Dual training as clinician-scientist in child and adolescent psychiatry : are we there yet?

Peer reviewe

Parenting style and functional outcomes of children with ADHD: a community-based longitudinal study

© 2017 Dr. Sampada BhideBackground: Many children with Attention Deficit Hyperactivity Disorder (ADHD) have trouble with social, emotional and academic functioning. Theoretical perspectives backed by evidence suggest that parenting style is associated with the development of functional competence in typically developing children; however, this association remains less well studied for children with ADHD. Aim: To investigate the role of parenting style in determining the social, emotional and academic functioning of children with ADHD. This aim was examined across three sub-studies. Sub-study 1 examined differences in parenting style between children with ADHD and non-ADHD controls. Sub-studies 1 and 2 investigated whether parenting style is associated with concurrent and prospective child functioning in ADHD respectively, and whether associations differ from non-ADHD controls. Sub-study 2 also investigated changes in parenting style over time. Sub-study 3 examined whether parenting style mediates the relationship between ADHD status and prospective child social functioning. Method: This study is part the Children’s Attention Project (CAP). Participants were 179 children with ADHD and 212 non-ADHD controls, their parents (93.5% female) and teachers. Children (66.2% male) were assessed at baseline (Time 1; Mage = 7.3 years; SD = 0.4) and after 18 months (Time 2; Mage = 8.9 years; SD = 0.4). ADHD status was assessed at baseline using the Conners ADHD index and Diagnostic Interview Schedule for Children-IV. At both time points, parenting style was assessed via parent-reported measures of warmth, consistency and anger; and child social, emotional and academic functioning was measured using parent- and teacher-reported subscales from the Strengths and Difficulties Questionnaire, and Social Skills Improvement System. The Wide Range Achievement Test-4 was also administered at Time 1. Results: Sub-study1: Parents reported less consistency and more anger in the ADHD group compared to non-ADHD controls, with no differences in warmth. Group differences in parenting consistency attenuated following consideration of parent distress. Parenting warmth, consistency and/or anger were concurrently associated with parent-reported aspects of child socio-emotional functioning. These associations were largely similar between groups. All associations held despite adjusting for socio-demographic factors, externalising co-morbidities, ADHD symptom severity and parent distress. Sub-study 2: Parenting warmth and anger at Time 1 were associated with parent-reported social outcomes in children at Time 2, while parenting consistency related to these outcomes, but through teacher-report. Pattern of associations was largely similar between groups. All associations held despite adjusting for socio-demographic factors, externalising co-morbidities, ADHD symptom severity, parent distress and child ASD. Following adjustment of social functioning at Time 1, associations for parenting consistency and parenting warmth remained, but most associations of parenting anger attenuated. From Time 1 to Time 2, there was a small decline in parenting warmth and anger, and an increase in parenting consistency. Sub-study 3: Parenting anger at Time 1 partially mediated the relationship between ADHD status at this age, and child social functioning at Time 2. Specifically, higher levels of parenting anger in the ADHD group, partially accounted for lower levels of social functioning in this group relative to non-ADHD controls over time. No mediating effect held following consideration of prior social functioning at age Time 1. Conclusion: Greater parenting anger at the commencement of primary school partially accounts for poorer social functioning over time for children with ADHD relative to typically developing children. However, factors such as parent distress and level of social competence at the beginning of primary school, contribute to disrupting parenting style and/or later social functioning, and undermine the contribution of parenting style to child social outcomes over time. Support for parents experiencing distress, and promotion of affectionate, calm and consistent parenting for children with ADHD may be necessary prior to the early years of primary school, to bridge the gap between future social outcomes for these children and their typically developing peers

Mindful parenting behaviors and emotional self-regulation in children with ADHD and controls

Mindfulness is defined as paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally and these behaviors can be applied to parenting. Thus far, it is not understood whether mindful parenting (MP) differs in parents of children with and without attention-deficit/hyperactivity disorder (ADHD), and how MP relates to other parenting practices and children’s self-regulation.MethodsThis study examined the relationships between MP, parenting behaviors and children’s self-regulation in 120 families with child ADHD (85% male; mean age = 11.93) and 105 control families (62% male; mean age = 11.98). Parents completed measures of MP (Interpersonal Mindfulness in Parenting Scale), parenting behaviors (parenting warmth, consistency, and anger assessed with the Longitudinal Study of Australian Children measures), psychological distress (Kessler 6), and children’s self-regulation (Social Skills Improvement System—self-control subscale).ResultsWhen compared with controls, parents of children with ADHD reported significantly lower MP. Higher MP was associated with lower levels of parent psychological distress, higher levels of parenting warmth and consistency, lower levels of parenting anger, and higher child emotion self-regulation in both groups. In mediation analyses, MP was indirectly associated with child emotion self-regulation through lower parenting anger, with the model accounting for 55% of the variance in child self-regulation. ConclusionsMP is a useful construct for understanding parent behaviors, and children’s emotion self-regulation

Practitioner Review: It's time to bridge the gap – understanding the unmet needs of consumers with attention-deficit/hyperactivity disorder – a systematic review and recommendations

Objective: Understanding the unmet needs of healthcare consumers with attention-deficit/hyperactivity disorder (ADHD) (individuals with ADHD and their caregivers) provides critical insight into gaps in services, education and research that require focus and funding to improve outcomes. This review examines the unmet needs of ADHD consumers from a consumer perspective. Methods: A standardised search protocol identified peer-reviewed studies published between December 2011 and December 2021 focusing on consumer-identified needs relating to ADHD clinical care or research priorities. Results: 1,624 articles were screened with 23 studies that reviewed examining the needs of ADHD consumers from Europe, the U.K., Hong Kong, Iran, Australia, the U.S.A. and Canada. Consumer-identified needs related to: treatment that goes beyond medication (12 studies); improved ADHD-related education/training (17 studies); improved access to clinical services, carer support and financial assistance (14 studies); school accommodations/support (6 studies); and ongoing treatment efficacy research (1 study). Conclusion: ADHD consumers have substantial unmet needs in clinical, psychosocial and research contexts. Recommendations to address these needs include: improving access to and quality of multimodal care provision; incorporating recovery principles into care provision; fostering ADHD health literacy; and increasing consumer participation in research, service development and ADHD-related training/education

Treatment of polymyalgia rheumatica: British Society for Rheumatology guideline scope

The last British Society for Rheumatology (BSR) guideline on PMR was published in 2009. The guideline needs to be updated to provide a summary of the current evidence for pharmacological and non-pharmacological management of adults with PMR. This guideline is aimed at healthcare professionals in the UK who directly care for people with PMR, including general practitioners, rheumatologists, nurses, physiotherapists, occupational therapists, pharmacists, psychologists and other health professionals. It will also be relevant to people living with PMR and organisations that support them in the public and third sector, including charities and informal patient support groups. This guideline will be developed using the methods and processes outlined in the BSR Guidelines Protocol. Here we provide a brief summary of the scope of the guideline update in development.What does this mean for patients?PMR is a common condition that causes pain, stiffness, fatigue and difficulty in doing everyday activities. PMR is usually treated with glucocorticoids (corticosteroids, 'steroids'). However, the side effects of treatment can cause problems for many patients. Since the publication of the last guideline for PMR, new research has been published. This guideline will provide healthcare professionals and people with PMR with the information they need to reach shared decisions with clinicians about their treatment, based on the best currently available evidence. In order to do this, we have formed a guideline working group and we will follow the BSR's protocol for creating a robust clinical guideline []