Conceptualisation and conscience assessment in adolescence in forensic mental healthcare: experts’ perspectives

Child and adolescent psychology and psychiatry healthcare guidelines recommend a structured clinical assessment of conscience of juveniles displaying antisocial behaviour to substantiate the allocation of treatment or penal sanctions. The scientific literature on conscience development is accumulating, yet no widely accepted, integrative clinical instrument for assessment of conscience is available. Consequently, clinicians assess conscience, utilising their acquired knowledge and experience. Resulting in a largely intuitive process that varies vastly among professionals. This study aimed to gather and explicate the implicit knowledge of experienced clinicians on the assessment of adolescent conscience. Semi-structured interviews were conducted with seven clinical experts working in various Dutch (forensic) mental health organisations. Using a five-phase systematic and structured content analysis, the framework method was applied to explore the techniques and concepts used by clinical experts. The concepts they used grossly matched the concepts found in the literature. We identified three pivotal domains: empathic capacity, self-conscious emotions, and moral reasoning. Moreover, the data suggested to consider these domains expressing the overarching concept of self-image or identity. These results will enable the design of a clinically based, comprehensive instrument to improve the quality of the assessment of conscience in the context of child and adolescent forensic psychiatric healthcare

Improving methylphenidate titration in children with attention-deficit/hyperactivity disorder (ADHD): a randomized controlled trial using placebo-controlled titration implemented in clinical practice

Education and Child Studie

<em>Time-on-task</em>-effecten bij kinderen met en zonder ADHD: Uitputting van executieve functies of uitputting van motivatie?

Kinderen met ADHD laten op cognitieve taken een achteruitgang in prestatie over tijd zien (dit is een time-on-task-effect). In deze studie werd onderzocht of dit komt door uitputting van executieve functies of door uitputting van motivatie. De Stop Signal Task (SST) werd twee keer achter elkaar afgenomen bij 42 kinderen met en 54 kinderen zonder ADHD (negen tot dertien jaar). Deze taak genereert zowel uitkomstmaten voor inhibitie als voor aandacht. De helft van de proefpersonen werd tijdens de tweede afname beloond. Multilevel-analyses toonden aan dat time-on-task-effecten groter waren bij kinderen met ADHD dan bij controles, en dat deze effecten deels konden worden teruggedrongen door beloning. De effecten beperkten zich tot het domein van aandacht. Dit toont aan dat er zowel sprake was van uitputting van executieve functies (beloning had immers niet op alle uitkomstmaten effect) als van uitputting van motivatie, waarbij dit laatste kan worden tegengegaan met beloning

Attention Deficit Hyperactivity Disorder and Functional Defecation Disorders in Children

Objectives: The aim of the study was to assess the prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with functional defecation disorders (FDDs) and to assess the prevalence of FDDs in children with ADHD. Methods: A cross-sectional cohort study was carried out between September 2014 and May 2016. Group 1: Parents of children with FDDs according to the Rome III criteria completed the Child Behavior Checklist and the VvGK (Dutch questionnaire based on the American Disruptive Behavior Disorder rating scale). Patients with ADHD subarea scores >= 70 on the Child Behavior Checklist and/or >= 16 on the VvGK were referred for further psychiatric evaluation. Group 2: Parents of children treated for ADHD at a specialized ADHD outpatient clinic completed a standardized questionnaire regarding their child's defecation pattern. Results: In group 1 (282 children with FDDs), 10.3% (7.1%-13.5% bias-corrected and accelerate confidence interval) were diagnosed with ADHD. Group 2 consisted of 198 children with ADHD, 22.7% (17.6-28.8 bias-corrected and accelerate confidence interval) fulfilled the Rome III criteria for an FDD. Children with both an FDD and ADHD reported urinary incontinence significantly more often compared to children with an FDD or ADHD alone: 57.1% in FDD+ADHD versus 22.8% in FDD alone (P <0.001) and 31.1% in ADHD+FDD versus 7.8% in ADHD alone (P <0.001). Conclusions: Approximately 10.3% of children with FDDs had ADHD and 22.7% of children with a known diagnosis of ADHD fulfilled the Rome III criteria for an FDD. This observation suggests that screening for behavioral disorders and FDDs should be incorporated into the diagnostic workup of these groups of childre