The severely impaired do profit most: short-term and long-term predictors of therapeutic change for a parent management training under routine care conditions for children with externalizing problem behavior

Short-term and long-term predictors of therapeutic change due to parent management training were investigated. Therapeutic change was defined as the change in outcome measures [externalizing problem behavior and parenting self-efficacy (PSE)] from before treatment to afterward. Three different types of predictors were analyzed: child variables (gender, age, and initial externalizing and internalizing behavior), parent variables (age, initial PSE and parental psychopathology) and socioeconomic status and other sociodemographic characteristics of the family (parental school education, employment, family status, language). The parent management training was part of the Prevention Program for Externalizing Problem Behavior, which was evaluated as an effectiveness trial under routine care conditions using a within-subject control group design. Between 78 and 270 families were included in the analysis, which investigated therapeutic change over two time intervals: (1) immediate change from the pre-treatment to the post-treatment assessments, and (2) long-term-change from pre-treatment to 1-year follow-up. Throughout several analyses, the only predictor of therapeutic change that was consistently significant over the two time periods for the externalizing problem behavior of the child was the initial externalizing problem behavior. More impaired children improved more. Similarly, the only predictor of therapeutic change for the two time periods in PSE was the initial level of PSE. Parents with less PSE gained more during the course of the training

Assessment of daily profiles of ADHD and ODD symptoms, and symptomatology related to ADHD medication, by parent and teacher ratings

DAYAS is a new two-part rating scale that assesses: (1) ADHD and ODD symptoms (externalising symptom ratings) and (2) symptomatology potentially related to ADHD medication (potentially medication-related symptoms) in real-world settings at different time periods throughout a normal school day. Data from a proof-of-concept study and two observational trials (Medikinet® retard [methylphenidate] and the Equasym XL® [methylphenidate] OBSEER study) evaluated: (1) validity of weekly externalising symptom ratings using DAYAS, in place of daily ratings; (2) reliability and internal consistency of DAYAS ratings for externalising symptoms and potentially medication-related symptoms; and (3) convergent and divergent validity of the externalising symptom ratings with existing validated scales. From the proof-of-concept study, daily scores by period of day and during the whole day correlated strongly with equivalent weekly scores (r = 0.83–0.92). Internal consistency of externalising symptom rating scales calculated from pooled data were acceptable or good by period of day (Cronbach’s alpha = 0.68–0.90) and very high for whole day scores (Cronbach’s alpha = 0.88–0.95). Internal consistency of the rating scale for potentially medication-related symptoms was also good for both teacher and parent ratings. From OBSEER data, correlations between FBB-ADHD total symptom scores and ratings on both parent and teacher versions of DAYAS were high (r = 0.73 and r = 0.84, respectively). Correlations between DAYAS and SDQ were highest for the SDQ subscales hyperactivity and conduct problems and substantially lower for pro-social behaviour, peers and emotional problems. The DAYAS rating scale had good internal consistency, and DAYAS scores correlated well with existing validated scales and the SDQ subscales hyperactivity and conduct problems. Weekly DAYAS scores (whole day and by period of day) could be considered a suitable replacement for daily assessment scores

Gender and Age Differences in ADHD Symptoms and Co‑occurring Depression and Anxiety Symptoms Among Children and Adolescents in the BELLA Study

Attention-deficit/hyperactivity disorder (ADHD) is one of the most diagnosed neurodevelopmental disorders of childhood. Current studies addressing gender and age differences in ADHD are lacking. The present study aims to fill this research gap by dimensionally evaluating gender and age differences in ADHD symptoms, as measured by a DSM-5-based parent rating scale, in children and adolescents who participated in the two-year follow-up of the community-based BELLA study (n = 1326). Associations between ADHD symptoms and depression symptoms and anxiety symptoms were also examined. Multiple linear regressions revealed significant associations between gender and all ADHD symptoms. Age was significantly associated with hyperactive/impulsive symptoms. Additional multiple linear regressions demonstrated significant positive associations between depression and anxiety symptoms and ADHD symptoms. Further, female gender was found to be posi- tively associated with both depression and anxiety symptoms. These findings may suggest a need for more gender-specific approaches to ADHD diagnosis and treatment, as well as more research into the intersections of ADHD and depression and anxiety symptoms in children and adolescents.Peer Reviewe

Mental health problems of children and adolescents at special schools for emotional and behavioral disorders

Bisher liegen für Deutschland kaum belastbare Daten zur Verbreitung psychischer Auffälligkeiten und zur Inanspruchnahme von Versorgungsleistungen von Schüler*innen an Förderschulen mit dem Förderschwerpunkt emotionale-soziale Entwicklung (FSP EsE) vor. Die vorliegende Studie geht daher der Fragestellung nach, wie häufig die unterschiedlichen Formen psychischer Auffälligkeiten an Förderschulen mit dem FSP EsE vorkommen und wie sich die Versorgungssituation betroffener Schüler*innen darstellt. Hierzu schätzten Lehrkräfte an sieben Förderschulen mit dem FSP EsE das Verhalten ihrer 6 – 18 Jahre alten Schüler*innen (N = 745) mit Hilfe des Fragebogens DISYPS-III (Döpfner & Görtz-Dorten, 2017) ein. 60,5% der Schüler*innen wurden als auffällig bzw. sehr auffällig im Bereich Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörung (ADHS) beschrieben. Auffälligkeiten im Bereich oppositioneller Störungen (OPP) lagen aus Sicht der Lehrkräfte bei 42% aller Schüler*innen, im Bereich der Störung des Sozialverhaltens (SSV) bei 25,9%, der Angststörung bei 6,5% und der Depression bei 15,0% vor. Bei einem beträchtlichen Anteil der Schüler*innen wurden Auffälligkeiten in mehreren Bereichen gesehen, z. B. wiesen 47,1% derjenigen, die als auffällig im Bereich ADHS eingeschätzt wurden, auch Auffälligkeiten in Bezug auf OPP/ SSV auf. Bei 20,7% traten Symptome der SSV gemeinsam mit depressiven Problemen auf. Demgegenüber steht eine sehr viel geringere Anzahl an Schüler*innen, die außerschulische Unterstützungsleistungen wie Psychotherapie, Jugendhilfe etc. erhalten. (DIPF/Orig.)So far, there are no reliable data on the prevalence of mental health problems and the use of care services of students at special schools for emotional and behavioral disorders (EBD). Therefore, the current study investigates how often the different forms of mental disorders can be found at special schools for EBD and how the care situation of affected students can be described. As part of the PEARL research project, seven special schools for students with EBD (N = 745) were surveyed for mental health problems and the use of care services. Using the DISYPS-III questionnaire (Döpfner & Görtz-Dorten, 2017), teachers rated 60.5% of their 6 – 18 years old students to have severe problems in the area of ADHD. Symptoms of oppositional disorders (OPP) were present in 42% of all students, in the area of conduct disorder (CD) in 25.9%, anxiety disorder in 6.5%, and depression in 15.0%. A significant proportion of students were seen to have severe problems in multiple domains, e.g., 47.1% of those assessed as having symptoms of ADHD also had symptoms related to OPP/ SSV. In 20.7%, symptoms of SSV co-occurred with depressive problems. In contrast, there is a much smaller number of students who receive support services outside of school, such as psychotherapy, youth services, etc. (DIPF/Orig.

Langversion der interdisziplinären evidenz- und konsensbasierten S3-Leitlinie für Diagnostik und Therapie von Zwangsstörungen im Kindes- und Jugendalter

Zwangsstörungen gehören mit einer Langzeitprävalenz von 1-3% auch im Kindes- und Jugendalter zu den häufigsten psychischen Störungen. Es liegen zwei Erkrankungsgipfel im Altersbereich von 11-14 Jahren und im jungen Erwachsenenalter mit 20 Jahren vor. 20% der Zwangsstörungen beginnen vor dem Alter von 10 Jahren und 60% vor dem Alter von 25 Jahren. Die Erkrankung wird oftmals sehr spät erkannt. Es dauert im Durchschnitt über 10 Jahre bis die Patienten professionelle Hilfe aufsuchen. Es gibt einige behandlungsrelevante Unterschiede von Zwangsstörungen im Kindes- und Jugendalter im Vergleich zum Erwachsenenalter. In der Diagnostik und Behandlung müssen das Alter und der Entwicklungsstand der Betroffenen sowie die Bedingungen um familiären und sozialen Umfeld berücksichtigt werden. Die Fehl- und Unterdiagnosen sind im Kindes- und Jugendalter wie im Erwachsenenalter sehr hoch. Verlaufsstudien zeigen, dass die Erkrankung oft chronisch verläuft und zu einer erheblichen psychosozialen Beeinträchtigung führt. Auch ist das Risiko für die Entwicklung von weiteren psychischen, aber auch somatischen Störungen und Folgeerkrankungen hoch. Aus der Studienlage wird deutlich, dass der frühe Behandlungsbeginn einer der wichtigsten positiven prognostischen Faktoren ist (Walitza et al., 2020, Fineberg et al., 2019). Wegen der hohen Bedeutung der Früherkennung und frühen Interventionen wurde 2019 ein internationales Consensus-Statement verfasst (Fineberg et al., 2019) in welchem auch die Aspekte, die Kinder und Jugendliche betreffen, berücksichtigt werden. Zudem besteht eine Unterversorgung, diese kommt unter anderem zustande durch mangelnde Verfügbarkeit von einer anwendergerechten Zusammenfassung der Evidenz von Behandlungsansätzen im Rahmen einer Leitlinie für Diagnostik und Therapie im Kindes- und Jugendalter. Diese Gründe, aber auch das Ziel der breiten Disseminierung der Leitlinie zu allen Versorgern, die Kinder und Jugendliche sehen, ist Anlass und Grund für diese Leitlinie. Neben der Praxis und Anwendung selbst, ist eine Leitlinie auch relevant für die Aus- und Weiterbildung. Zum aktuellen Zeitpunkt werden die evidenzbasierten Therapien national und international nicht flächendeckend eingesetzt. Bislang gibt es für Zwangsstörungen im Kindes- und Jugendalter keine S3-Leitlinie. Ziel ist es die Diagnostik und Behandlung von Zwangsstörungen zu verbessern und den Therapeuten eine Leitlinie auf S3 Niveau an die Hand zu geben. Die Langversion der Leitlinie gibt zusätzlich eine Zusammenfassung des Hintergrundwissens zu Zwangsstörungen im Kindes- und Jugendalter und einen Teil der Diskussion im Konsentierungsprozess wieder, die neben der Evidenz und der Konsentierung ebenfalls hinter den Empfehlungen steht

Опыт внедрения электронного курса на базе платформы LMS Moodle с использованием содержания на английском языке

Представлен разработанный курс для смешанного обучения магистрантов направления "Инноватика" профиля "Информационные технологии в рекламе и связях с общественностью"

An observational study of once-daily modified-release methylphenidate in ADHD: the effect of previous treatment on ADHD symptoms, other externalising symptoms and quality-of-life outcomes

Methylphenidate (MPH) is the most commonly prescribed stimulant for children with ADHD. Data on the effects of different MPH formulations in real-life settings are scarce, and the role of previous therapy on treatment outcome when switching medications has not been well studied. OBSEER was an observational study designed to evaluate the effectiveness and safety of Equasym XL® in routine care. This study assessed whether the improvements reported with Equasym XL® are influenced by the degree of symptom control achieved with the previous medication. Patients enrolled in OBSEER were stratified by prior treatment (none, MPH-immediate release [IR] once daily [o.d.] [MPH-IR o.d.], MPH-IR repeated [MPH-IR >o.d.] and MPH-MR [modified release] excluding Equasym XL®), and changes in ADHD and other externalising symptoms (CGI-S, FBB-ADHD and DAYAS) and quality of life (QoL, KINDL) were evaluated during treatment with Equasym XL®. A total of 782 patients were analysed. Significant group-by-time interactions were found for all symptom variables analysed, indicating that effects varied by previous medication. For CGI-S and FBB-ADHD total scores, the greatest reductions in ADHD symptoms were observed in the treatment-naïve subgroup, followed (in order) by MPH-IR o.d., MPH-IR >o.d. and MPH-MR. A similar profile was seen for DAYAS ratings for all periods of the day except the evening, when there were no significant differences between subgroups. Similarly, the treatment-naïve and MPH-IR o.d. subgroups showed the greatest improvements in KINDL ratings. Although effects were greatest for treatment-naïve patients, improvements were also observed in the prior treatment subgroups for symptoms and QoL. This suggests that a change to Equasym XL® may be beneficial in patients with suboptimal effects on prior medication

Editorial: Observational studies in ADHD: the effects of switching to modified-release methylphenidate preparations on clinical outcomes and adherence

Patients with ADHD may have better adherence to treatment with modified-release methylphenidate (MPH-MR) formulations, which are taken once daily, compared with immediate-release (IR) formulations, which need to be taken several times a day. Data on long-term outcomes such as adherence may be lacking from randomised controlled trials as these are usually only short-term. Observational studies, if performed and reported appropriately, can provide valuable long-term data on such outcomes, as well as additional information on effectiveness and efficiency, from a real-life setting. By reviewing previous observational studies that have investigated switching treatment from MPH-IR to MPH-MR, results from a new, naturalistic observational study, the OBSEER study, are put into context. We conclude that, based on observational trial data, switching from MPH-IR to MPH-MR is a valid clinical approach, with the potential for improved clinical outcome and treatment adherence

Impact of the COVID-19 pandemic on children with and without affective dysregulation and their families

Analyzing COVID-19-related stress in children with affective dysregulation (AD) seems especially interesting, as these children typically show heightened reactivity to potential stressors and an increased use of maladaptive emotion regulation strategies. Children in out-of-home care often show similar characteristics to those with AD. Since COVID-19 has led to interruptions in psychotherapy for children with mental health problems and to potentially reduced resources to implement treatment strategies in daily life in families or in out-of-home care, these children might show a particularly strong increase in stress levels. In this study, 512 families of children without AD and 269 families of children with AD reported on COVID-19-related stress. The sample comprised screened community, clinical, and out-of-home care samples. Sociodemographic factors, characteristics of child and caregiver before the pandemic, and perceived change in external conditions due to the pandemic were examined as potential risk or protective factors. Interestingly, only small differences emerged between families of children with and without AD or between subsamples: families of children with AD and families in out-of-home care were affected slightly more, but in few domains. Improvements and deteriorations in treatment-related effects balanced each other out. Overall, the most stable and strongest risk factor for COVID-19-related stress was perceived negative change in external conditions—particularly family conditions and leisure options. Additionally, caregiver characteristics emerged as risk factors across most models. Actions to support families during the pandemic should, therefore, facilitate external conditions and focus on caregiver characteristic to reduce familial COVID-19-related stress. Trial registration: German Clinical Trials Register (DRKS), ADOPT Online: DRKS00014963 registered 27 June 2018, ADOPT Treatment: DRKS00013317 registered 27 September 2018, ADOPT Institution: DRKS00014581 registered 04 July 2018