Treatment of ADHD in adults – prevalence of discontinuation and associated factors – results from a cross-sectional analysis of Danish register data

BackgroundA growing number of adults are receiving pharmacological treatment for ADHD but a sizable proportion also discontinues or have gaps in treatment. The primary aims of this study were to identify how many patients treated for ADHD in adulthood, have at least one event of discontinuation in treatment and to identify possible associated variables.MethodsWithin the Danish population aged 18–60 years on the 1st of January 2013, we identified the number of individuals who had been prescribed ADHD-medication at least once during the 1st of January 2002–31st of December 2013 using Danish register data. Among those who filed more than one prescription, treatment discontinuation was defined as having more than 211 days between two prescriptions. In crude and adjusted logistic regression analysis, we explored potential associations to discontinuation for variables such as gender and age at treatment initiation.ResultsIn a population, if N = 3,165,844 individuals, n = 42,892 had received at least one prescription for ADHD medication. Among those with more than one prescription (N = 38,289), 29.4% had discontinued their treatment at least once, according to our definition of treatment discontinuation. ADHD treatment discontinuation was associated with being male, unemployment, lower educational attainment, receiving incapacity benefits and younger age at treatment initiation (p [less than] 0.001).ConclusionsA large proportion of individuals treated for ADHD had at least one discontinuation of treatment according to our definition. Although the present study does not allow for investigating the direction of these effects, nor whether some patients later resumed treatment, having at least one discontinuation was associated with a range of variables relating to e.g. age and gender, and provides an emerging profile for clinicians of patients more likely to discontinue

Are Weight Status and Cognition Associated?:An Examination of Cognitive Development in Children and Adolescents with Anorexia Nervosa 1 Year after First Hospitalisation

OBJECTIVE: The aim of this study was to characterise the association between the cognitive profile and weight restoration in children and adolescents with anorexia nervosa. METHODS: The study was a longitudinal, matched case–control, multicentre study. An assessment of cognitive functions was conducted by using the Wechsler Intelligence Scale for Children–III/the Wechsler Adult Intelligence Scale–III, the Test of Memory and Learning–second edition, Trail Making Tests A and B, the Rey–Osterrieth Complex Figure Test and the Cambridge Neuropsychological Test Automated Battery. RESULTS: One hundred twenty individuals, 60 patients with anorexia nervosa with mean age of 14.65 (SD 1.820) years and 60 healthy controls with mean age of 14.76 (SD 1.704) years, participated. No association was found between weight recovery and cognitive functions. However, a significant increase in motor speed was found in Trail Making Test A (p = 0.004), Reaction Time (RTI) five‐choice movement time (p = 0.002) and RTI simple movement time (p = 0.011), resulting in a normalisation corresponding to that found in healthy controls. Furthermore, a significantly lower score in the perceptual organization index (p = 0.029) was found at follow‐up. CONCLUSIONS: Weight recovery appears not to be associated with cognition. Copyright © 2016 The Authors European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Lt

Sexual obsessions in children and adolescents : Prevalence, clinical correlates, response to cognitive-behavior therapy and long-term follow up

No funding was received for this study. Publisher Copyright: © 2022 The AuthorsSexual obsessions occur in pediatric and adult OCD including thoughts about sexual acts with family members, sexually inappropriate behavior, or homosexual orientation. They may remain undiagnosed because of embarrassment to report thoughts that are perceived as unacceptable. Prevalence studies of sexual obsessions in pediatric populations are rare. The present study investigated prevalence of sexual obsessions and treatment outcome compared to youth with OCD without sexual obsessions in a large sample. Sexual obsessions and OCD severity were assessed with the Children's Yale-Brown Obsessive- Compulsive Scale in all 269 participants of the Nordic Longterm OCD Treatment study (mean age 12.8 years, 48.7% boys) at baseline, after treatment and three years follow-up. Treatment consisted in individual manualized CBT with exposure and response prevention. Patients with and without sexual obsessions were compared on clinical characteristics and treatment outcomes. Sexual obsessions were reported by 18%, those with sexual obsessions were slightly older (13.5 versus 12.7 years). Both groups had no difference in treatment outcome, suggesting that if addressed, the response to CBT is similar in sexual, as in other obsessions. Clinicians need to be aware that children may need help to disclose and to identify these thoughts as obsessions to address them in treatment.Peer reviewe

Parent training for preschool ADHD in routine, specialist care: a randomized controlled trial

Objective Parent training (PT) is recommended for attention-deficit/hyperactivity disorder (ADHD) in preschool children. Evidence-based interventions are important, but only if they produce better outcomes than usual care. Method We conducted a multi-center, two-arm parallel group randomized controlled trial in routine, specialist ADHD clinics in Danish Child and Adolescent Mental Health Services (CAMHS). Children (N=164, age 3-7) with ADHD received either a well-established PT programme (New Forest Parenting Programme (NFPP)) (n=88) or treatment as usual (TAU) (n=76). The primary outcome was parent ratings of child ADHD symptoms. Secondary outcomes included teacher ratings and direct observations of ADHD symptoms. Outcomes were measured at baseline (T1) and post-treatment (T2) and at follow-up (T3: 36 weeks after T2). Representativeness of participants was evaluated against the total national cohort of children (n=1378, age 3-7) diagnosed with ADHD during the same time period, using the Danish Civil Registration System. Statistical analysis employed a repeated measure model. Results By T2, NFPP was superior to TAU on parent-rated ADHD symptoms (p=0.009; ES d.=0.30), and on parenting self-efficacy and family strain. Effects persisted to T3. There were no effects on teacher ratings or direct observations of ADHD or on ratings of conduct problems or parenting. Our clinical sample was similar to the national cohort of young children with ADHD. Conclusions Evidence-based PT has value as an intervention for preschool ADHD in routine clinical settings. As in previous trials effects were restricted to parent-reported outcomes. Surprisingly, there were no effects on child conduct problems

Randomised social-skills training and parental training plus standard treatment versus standard treatment of children with attention deficit hyperactivity disorder - The SOSTRA trial protocol

Abstract Background Children with attention deficit hyperactivity disorder (ADHD) are hyperactive and impulsive, cannot maintain attention, and have difficulties with social interactions. Medical treatment may alleviate symptoms of ADHD, but seldom solves difficulties with social interactions. Social-skills training may benefit ADHD children in their social interactions. We want to examine the effects of social-skills training on difficulties related to the children's ADHD symptoms and social interactions. Methods/Design The design is randomised two-armed, parallel group, assessor-blinded trial. Children aged 8-12 years with a diagnosis of ADHD are randomised to social-skills training and parental training plus standard treatment versus standard treatment alone. A sample size calculation estimated that at least 52 children must be included to show a 4-point difference in the primary outcome on the Conners 3rd Edition subscale for 'hyperactivity-impulsivity' between the intervention group and the control group. The outcomes will be assessed 3 and 6 months after randomisation. The primary outcome measure is ADHD symptoms. The secondary outcome is social skills. Tertiary outcomes include the relationship between social skills and symptoms of ADHD, the ability to form attachment, and parents' ADHD symptoms. Discussion We hope that the results from this trial will show that the social-skills training together with medication may have a greater general effect on ADHD symptoms and social and emotional competencies than medication alone. Trial registration ClinicalTrials (NCT): NCT00937469</p

Better mental health in children of Vietnamese refugees compared with their Norwegian peers - a matter of cultural difference?

<p>Abstract</p> <p>Background</p> <p>There are conflicting results on whether immigrant children are at a heightened risk of mental health problems compared with native youth in the resettlement country.</p> <p>The objective of the study</p> <p>To compare the mental health of 94 Norwegian-born children from a community cohort of Vietnamese refugees, aged 4 - 18 years, with that of a Norwegian community sample.</p> <p>Methods</p> <p>The SDQ was completed by two types of informants; the children's self-reports, and the parents' reports, for comparison with Norwegian data from the Health Profiles for Children and Youth in the Akershus study.</p> <p>Results</p> <p>The self-perceived mental health of second-generation Vietnamese in Norway was better than that of their Norwegian compatriots, as assessed by the SDQ. In the Norwegian-Vietnamese group, both children and parents reported a higher level of functioning.</p> <p>Conclusion</p> <p>This surprising finding may result from the lower prevalence of mental distress in Norwegian-Vietnamese children compared with their Norwegian peers, or from biased reports and cultural differences in reporting emotional and behavioural problems. These findings may represent the positive results of the children's bi-cultural competencies.</p

Måleegenskaper ved den norske versjonen av Inventory of Life Quality in Children and Adolescents (ILC)

Beskrivelse. Inventory of Life Quality in Children and Adolescents (ILC) er et spørreskjema som skal gi mål på helserelatert livskvalitet hos barn og unge med psykiske og somatiske lidelser i alderen 6-18 år. ILC kan også brukes hos friske barn og unge. Spørreskjemaet består av sju testledd (ni for pasienter) med en fem-delt skala. Det er en foreldreversjon og en selvrapportversjon. Selvrapporteringen er i intervjuform for barn mellom 6 og 11 år. Spørreskjemaet tar 5-15 minutter å besvare. Den norske oversettelse av Thomas Jozefiak og Ulrich Linnemann er basert på den tyske originalen av ILC som ble utviklet av Mattejat og Remschmidt i 2006. Brukergrupper er leger, psykologer og andre med relevant høyskoleutdanning som har fått opplæring i livskvalitetskartlegging og ILC. Den norske utgaven av ILC er tilgjengelig fra Hogrefe Psykologiförlaget AB. Litteratursøk. Vårt systematiske litteratursøk resulterte i 72 treff, hvorav fem publikasjoner fra fire norske studier ble inkludert; en skolebasert befolkningsstudie og tre kliniske studier. I tillegg inkluderte vi den norske ILC manualen. Psykometri. Det foreligger norske normer basert på et representativt populasjonsutvalg av barn og unge, 6-18 år, fra Sør-Trøndelag fylke. Fra samme fylket er det også kliniske sammenligningsverdier fra et barne- og ungdomspsykiatrisk utvalg. Det er vist tilfredsstillende validitet mot et annet livskvalitetsmål og et depresjonsmål samt klinisk validitet. Når det gjelder reliabilitet, er den indre konsistensen akseptabel til god bortsett fra selvrapport for de yngste barna og barna i det kliniske utvalget. Test-retest er rapportert god i to årsklasser. Endringssensitivitet ble målt i det populasjonsbaserte utvalget, men ikke i det kliniske utvalget. Konklusjon. Dokumentasjonsgrunnlaget for de psykometriske egenskapene ved den norske utgaven av ILC er begrenset. De foreliggende studier vurderes imidlertid til å være av gjennomgående god kvalitet med generelt tilfredsstillende normer og validitets- og reliabilitetsmål

Måleegenskaper ved den norske versjonen av Inventory of Life Quality in Children and Adolescents (ILC)

-Beskrivelse. Inventory of Life Quality in Children and Adolescents (ILC) er et spørreskjema som skal gi mål på helserelatert livskvalitet hos barn og unge med psykiske og somatiske lidelser i alderen 6-18 år. ILC kan også brukes hos friske barn og unge. Spørreskjemaet består av sju testledd (ni for pasienter) med en fem-delt skala. Det er en foreldreversjon og en selvrapportversjon. Selvrapporteringen er i intervjuform for barn mellom 6 og 11 år. Spørreskjemaet tar 5-15 minutter å besvare. Den norske oversettelse av Thomas Jozefiak og Ulrich Linnemann er basert på den tyske originalen av ILC som ble utviklet av Mattejat og Remschmidt i 2006. Brukergrupper er leger, psykologer og andre med relevant høyskoleutdanning som har fått opplæring i livskvalitetskartlegging og ILC. Den norske utgaven av ILC er tilgjengelig fra Hogrefe Psykologiförlaget AB. Litteratursøk. Vårt systematiske litteratursøk resulterte i 72 treff, hvorav fem publikasjoner fra fire norske studier ble inkludert; en skolebasert befolkningsstudie og tre kliniske studier. I tillegg inkluderte vi den norske ILC manualen. Psykometri. Det foreligger norske normer basert på et representativt populasjonsutvalg av barn og unge, 6-18 år, fra Sør-Trøndelag fylke. Fra samme fylket er det også kliniske sammenligningsverdier fra et barne- og ungdomspsykiatrisk utvalg. Det er vist tilfredsstillende validitet mot et annet livskvalitetsmål og et depresjonsmål samt klinisk validitet. Når det gjelder reliabilitet, er den indre konsistensen akseptabel til god bortsett fra selvrapport for de yngste barna og barna i det kliniske utvalget. Test-retest er rapportert god i to årsklasser. Endringssensitivitet ble målt i det populasjonsbaserte utvalget, men ikke i det kliniske utvalget. Konklusjon. Dokumentasjonsgrunnlaget for de psykometriske egenskapene ved den norske utgaven av ILC er begrenset. De foreliggende studier vurderes imidlertid til å være av gjennomgående god kvalitet med generelt tilfredsstillende normer og validitets- og reliabilitetsmål