Center of AUSL-Modena, who agreed to participate in this study, were selected. Socio-demographic and clinical variables were collected. DIVA-5, Barkley Adult ADHD Rating Scale (BAARS), and Adult ADHD Self Rating Scale (ASRS-v1.1) were administered. We assessed the internal consistency of the DIVA-5 Italian version and its concurrent validity with ASRS-v1.1 and BAARS-IV. An exploratory factor analysis (EFA) was conducted to evaluate the construct validity, and a multiple linear regression to evaluate the predictive validity. Results: Our analysis indicated good internal consistence of the DIVA-5 Italian version (Cronbach’s alpha and Kuder coefficients ranged between 0.61 and 0.78). The EFA showed five factors representing specific variance. The correlation between the corresponding ADHD dimensions of DIVA-5 and BAARS was found to be statistically significant (Spearman’s coefficient ranged between 0.61 and 0.47, p = 0.000), while the correlation between the DIVA-5 dimensions and ASRS-v1.1 was statistically significant for all the dimensions except child hyperactivity/impulsivity. The multiple linear regression showed a positive association of the DIVA-5 score with the “job” variable and a negative association with “drug therapy”. DIVA-5 showed greater sensitivity for inattention in adulthood and greater specificity for hyperactivity/impulsivity in childhood. Conclusions: Our results confirm that the DIVA-5 Italian version represents a valid and reliable tool to diagnose adult ADHD. Full article

Background: Child ADHD symptoms are highly prevalent in middle childhood, alongside impairment in social functioning. The parent–child relationship has been shown to play an important role; however, studies investigating specific facets of the parent–child relationship in ADHD symptomatology in middle childhood have been neglected. We assumed that higher ADHD symptoms were associated with both (1) lower maternal emotional availability (EA) and (2) lower child attachment security. Moreover, (3) we aimed to explore which specific EA dimensions were associated with ADHD symptoms. Methods: In a socio-pediatric clinic in Germany, 71 inpatient mother–child dyads (child age: M = 7.70, SD = 1.06; n = 54 boys) were assessed. Clinical data about child ADHD symptoms (Child Behavior Checklist 6–18 subscale “attention deficit/hyperactivity problems”), maternal EA (free play), and child attachment representation (Attachment Story Completion Task, GEV-B) were analyzed cross-sectionally. Results: Controlling for child oppositional behavior and sex, child ADHD symptoms were associated with overall maternal EA, and more specifically non-hostility, but not with child attachment representation. Conclusions: Our results imply that the role of parent–child interaction quality should be considered in the treatment of ADHD. Bidirectional effects cannot be ruled out. Full article

Background: Pediatric rheumatic diseases (PRDs) are a group of chronic disorders that start in childhood and are characterized by periodic exacerbations and remissions of symptoms, with limitations in family, school, and social activities. The aim of this study was to detect differences in parents’ psychological adjustment and emotion regulation strategies, and parent-reported children’s adjustments in families of children with active and inactive PRDs. Methods: Fifty-four parents (38 mothers and 16 fathers) of children with PRD were recruited from a pediatric unit. Disease activity was evaluated by their pediatric rheumatologist, while parents’ depressive and anxiety symptoms, emotion regulation strategies, and children’s emotional difficulties and hyperactivity–inattention symptoms were assessed through a web-based survey. Results: Parents of children with active PRDs reported higher levels of their child’s emotional difficulties and hyperactivity–inattention symptoms. Linear regression analysis demonstrated that having a child in the active phases of PRD and lower use of cognitive reappraisal lead to higher children’s emotional symptoms, while active disease, low use of cognitive reappraisal, and greater expressive suppression were associated with higher hyperactivity–inattention symptoms. Our study highlights that children with PRDs and their parents may be at increased risk for psychological problems, especially during the active disease phase, highlighting the importance of a multidisciplinary approach. Full article

Background: Studies indicate a higher prevalence of mental health problems among immigrants, but findings on immigrant children and adolescents are mixed. We sought to understand the magnitude of differences in mental health indicators between immigrant and non-immigrant children and adolescents in Canada and the influence of age, sex, household income, and household education. Methods: We completed a secondary analysis of data from the Canadian Health Measures Survey, using a pooled estimate method to combine data from four survey cycles. A weighted logistic regression was used to estimate the unadjusted and adjusted odds ratios with 95% confidence intervals. Results: We found an association between the mental health of immigrant versus non-immigrant children and adolescents (6–17 years) as it relates to emotional problems and hyperactivity. Immigrant children and adolescents had better outcomes with respect to emotional problems and hyperactivity/inattention compared to non-immigrant children and adolescents. Lower household socioeconomic status was associated with poorer mental health in children and adolescents. Conclusion: No significant differences in overall mental health status were evident between immigrant and non-immigrant children and adolescents in Canada but differences exist in emotional problems and hyperactivity. Sex has an influence on immigrant child mental health that varies depending on the specific mental health indicator. Full article

Background: Attention deficit hyperactivity disorder (ADHD) is characterised by inattentiveness, hyperactivity, and impulsivity. Up to half of the affected children have a parent with ADHD. In this study, the risk of ADHD among parents of ADHD children was estimated. The associations between parental ADHD and child ADHD severity and medication adherence were determined. Methodology: Parents of children and adolescents diagnosed with ADHD attending the University Kebangsaan Malaysia Medical Centre (UKMMC) were recruited between June to August 2022 and the administered Conners’ Adult ADHD Rating Scale (CAARS) self-report short form, Vanderbilt ADHD Parent Rating Scale (performance section), and Medication Adherence Report Scale (MARS). Results: Forty-five children with ADHD were recruited and 15 out of 45 (33%) parents were detected to have ADHD. ADHD severity was worse in children with ADHD parents for total severity (mean of 34.67 vs. 29.13, p = 0.047) and difficult behaviours at home (mean of 7.87 vs. 6.27, p = 0.036). The children’s academic performance and behavioural challenges at home and school were positively correlated with the parental ADHD scores for ‘inattention’ and ‘problems with self-care’ subscales. Conclusions: A total of 33% of ADHD children had parents with ADHD. ADHD children with ADHD parents were more likely to have behavioural problems at home and more severe ADHD. However, no statistical significance was noted with medication adherence. Full article

Attention deficit hyperactivity disorder (ADHD) results in various functioning impairments in children’s lives and families. Parents of children with ADHD report high levels of parenting stress, low levels of parental self-efficacy, and use of more authoritarian and/or permissive parenting practices than parents of typically developing children. Intervention programs need to address both children’s and parents’ needs and multimodal intervention programs could cover this demand. The aim of this study was to examine the efficacy of “Child ViReal Support Program”—a multi-level evidence-based comprehensive program—on parenting stress, parental self-efficacy, parenting practices, and the core symptoms of children’s ADHD. Families with a child diagnosed with ADHD (n = 16) were randomly allocated to two groups (PC and CP; P = parent training, C = child training), and a cross-over design was utilized. Participating parents completed, in four different times during the study, the Parenting Stress Index-Short Form, the Parenting Sense of Competence Scale, the Parenting Styles and Dimensions Questionnaire-Short Version, and the parent form of the ADHD Rating Scale-IV. Parents from both groups, after their participation in the parent training, demonstrated reduced parenting stress, enhanced parental self-efficacy, and increased the employ of democratic parenting practices. More than that, they reported decreased levels of inattention and impulsivity/hyperactivity for their children. Evidence-based multi-level intervention programs could produce positive effects on parents and children by incorporating effective methods and tools in accordance with the needs and the demands of the family context. Full article

Background and objectives: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by two dimensions: inattentiveness and hyperactivity/impulsivity. ADHD may be the result of complex interactions between genetic, biological and environmental factors possibly including fluoride exposure. Materials and methods: A literature search was performed on 31 March 2023 in the following databases: PubMed, Embase and Web of Science. We defined the following inclusion criteria according to the PECOS statement: a healthy child and adolescent population (P), fluoride exposure of any type (E), comparison with low or null exposure (C), ADHD spectrum disorder (O), and ecological, cross-sectional, case–control and cohort studies (S). Results: We found eight eligible records corresponding to seven different studies investigating the effect of fluoride exposure on children and adolescents. One study had a cohort design and one a case–control one, while five were cross-sectional. Only three studies applied validated questionnaires for the purpose of ADHD diagnosis. As regards exposure assessment, levels of fluoride in urine and tap water were, respectively used in three and two studies, while two used both. Three studies reported a positive association with ADHD risk, all assessing exposure through fluoride levels. By using urinary fluoride, conversely, a positive correlation with inattention, internalizing symptoms, cognitive and psychosomatic problems was found in three studies, but no relation was found in the other one. Conclusions: The present review suggests that early exposure to fluoride may have neurotoxic effects on neurodevelopment affecting behavioral, cognitive and psychosomatic symptoms related to ADHD diagnosis. However, due to the heterogeneity of the studies included, current evidence does not allow to conclusively confirm that fluoride exposure is specifically linked to ADHD development. Full article

Attention-deficit/hyperactivity disorder (ADHD), a neuropsychiatric condition characterized by inattention, hyperactivity, and impulsivity, afflicts 5% of children worldwide. Each ADHD patient presents with individual cognitive and motivational peculiarities. Furthermore, choice of appropriate therapy is still up to clinicians, who express somewhat qualitative advice on whether a child is being successfully cured or not: it would be more appropriate to use an objective biomarker to indicate whether a treatment led to benefits or not. The aim of our work is to search for such clinical biomarkers. We recruited 60 ADHD kids; psychopathological scales were administered at recruitment and after six weeks of therapy. Out of such a cohort of ADHD children, we rigorously extracted two specific subgroups; regardless of the initial severity of their disease, we compared those who obtained the largest improvement (ΔCGAS > 5) vs. those who were still characterized by a severe condition (CGAS < 40). After such a therapy, methylation levels of DNA extracted from buccal swabs were measured in the 5′-UTR of the DAT1 gene. CpGs 3 and 5 displayed, in relation to the other CpGs, a particular symmetrical pattern; for “improving” ADHD children, they were methylated together with CpG 2 and CpG 6; instead, for “severe” ADHD children, they accompanied a methylated CpG 1. These specific patterns of methylation could be used as objective molecular biomarkers of successful cures, establishing if a certain therapy is akin to a given patient (personalized medicine). Present data support the use of post-therapy molecular data obtained with non-invasive techniques. Full article

Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine. Full article

The potential impact of the COVID-19 pandemic on young people’s mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018–2019 and in 2019–2020. Collections during the pandemic took place in 2020–2021 and 2021–2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019–2020 to the pandemic cohort 2021–2022 (β = 0.56, 95% CI (0.51–0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (β = 0.19, 95% CI (0.16–0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people’s health in Germany. Full article

Background and Objectives: ADHD is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity and can persist in adulthood. The aim of this study is to deepen knowledge about adult ADHD follow-up. Materials and Methods: This observational study consists of one retrospective part aimed at collecting records of children and adolescents treated for ADHD in the Children and Adolescent Mental Health Service (CAMHS) from 1995 to 2015 and, successively, at identifying their adult follow-up in Adult Mental Health Service (AMHS); the second part consists of ADHD scale administration, Diagnostic Interview for ADHD in Adults (DIVA 2-0) and Adult Self Rating Scale (ASRSv1.1), for the subjects currently being treated at AMHS who agreed to participate in the study. Results: We observed that among the 55 patients treated at CAMHS between 1995 and 2015 for ADHD and subsequently at the AMHS, none presented a diagnosis of ADHD; instead, they were treated for Intellectual Dysfunction (33%), Borderline Personality Disorder (15%) and Anxiety Disorders (9%), and two individuals were also diagnosed with comorbid substance/alcohol abuse (4%). Of the 55 patients, only 25 (45%) were treated at AMHS during the study period. Though we asked for their informed consent to administer the questionnaires, we were able to test only seven patients. The ASRS-V1.1 score showed that 43% of patients reported symptoms of ADHD persistence in adulthood. For DIVA 2.0, 57% of individuals reported scores indicating the persistence of the ADHD inattention component, and 43% the persistence of both ADHD dimensions. Conclusions: ADHD cannot be considered a disorder confined to childhood/adolescence but instead is a chronic and complex condition that can persist into adulthood. The very small size of our final sample may account for both the high ADHD dropout rate over the long follow-up period and the difficult transition from child to adult health care in ADHD treatment. Our investigation suggests the need for specific training in the diagnosis and treatment of adult ADHD and the implementation of transition protocols between minor and adult services to improve long-term treatments. Full article

Diet, screen time, physical activity, and sleep combine into lifestyle patterns with synergistic effects on health. This study aimed to identify lifestyle patterns in children without housing and assess their associations with physical and mental health and family socio-ecological factors. In the 2013 ENFAMS cross-sectional survey (children aged 6–12 experiencing homelessness, Greater Paris area, n = 235), parents reported socio-ecological factors, children’s behaviours, and mental health (the latter was also child-reported). Nurses measured children’s haemoglobin concentrations and body mass index. Principal component analysis was used to derive sex-specific lifestyle patterns. Hierarchical linear regressions and “outcome-wide” analyses assessed, respectively, these patterns’ relations to health and family socio-ecological factors. A rather healthy lifestyle pattern—similarly characterized by diverse diet and high sleep time—was identified, with slight differences by sex. Scores for this pattern were higher for children in food-secure or higher-income households, whose parents were proficient in French, who slept longer, or who received more social support compared to their counterparts, with some nuances by sex. Higher scores for this pattern were associated with higher prosocial behaviour scores (girls) and lower anxiety and hyperactivity–inattention symptoms scores (boys), but not with physical health. For this underserved and understudied population, the results highlight the importance of family socio-ecological factors in shaping the lifestyles and mental health of children. Full article

Objectives: The aim of this study was to evaluate neurodevelopmental outcomes (motor development, nonverbal intelligence, and attention) in children with cyanotic congenital heart disease (CHD) compared with healthy children from a public hospital in southern Brazil. Materials and Methods: This was a cross-sectional study with pediatric patients of both sexes: 37 children with cyanotic CHD and a control group with 38 healthy children. Parents/guardians undertook a questionnaire and the SNAP IV scale (to evaluate attention) was applied. Two instruments were applied to each child: the R-2 Non-Verbal Intelligence test and the motor development scale. To assess the factors associated with insufficient performance in the three fields of neurodevelopment, a Poisson regression analysis was performed with a robust estimate. Results: There were no significant differences between children with cyanotic CHD and the control group for any of the neurodevelopmental outcomes studied. Low socioeconomic class was a factor associated with worse performance on the intelligence test and inattention. Furthermore, age was a factor for performance on the intelligence test, while a greater number of siblings was a factor associated with worse performance on the attention test. Conclusions: Public policies regarding child health must involve prioritizing the improvement of families’ social conditions. Full article