Treatment planning for children with attention-deficit/hyperactivity disorder: treatment utilization and family preferences

William B Brinkman, Jeffery N EpsteinDepartment of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USABackground: Attention-deficit/hyperactivity disorder (ADHD) is a common condition that often results in child and family functional impairments. Although there are evidence-based treatment modalities available, implementation of and persistence with treatment plans vary with patients. Family preferences also vary and may contribute to variability in treatment utilization.Objective: The objective of this study is to describe the evidence-based treatments available for ADHD, identify patterns of use for each modality, and examine patient and parent treatment preferences.Method: Literature review.Results: Treatment options differ on benefits and risks/costs. Therefore, treatment decisions are preference sensitive and depend on how an informed patient/parent values the tradeoffs between options. Literature on patient and parent ADHD treatment preferences is based on quantitative research assessing the construct of treatment acceptability and qualitative and quantitative research that assesses preferences from a broader perspective. After a child is diagnosed with ADHD, a variety of factors influence the initial selection of treatment modalities that are utilized. Initial parent and child preferences are shaped by their beliefs about the nature of the child's problems and by information (and misinformation) received from a variety of sources, including social networks, the media, and health care providers. Subsequently, preferences become further informed by personal experience with various treatment modalities. Over time, treatment plans are revisited and revised as families work with their health care team to establish a treatment plan that helps their child achieve goals while minimizing harms and costs.Conclusions: Studies have not been able to determine the extent to which utilization rates are consistent with the underlying distribution of informed patient/parent treatment preferences. There are challenges to ensure that patient/parent preferences are consistently well informed, elicited, and discussed in the treatment planning process. Interventions are needed to promote such interactions.Keywords: attention-deficit/hyperactivity disorder, ADHD, adherence, preferences, physician–patient/parent communication, collaborative/shared decision makin

Frontostriatal Maturation Predicts Cognitive Control Failure to Appetitive Cues in Adolescents

Adolescent risk-taking is a public health issue that increases the odds of poor lifetime outcomes. One factor thought to influence adolescents' propensity for risk-taking is an enhanced sensitivity to appetitive cues, relative to an immature capacity to exert sufficient cognitive control. We tested this hypothesis by characterizing interactions among ventral striatal, dorsal striatal, and prefrontal cortical regions with varying appetitive load using fMRI scanning. Child, teen, and adult participants performed a go/no-go task with appetitive (happy faces) and neutral cues (calm faces). Impulse control to neutral cues showed linear improvement with age, whereas teens showed a nonlinear reduction in impulse control to appetitive cues. This performance decrement in teens was paralleled by enhanced activity in the ventral striatum. Prefrontal cortical recruitment correlated with overall accuracy and showed a linear response with age for no-go versus go trials. Connectivity analyses identified a ventral frontostriatal circuit including the inferior frontal gyrus and dorsal striatum during no-go versus go trials. Examining recruitment developmentally showed that teens had greater between-subject ventral-dorsal striatal coactivation relative to children and adults for happy no-go versus go trials. These findings implicate exaggerated ventral striatal representation of appetitive cues in adolescents relative to an intermediary cognitive control response. Connectivity and coactivity data suggest these systems communicate at the level of the dorsal striatum differentially across development. Biased responding in this system is one possible mechanism underlying heightened risk-taking during adolescence

Thin front propagation in random shear flows

Front propagation in time dependent laminar flows is investigated in the limit of very fast reaction and very thin fronts, i.e. the so-called geometrical optics limit. In particular, we consider fronts evolving in time correlated random shear flows, modeled in terms of Ornstein-Uhlembeck processes. We show that the ratio between the time correlation of the flow and an intrinsic time scale of the reaction dynamics (the wrinkling time $t_w$) is crucial in determining both the front propagation speed and the front spatial patterns. The relevance of time correlation in realistic flows is briefly discussed in the light of the bending phenomenon, i.e. the decrease of propagation speed observed at high flow intensities.Comment: 5 Revtex4 pages, 4 figures include

A Relativistic Mean Field Model for Entrainment in General Relativistic Superfluid Neutron Stars

General relativistic superfluid neutron stars have a significantly more intricate dynamics than their ordinary fluid counterparts. Superfluidity allows different superfluid (and superconducting) species of particles to have independent fluid flows, a consequence of which is that the fluid equations of motion contain as many fluid element velocities as superfluid species. Whenever the particles of one superfluid interact with those of another, the momentum of each superfluid will be a linear combination of both superfluid velocities. This leads to the so-called entrainment effect whereby the motion of one superfluid will induce a momentum in the other superfluid. We have constructed a fully relativistic model for entrainment between superfluid neutrons and superconducting protons using a relativistic $\sigma - \omega$ mean field model for the nucleons and their interactions. In this context there are two notions of ``relativistic'': relativistic motion of the individual nucleons with respect to a local region of the star (i.e. a fluid element containing, say, an Avogadro's number of particles), and the motion of fluid elements with respect to the rest of the star. While it is the case that the fluid elements will typically maintain average speeds at a fraction of that of light, the supranuclear densities in the core of a neutron star can make the nucleons themselves have quite high average speeds within each fluid element. The formalism is applied to the problem of slowly-rotating superfluid neutron star configurations, a distinguishing characteristic being that the neutrons can rotate at a rate different from that of the protons.Comment: 16 pages, 5 figures, submitted to PR

Negative Energy Density States for the Dirac Field in Flat Spacetime

Negative energy densities in the Dirac field produced by state vectors that are the superposition of two single particle electron states are examined. I show that for such states the energy density of the field is not bounded from below and that the quantum inequalities derived for scalar fields are satisfied. I also show that it is not possible to produce negative energy densities in a scalar field using state vectors that are arbitrary superpositions of single particle states.Comment: 11 pages, LaTe

Renormalization : A number theoretical model

We analyse the Dirichlet convolution ring of arithmetic number theoretic functions. It turns out to fail to be a Hopf algebra on the diagonal, due to the lack of complete multiplicativity of the product and coproduct. A related Hopf algebra can be established, which however overcounts the diagonal. We argue that the mechanism of renormalization in quantum field theory is modelled after the same principle. Singularities hence arise as a (now continuously indexed) overcounting on the diagonals. Renormalization is given by the map from the auxiliary Hopf algebra to the weaker multiplicative structure, called Hopf gebra, rescaling the diagonals.Comment: 15 pages, extended version of talks delivered at SLC55 Bertinoro,Sep 2005, and the Bob Delbourgo QFT Fest in Hobart, Dec 200

Dust Dynamics in Compressible MHD Turbulence

We calculate the relative grain-grain motions arising from interstellar magnetohydrodynamic (MHD) turbulence. The MHD turbulence includes both fluid motions and magnetic fluctuations. While the fluid motions accelerate grains through hydro-drag, the electromagnetic fluctuations accelerate grains through resonant interactions. We consider both incompressive (Alfv\'{e}n) and compressive (fast and slow) MHD modes and use descriptions of MHD turbulence obtained in Cho & Lazarian (2002). Calculations of grain relative motion are made for realistic grain charging and interstellar turbulence that is consistent with the velocity dispersions observed in diffuse gas, including cutoff of the turbulence from various damping processes. We show that fast modes dominate grain acceleration, and can drive grains to supersonic velocities. Grains are also scattered by gyroresonance interactions, but the scattering is less important than acceleration for grains moving with sub-Alfv\'{e}nic velocities. Since the grains are preferentially accelerated with large pitch angles, the supersonic grains will be aligned with long axes perpendicular to the magnetic field. We compare grain velocities arising from MHD turbulence with those arising from photoelectric emission, radiation pressure and H$_{2}$ thrust. We show that for typical interstellar conditions turbulence should prevent these mechanisms from segregating small and large grains. Finally, gyroresonant acceleration is bound to preaccelerate grains that are further accelerated in shocks. Grain-grain collisions in the shock may then contribute to the overabundance of refractory elements in the composition of galactic cosmic rays.Comment: 15 pages, 17 figure

Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient–Clinician Communication Model® intervention in a primary health-care setting

Funded by Informed Medical Decisions Foundation. Grant Number: #0175-1 National Health and Medical Research Council Public Health Training Fellowship. Grant Number: 568962Peer reviewedPublisher PD