Limited usefulness of neurocognitive functioning indices as predictive markers for treatment response to methylphenidate or neurofeedback@home in children and adolescents with ADHD

IntroductionEarlier studies exploring the value of executive functioning (EF) indices for assessing treatment effectiveness and predicting treatment response in attention-deficit/hyperactivity disorder (ADHD) mainly focused on pharmacological treatment options and revealed rather heterogeneous results. Envisioning the long-term goal of personalized treatment selection and intervention planning, this study comparing methylphenidate treatment (MPH) and a home-based neurofeedback intervention (NF@Home) aimed to expand previous findings by assessing objective as well as subjectively reported EF indices and by analyzing their value as treatment and predictive markers.MethodsChildren and adolescents (n = 146 in the per protocol sample) aged 7–13 years with a formal diagnosis of an inattentive or combined presentation of ADHD were examined. We explored the EF performance profile using the Conners Continuous Performance Task (CPT) and the BRIEF self-report questionnaire within our prospective, multicenter, randomized, reference drug-controlled NEWROFEED study with sites in five European countries (France, Spain, Switzerland, Germany, and Belgium). As primary outcome for treatment response, the clinician-rated ADHD Rating Scale-IV was used. Patients participating in this non-inferiority trial were randomized to either NF@home (34–40 sessions of TBR or SMR NF depending on the pre-assessed individual alpha peak frequency) or MPH treatment (ratio: 3:2). Within a mixed-effects model framework, analyses of change were calculated to explore the predictive value of neurocognitive indices for ADHD symptom-related treatment response.ResultsFor a variety of neurocognitive indices, we found a significant pre-post change during treatment, mainly in the MPH group. However, the results of the current study reveal a rather limited prognostic value of neurocognitive indices for treatment response to either NF@Home or MPH treatment. Some significant effects emerged for parent-ratings only.DiscussionCurrent findings indicate a potential value of self-report (BRIEF global score) and some objectively measured neurocognitive indices (CPT commission errors and hit reaction time variability) as treatment markers (of change) for MPH. However, we found a rather limited prognostic value with regard to predicting treatment response not (yet) allowing recommendation for clinical use. Baseline symptom severity was revealed as the most relevant predictor, replicating robust findings from previous studies

Adolescence, should we turn it into a disease?

The increasing number of questions posed by problems arising from the behavior of teenagers make it logical for us to ask whether or not we should consider adolescence to be a disease. The answer is obvious: of course not! And we can affirm that response with empirical evidence. Most adolescents we see in consultation do well without having any need for psychiatric assistance, an observation confirmed by a French Ministry of Health 2002 study that found only one out of eight adolescents suffered from mental disorders. This, of course, clearly implies that seven out of eight enjoy good mental health. If adolescence is not a disease, it could become one if friends and families of teenagers fail to understand the profound changes these young people are passing through or misinterpret the manifestations of this crucial life stage

Haut potentiel

L'association entre haut potentiel (HP) et Trouble Déficit de l'Attention/Hyperactivité (TDA/H), couple mythique ou infernal, représente un vrai défi diagnostique et thérapeutique, du fait de similitudes sémiologiques entre les deux syndromes d'une part, mais aussi de leur possible coexistence d'autre part. Identifier, poser un diagnostic puis traiter deviennent un challenge complexe, à la hauteur de ces enfants à besoins particuliers. Nombre d'enfants sont amenés en consultation car ils souffrent d'isolement, de difficultés scolaires, voire sont poursuivis par la réputation d'être ingérables ou mal éduqués. La question d'un HP ou d'un TDA/H est alors évoquée. Mais si l'enfant HP peut être pris pour un TDA/H et inversement, l'un peut-il masquer l'autre, en cas de co-morbidité? Comment éviter alors de se fourvoyer en traitant des faux positifs tout en négligeant les faux négatifs

Aspects psychodynamiques de l'instabilité psychomotrice de l'enfant

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Hyperactivité de l'enfant et résistance aux hormones thyroïdiennes (quel lien ?)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

L'échec scolaire chez l'enfant intellectuellement précoce

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF