Co-existing psychiatric problems in ADHD in the ADORE cohort

Abstract : Objective : To study the impact of co-existing psychiatric problems with ADHD on behavioural features, psychosocial functioning and quality of life in subjects of the ADORE cohort (N=1,478). Methods : The following six groups of associated psychiatric problems with ADHD were compared: oppositional-defiant disorder or conduct disorder only (ODD/CD); anxiety or depressive disorder only (ANX/DEP); tic/Tourette's disorder only (TIC/ Tourette's); developmental co-ordination disorder only (DCD); two or more associated conditions; and none. Dependent variables included the ADHD Rating Scale-IV, the Strengths and Difficulties Questionnaire, the Clinical Global Impression-Severity scale, the Children's Global Assessment Scale and the Child Health Illness Profile-Child Edition. Results : Having multiple co-existing psychiatric problems increased the severity of ADHD in all domains, be it behavioural features, psychosocial impairment or deterioration of quality of life. A similar though less consistent pattern applied to subjects with co-existing ODD/CD. Conclusions : The ADORE study provides impressive evidence for the far-reaching consequences of co-existing psychiatric problems in children with ADHD that warrant intensive consideration in clinical assessment and treatmen

Quality of Life, family function and mental health of deaf and hard-of-hearing adolescents in mental health services in Norway - a pilot study

Object: The main aim of this study was to gain a better understanding of Quality of Life, family functioning and mental health for Norwegian deaf and hard-of-hearing children and adolescents. Method: We used the Inventory of Life Quality for Children (ILC), McMaster Family Assessment Device (GFS) and the Strengths and Difficulties Questionnaire (SDQ). These instruments were used to assess Quality of Life, family functioning, emotional and behavioural problems in deaf and hard-of-hearing (n= 20) and hearing Child and Adolescent Psychiatry (CAP) patients (n = 717) as well as in a hearing normative sample (n= 1032). Results: We found that Quality of Life and family functioning of deaf and hard-of-hearing (DHH) CAP patients were comparable to those of their hearing CAP peers. DHH CAP patients showed a non-significant tendency to report more emotional and behavioural difficulties than hearing CAP patients. Conclusion: Based on these results, Norwegian deaf and hard-of-hearing CAP patients score similarly to their hearing peers in CAP on measures of Quality of Life and family function, whereas there may be a tendency for DHH CAP patients to report more emotional and behavioural problems than hearing CAP patients. Due to the very small sample size more research is needed on the subject.publishedVersion©This is an Open Access Article which permits unrestricted noncommercial use, provided the original work is properly cited

Quality of Life, family function and mental health of deaf and hard-of-hearing adolescents in mental health services in Norway - a pilot study

Object: The main aim of this study was to gain a better understanding of Quality of Life, family functioning and mental health for Norwegian deaf and hard-of-hearing children and adolescents. Method: We used the Inventory of Life Quality for Children (ILC), McMaster Family Assessment Device (GFS) and the Strengths and Difficulties Questionnaire (SDQ). These instruments were used to assess Quality of Life, family functioning, emotional and behavioural problems in deaf and hard-of-hearing (n= 20) and hearing Child and Adolescent Psychiatry (CAP) patients (n = 717) as well as in a hearing normative sample (n= 1032). Results: We found that Quality of Life and family functioning of deaf and hard-of-hearing (DHH) CAP patients were comparable to those of their hearing CAP peers. DHH CAP patients showed a non-significant tendency to report more emotional and behavioural difficulties than hearing CAP patients. Conclusion: Based on these results, Norwegian deaf and hard-of-hearing CAP patients score similarly to their hearing peers in CAP on measures of Quality of Life and family function, whereas there may be a tendency for DHH CAP patients to report more emotional and behavioural problems than hearing CAP patients. Due to the very small sample size more research is needed on the subject

Improved quality of life among adolescents with attention-deficit/hyperactivity disorder is mediated by protective factors: A cross sectional survey

Background: The aim of this study was to assess the role of protective factors as mediators and/or moderators of the relationship between coexisting emotional and conduct problems and quality of life (QoL) among adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods: The sample consisted of 194 adolescents with ADHD. Participants completed measures of individual competencies, family cohesion and social support, and QoL. Coexisting emotional and conduct problems were assessed using the Strength and Difficulties Questionnaire. Results: Individual competencies and social support mediated the association between emotional and conduct problems and QoL. Family cohesion was associated with both emotional and conduct problems. No moderating effects of protective factors and coexisting problems were found. Conclusions: The assessment of individual competencies, social resources, and family cohesion may identify potential treatment goals for adolescents with ADHD and coexisting problems, and may contribute to improvements in QoL. Keywords: ADHD, Adolescence, Coexisting problems, Protective factors, QoL

Psychometric properties of the Weiss Functional Impairment Rating Scale parent and self-reports in a Norwegian clinical sample of adolescents treated for ADHD

Objective To analyze the psychometric properties of the Norwegian version of the Weiss Functional Impairment Rating Scale parent and self-reports (WFIRS-P and WFIRS-S) in adolescents with ADHD. Methods 102 clinically referred patients, of which 86% were enrolled in an ongoing RCT program (Clinical trials NCT02937142), were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV). The conceptual framework of the WFIRS-P and the WFIRS-S was evaluated using confirmatory factor analysis (CFA), reliability was estimated using Cronbach’s alpha, convergent and divergent validity was assessed using correlations with the Children’s Global Assessment Scale (C-GAS) and the ADHD Rating Scale-IV (ADHD-RS-IV). Results CFA supported the original factor structure of the questionnaires, both a first-order and a second-order model revealed acceptable model fit. Internal consistency was satisfactory across domains. The parent-adolescent agreement was moderate. The correlations between the C-GAS and the total scores of the WFIRS-P and WFIRS-S were low to moderate (r = –0.29 to −0.38). The ADHD-RS-IV correlated moderately (r = 0.49) with WFIRS-P, the correlation with WFIRS-S was weak (r = 0.28) supporting divergent validity. In multiple regression analyses, the ADHD-RS total score was the strongest predictor of the total score in both the WFIRS questionnaires, with internalizing disorder showing an additional small contribution. Age, gender and full-scale IQ gave no additional contribution in explaining the variance. Conclusions The findings support the use of the Norwegian version of the WFIRS-S and the WFIRS-P in the evaluation of functional impairment in adolescents with ADHD

Cognitive behavioural group therapy for adolescents with ADHD: a study of satisfaction and feasibility

Adolescents with ADHD are at increased risk of adverse outcomes and a negative life trajectory into adulthood. Evidence regarding treatment specifically tailored for the needs of this age group are still limited. High dropout rates, discontinuation of medication and treatment resistance are common issues in this population, and the patient perspective on new treatment options is therefore important. In this study, we aimed to investigate treatment satisfaction and feasibility of a group CBT program for adolescents with ADHD. We further aimed to identify any baseline characteristics predicting satisfaction. Materials and methods This study was part of a larger RCT of group CBT as add-on treatment for adolescents aged 14–18 years (Mean age 15.9 years, SD 1.3) with ADHD in Norway. Satisfaction and feasibility in the treatment group (n = 48) were measured by completion of an evaluation questionnaire, attendance of group sessions and a group-leaders checklist. Predictors of satisfaction were analysed using linear regression. Results Overall satisfaction was very high with a significant age effect, the eldest participants being most satisfied. Attendance rate was high with few dropouts and medical adherence during the treatment period was good. Group-leaders generally self-evaluated adherence to treatment manual positively but addressing resistance towards homework as challenging. Conclusions The participants were very satisfied with the group CBT treatment. Treatment options that are accepted and well-liked by the targeted population have the potential of reducing resistance towards treatment, improving future health and adherence to medication. The program is considered suitable for a clinical setting and may represent a feasible treatment supplement for adolescent ADHD

Cognitive-behavioural group therapy for adolescents with ADHD: study protocol for a randomised controlled trial

Introduction Persistence of attention deficit hyperactivity disorder (ADHD) into adolescence is a significant burden to patients. Clinical guidelines recommend non-pharmacological therapies, but the evidence to support this recommendation is sparse. This study aims to evaluate the effect of a 12-week group cognitive–behavioural therapy (CBT) programme for adolescents with ADHD aged 14–18 years, who still have impairing symptoms after treatment with medication. We will study the effect of the treatment on ADHD symptoms and examine moderators and mediators of the effect of the treatment on ADHD. Methods and analysis We conduct a randomised controlled trial of CBT group therapy in adolescents with ADHD recruited from child psychiatric outpatient units in Mid-Norway. 99 adolescents who met inclusion criteria and consented to participation have been randomised to a 12-week group intervention or to a control group receiving treatment as usual. Assessments are made at admission to the clinic, preintervention, postintervention and at a 9-month follow-up, obtaining adolescent, parent and teacher reports. Clinicians blinded to group allocation rate all participants as to their functioning preintervention and at the two postintervention assessment points. The primary outcome is change in symptom scores on the ADHD Rating Scale-IV. Ethics and dissemination The Regional Committee for Medical and Health Research Ethics in South East Norway approved the study protocol (2015/2115). We will disseminate the findings in peer-reviewed publications and conference presentations, to user organisations and at courses attended by families and professionals. Two PhD students will publish and defend dissertations relating to the study. Planned publications include primary and secondary outcomes and patient satisfaction with the treatment. Furthermore, we plan to publish a manual of CBT group therapy in adolescent ADHD to benefit treatment of patients in Norway and elsewhere

Co-existing psychiatric problems in ADHD in the ADORE cohort

OBJECTIVE: To study the impact of co-existing psychiatric problems with ADHD on behavioural features, psychosocial functioning and quality of life in subjects of the ADORE cohort (N=1,478). METHODS: The following six groups of associated psychiatric problems with ADHD were compared: oppositional-defiant disorder or conduct disorder only (ODD/CD); anxiety or depressive disorder only (ANX/DEP); tic/Tourette's disorder only (TIC/Tourette's); developmental co-ordination disorder only (DCD); two or more associated conditions; and none. Dependent variables included the ADHD Rating Scale-IV, the Strengths and Difficulties Questionnaire, the Clinical Global Impression-Severity scale, the Children's Global Assessment Scale and the Child Health Illness Profile-Child Edition. RESULTS: Having multiple co-existing psychiatric problems increased the severity of ADHD in all domains, be it behavioural features, psychosocial impairment or deterioration of quality of life. A similar though less consistent pattern applied to subjects with co-existing ODD/CD. CONCLUSIONS: The ADORE study provides impressive evidence for the far-reaching consequences of co-existing psychiatric problems in children with ADHD that warrant intensive consideration in clinical assessment and treatment