Free-living Physical Activity and Executive Function : A Multi-Study Analysis of Age Groups and Times of Day

Acknowledgments The authors wish to thank all participants (and parents) for taking part in the studies. Additionally, we want to thank Merle Reuter and Ulrike Schwarz for their help in data collection and preparation of the AttentionGO project. We also thank the student assistants for their support in data collection in all studies. Further, we thank Patrick E. Shrout for his expert advice and valuable feedback on the first draft of the manuscript.Peer reviewedPublisher PD

Telehealth interventions in outpatient psychotherapy practices (TIpp)

Based on epidemiological studies, the number of mental illnesses in Germany is steadily increasing. While 15,6 million people were affected by mental illness in 1998, this figure will rise to almost 18 million in 2022 (Wittich et al., 2001). The care of mentally ill people represents a complex challenge for the entire healthcare system. The need for people who require psychotherapeutic help is therefore continuously increasing. The existing structural supply problem is primarily characterized by a low number of outpatient and inpatient therapy places (Gerhardinger, 2022). If the waiting time nationwide in 2018 for a therapy place was already 22 weeks, there are significantly fewer treatment places available due to the effects related to the Corona pandemic, so that waiting times can be up to 9 months (Deutsches Ärzteblatt, 2021; Bundespsychotherapeuten Kammer, 2021). Due to the low level of care in rural areas, people there have to wait even longer for therapeutic treatment than in large cities (Walendzik et al., 2014). A large proportion of people with mental illness have no access to therapeutic help due to insufficient care options (Landespsychotherapeutenkammer Rheinland-Pfalz, 2022). This raises the question of what therapeutic interventions and services can be used to counteract the underuse of people with mental illness? Since 2019, when the Digital Health Care Act comes into force, digital health applications may be prescribed as a health insurance benefit (Bundesministerium für Gesundheit, 2020). Through telemedical offers in psychotherapy, patients can be treated with the help of digital communication media independent of location and time (Marx et al., 2021). The possibility of telemedical, cross-sector care for patients can minimize existing deficits within the care structure and enable better patient care (Weitzel et al., 2021). In the wake of the Covid-19 pandemic and the associated contact restrictions that went into effect to contain the pandemic in the spring of 2020, digital consultations, such as video consultations, were used by many outpatient psychotherapists in Germany to maintain outpatient care for people with mental illnesses (Beck-Hiestermann et al.,2021). Digital therapy interventions in some cases completely replaced the traditional face-to-face setting in psychotherapy and thus became the focus of psychotherapists' daily work (Richter et al., 2020). The Covid-19 Pandemic can thus be described as a catalyst for digital psychotherapy interventions in Germany. The focus of previous studies (during the Covid-19 pandemic) was only on the usage behavior and satisfaction of medical-therapeutic staff (physicians, psychiatrists and therapists) with video consultation (Oberman, 2020). Representative results from patients, who were equally affected by the changeover to digital therapy settings, are completely missing, as are study results from the group of psychotherapists working in outpatient settings on general satisfaction with digital interventions in Germany, combined with the survey of change requests (usability) with regard to digital interventions in psychotherapy. Digital psychotherapy applications enable psychotherapeutic interventions for a variety of disorders independent of time and place. However, the usage behavior and acceptance of these digital applications by therapists in private practice have not yet been sufficiently investigated. Therefore, the aim of the TIpP study is to evaluate the usage behavior of therapists and patients of telemedical interventions in psychotherapy, the satisfaction with digital offers and the interest in the integration of digital applications in the therapeutic everyday life

Neurophysiological markers of ADHD symptoms in typically-developing children

Children with attention-deficit/hyperactivity disorder (ADHD) are characterized by symptoms of inattention, impulsivity, and hyperactivity. Neurophysiological correlates of ADHD include changes in the P3 component of event-related brain potentials (ERPs). Motivated by recent advances towards a more dimensional understanding of ADHD, we investigate whether ADHD-related ERP markers relate to continuous variations in attention and executive functioning also in typically-developing children. ERPs were measured while 31 school children (9–11 years) completed an adapted version of the Continuous Performance Task that additionally to inhibitory processes also isolates effects of physical stimulus salience. Children with higher levels of parent-reported ADHD symptoms did not differ in task performance, but exhibited smaller P3 amplitudes related to stimulus salience. Furthermore, ADHD symptoms were associated with the variability of neural responses over time: Children with higher levels of ADHD symptoms demonstrated lower variability in inhibition- and salience-related P3 amplitudes. No effects were observed for ERP latencies and the salience-related N2. By demonstrating that ADHD-associated neurophysiological mechanisms of inhibition and salience processing covary with attention and executive functioning in a children community sample, our study provides neurophysiological support for dimensional models of ADHD. Also, temporal variability in event-related potentials is highlighted as additional indicator of ADHD requiring further investigation

The Association of Self-Reported ADHD Symptoms and Sleep in Daily Life of a General Population Sample of School Children: An Inter- and Intraindividual Perspective

Sleep and Attention-Deficit/Hyperactivity Disorder (ADHD) have repeatedly been found to be associated with each other. However, the ecological validity of daily life studies to examine the effect of sleep on ADHD symptoms is rarely made use of. In an ambulatory assessment study with measurement burst design, consisting of three bursts (each 6 months apart) of 18 days each, 70 German schoolchildren aged 10–12 years reported on their sleep quality each morning and on their subjective ADHD symptom levels as well as their sleepiness three times a day. It was hypothesized that nightly sleep quality is negatively associated with ADHD symptoms on the inter- as well as the intraindividual level. Thus, we expected children who sleep better to report higher attention and self-regulation. Additionally, sleepiness during the day was hypothesized to be positively associated with ADHD symptoms on both levels, meaning that when children are sleepier, they experience more ADHD symptoms. No association of sleep quality and ADHD symptoms between or within participants was found in multilevel analyses; also, no connection was found between ADHD symptoms and daytime sleepiness on the interindividual level. Unexpectedly, a negative association was found on the intraindividual level for ADHD symptoms and daytime sleepiness, indicating that in moments when children are sleepier during the day, they experience less ADHD symptoms. Explorative analyses showed differential links of nightly sleep quality and daytime sleepiness, with the core symptoms of inattention and hyperactivity/impulsivity, respectively. Therefore, future analyses should take the factor structure of ADHD symptoms into account

E-Mental-Health aftercare for children and adolescents after partial or full inpatient psychiatric hospitalization: study protocol of the randomized controlled DigiPuR trial

BACKGROUND: During reintegration to daily school life following psychiatric hospitalization, children and adolescents are confronted with various challenges and are at risk for rehospitalization. Tailored post-discharge services could support a successful readjustment and accompany the high-risk transition period after discharge. The study DigiPuR (“Digital gestützte Psychotherapie und Reintegration,” digitally supported psychotherapy and reintegration) aims to establish and to evaluate an innovative digital aftercare program to alleviate challenges during reintegration and improve cross-sectoral care. METHODS: DigiPuR is a randomized controlled trial comparing a digital aftercare service with regular aftercare (TAU) (planned N = 150, 25 children/adolescents, 25 parents, and 25 teachers in each group). In the intervention group, direct communication via secure and regular video calls until 8 weeks after discharge and a secure messenger system between the hospital, family, and school, as well as, if needed, external support systems, are established. A longitudinal pre-post-follow-up assessment at admission, discharge, and 8, 24, and 36 weeks after discharge takes place supplemented by a daily smartphone-based ambulatory assessment from a triadic perspective of patients, parents, and teachers. Primary outcomes include whether participants in the intervention group have fewer readmissions and higher treatment satisfaction and health-related quality of life as well as lower symptom severity than participants in the control group. DISCUSSION: The present study is essential to address the cross-sectoral challenges associated with reintegration into daily (school) life following child and adolescent psychiatric hospitalization and to determine possible needed adaptations in partial or full inpatient settings. If applicability and efficacy of the aftercare service can be demonstrated, integration into regular care will be sought. TRIAL REGISTRATION: ClinicalTrials.govNCT04986228. Registered on August 2, 2021 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13063-022-06508-1