Induced EEG Gamma Oscillation Alignment Improves Differentiation Between Autism and ADHD Group Responses in a Facial Categorization Task

Children diagnosed with an autism spectrum disorder (ASD) often lack the ability to recognize and properly respond to emotional stimuli. Emotional deficits also characterize children with attention deficit/hyperactivity disorder (ADHD), in addition to exhibiting limited attention span. These abnormalities may effect a difference in the induced EEG gamma wave burst (35–45 Hz) peaked approximately 300–400 ms following an emotional stimulus. Because induced gamma oscillations are not fixed at a definite point in time poststimulus, analysis of averaged EEG data with traditional methods may result in an attenuated gamma burst power. We used a data alignment technique to improve the averaged data, making it a better representation of the individual induced EEG gamma oscillations. A study was designed to test the response of a subject to emotional stimuli, presented in the form of emotional facial expression images. In a four-part experiment, the subjects were instructed to identify gender in the first two blocks of the test, followed by differentiating between basic emotions in the final two blocks (i.e., anger vs. disgust). EEG data were collected from ASD (n = 10), ADHD (n = 9), and control (n = 11) subjects via a 128-channel EGI system, and processed through a continuous wavelet transform and bandpass filter to isolate the gamma frequencies. A custom MATLAB code was used to align the data from individual trials between 200 and 600 ms poststimulus, EEG site, and condition by maximizing the Pearson product–moment correlation coefficient between trials. The gamma power for the 400-ms window of maximum induced gamma burst was then calculated and compared between subject groups. Condition (anger/disgust recognition, gender recognition) × Alignment × Group (ADHD, ASD, Controls) interaction was significant at most of parietal topographies (e.g., P3-P4, P7-P8). These interactions were better manifested in the aligned data set. Our results show that alignment of the induced gamma oscillations improves sensitivity of this measure in differentiation of EEG responses to emotional facial stimuli in ADHD and ASD.     

Prevalence of allergic rhinitis in patients with attention-deficit/hyperactivity disorder: a population-based study

Allergic rhinitis (AR) is common in children. Characteristic symptoms of AR may result in daytime inattention, irritability, and hyperactivity, which are also components of ADHD. Conflicting data in previous studies exist regarding the relationship between ADHD and AR. The aim of this study was to examine the prevalence and risk of AR in ADHD patients in Taiwan. We conducted a cross-sectional study using the National Health Insurance Research Database in Taiwan. The study subjects included 469 patients who received psychiatric care for ADHD in 2005 and the general population (n = 220,599). Distributions of age, gender, and living areas as well as allergic diseases in the general population and in the ADHD group were examined by χ ² tests. Multivariate logistic regression models were used to analyze the risk factors of AR. The prevalence of AR in ADHD group and the general population was 28.4 and 15.2 %, respectively. The prevalence of asthma was 9.6 % in ADHD group and 6.4 % in the general population. Both the prevalence of AR (p < 0.001) and asthma (p = 0.008) was significantly higher in ADHD group than the general population. The multivariate logistic regression analysis showed that ADHD patients had an increased rate of AR than general population (OR = 1.83; 95 % CI = 1.48–2.27; p < 0.0001), and asthma was strongly associated with AR (OR = 9.28; 95 % CI = 8.95–9.63; p < 0.0001). Our data showed that ADHD patients had an increased rate of AR. Therefore, psychiatrists should be more aware of the comorbidity of AR when treating ADHD patients.     

The effect of methylphenidate treatment on suspiciousness in children with ADHD alone or comorbid with ODD

Objective: To assess the level of the suspiciousness in children with attention deficit/hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD) in comparison to ADHD alone and the response of suspiciousness symptoms to methylphenidate (MPH) treatment.

Methods: In this open-label comparative study, children with DSM-IV-TR ADHD, aged 8–18 years, with (N?=?30) or without (N?=?30) ODD received MPH treatment for 12 weeks. The severity of ODD symptoms was assessed by the Kiddie–Schedule for Affective Disorders and Schizophrenia. The severity of ADHD symptoms was assessed by the ADHD-Rating-Scale-IV and suspiciousness was assessed at baseline and at endpoint by a scale designed especially for assessment of suspiciousness and named Suspiciousness Rating Scale (SRS).

Results: Significant reductions in SRS scores were detected in both groups following MPH treatment (before and after: p?= .0012 and p?=?.0273, respectively). Only in the ADHD/ODD group a significant correlation was found between the rate of improvement in ADHD, as assessed by the ADHD–RS, and the reduction in suspiciousness, as assessed by the SRS (Spearman r?=?0.48, p?= .0066).

Conclusions: In addition to the beneficial effect of MPH treatment on ADHD and ODD symptoms it also diminishes suspiciousness. However, due to the small sample size further studies are needed to confirm the present results.     

Preschool self regulation predicts later mental health and educational achievement in very preterm and typically developing children

Abstract

Objective: To examine the extent to which preschool emotional and behavioral regulatory difficulties were associated with an increased risk of later mental health and educational problems. Of particular interest was whether early regulatory abilities contributed to later risk once baseline child behavioral adjustment and cognitive function were taken into account. Method: Data were drawn from a prospective longitudinal study of 223 children born very preterm (VPT; <32 weeks gestation, n = 110) and full term (37–40 weeks gestation). At corrected ages 2 and 4 years, children’s regulatory abilities were assessed using (1) direct observation of child behavior, (2) a modified version of the Emotion Regulation Checklist, and (3) tester ratings of child behavior during neuropsychological testing. At age 9 years, mental health and educational achievement were assessed using the Development and Well-being Assessment interview and the Woodcock Johnson-III Tests of Achievement. Results: VPT-born children had poorer emotional and behavioral regulation across all measures and time points. They also had higher rates of DSM-IV mental health disorder and educational delay at age 9. Across both study groups, poorer self regulation was associated with an increased risk of ADHD, conduct disorder, anxiety disorders and any disorder net of preschool child behavior problems and social risk. In contrast, only associations between early regulation and later language and any educational delay remained significant after adjustment for preschool cognitive functioning and family social risk. Conclusion: Early assessment of regulation in addition to behavioral screening may improve the early identification of preschool children at mental health risk.     

Effects of Neurofeedback Training on Inhibitory Capacities in ADHD Children: A Single-Blind,Randomized, Placebo-Controlled Study

Introduction. Studies performed during the last decades suggest that neurofeedback (NF) training can effectively reduce symptomatology in children with Attention deficit hyperactivity disorder (ADHD). Yet questions remain concerning specific effects of NF training in ADHD children, because these studies did not use a randomized, placebo-controlled approach. To address this issue, such an approach was used in the present study to measure the impact of NF training on inhibitory capacities.

Method. Nine ADHD children (with no comorbidity), aged 8 to 13 years, were randomly assigned to either an experimental group (n = 5) or a placebo group (n = 4). For both groups, training protocols comprised 40 one-hr sessions (20 meetings of 2 sessions each). Sensorimotor rhythm/Theta training was used in the experimental group. Prerecorded sessions of the first author's EEG activity were used in the placebo group. Pre- and posttraining assessments consisted of the Conner's Parent Rating Scales (CPRS–R) and neuropsychological tests. A multiple case study strategy was applied for data analysis using a Reliable Change Index when applicable.

Results. One experimental participant was a dropout, and one placebo participant had to be discontinued due to adverse effects. The latter participant accepted to undergo posttraining evaluations; hence an Intention-to-Treat analysis was performed on this participant's data. Remaining participants showed significant improvements on the CPRS–R. Improvements were measured on the Variability measure of the CPT–II consistently across the placebo group and on the Inhibition Condition of the Stroop Task for all but one placebo participant. The same trend was found for the Inhibition/Switching Condition (Stroop Task) across the experimental group (n = 4).

Conclusion. The small sample size precludes from evaluating specific neurofeedback effects. Still, the presence of placebo responses suggests that other factors, such as motivation or expectations, might contribute to the outcome of NF training in children with ADHD.     

The Beneficial Effects of Massage on Motor Development and Sensory Processing in Young Children with Developmental Delay: A Randomized Control Trial Study

ABSTRACT

Purpose: We investigated the effects of massage on young children with developmental delay but no clear diagnosis (e.g., cerebral palsy, genetic diseases, or autism).

Methods: Thirty-six children with DD, at 1–3 years of age, were randomly assigned to the massage (n = 18) or control group (n = 18) after being stratified by age and motor developmental quotient. The two groups continued to receive routine rehabilitation intervention, whereas the massage group additionally received 20 min of massage twice a week for 12 weeks. The Comprehensive Development Inventory for Infants and Toddlers – Diagnostic Test, the Infant/Toddler Sensory Profile – Chinese version, anthropometric measures, and a sleep questionnaire were administrated before and after the massage intervention.

Results: The results of analysis of covariance revealed that the massage group exhibited a greater improvement in the total motor score (p = 0.023), gross motor score (p = 0.047), and sensory sensitivity behavior (p = 0.042).

Conclusion: These findings suggest that massage can effectively enhance motor and sensory processing in children with DD.     

Parent-reported symptoms,impairment, helpfulness of treatment,and unmet service needs in a follow-up of outpatient children with attention-deficit/hyperactivity disorder

Background: Limited information exists regarding the associations between impairment, symptoms, helpfulness of treatments, and service needs after initial treatment of children with attention-deficit/hyperactivity disorder (ADHD). Aims: The aims of this study were to examine persistence rates and associations between parent-reported symptoms, impairment, helpfulness of treatments, and service needs in a retrospective follow-up study of children with ADHD.

Methods: Parents of 214 children with a mean age of 12.6 years (SD?=?2.1) who were diagnosed with ADHD at five child and adolescent mental health clinics (CAMHS) completed questionnaires 1–10 years (mean?=?3.7 years, SD?=?2.2) after baseline assessment. The response rate was 43.4%. A community comparison group (n?=?110) was recruited from the same area.

Results: Approximately two-thirds (60.3%) of the sample fulfilled the DSM-IV symptom criteria of ADHD at follow-up, 84.3% were functionally impaired, and most children (84.7%) were on medication. Inattentive and emotional symptoms were the strongest predictors of impairment across impairment areas. Perceived helpfulness of different treatments varied from 71.8–88.7%, and no significant difference was found between the ADHD sub-groups regarding reported helpfulness. ‘Adjustment of the school situation’ was the most frequent service need, and approximately half of the parents reported needs for care co-ordination. Children fulfilling the symptom criteria of the ADHD Combined sub-group were most impaired and had most service needs.

Conclusions: At follow-up, children were highly symptomatic and impaired, despite a high rate of persistent medication treatment. The findings underline the need for more tailored treatment and co-ordinated care over time.     

Influence of assessment instrument on ADHD diagnosis

We compared four instruments commonly used to screen for and diagnose Attention-Deficit/Hyperactivity Disorder (ADHD) in children. The Bergen Child Study included a DSM-IV ADHD symptom list and the Strengths and Difficulties Questionnaire (SDQ) as screen in Phase one. Phase two included the parent Development and Well-Being Assessment (DAWBA), whereas Phase three comprised in-depth clinical assessment, including the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS). We compared ADHD as diagnosed by the four instruments in the children with normal intellectual functioning participating in all three phases (N = 234). The DSM-IV ADHD symptom list showed moderate agreement with all other instruments (κ = 0.53–0.57), whereas there was fair agreement between the K-SADS-DAWBA (κ = 0.31) and between SDQ–DAWBA (κ = 0.33). The DAWBA diagnosed fewer children with ADHD than did the other instruments. Implications for use of the instruments are discussed.     

SNAP-25 gene variations and attention-deficit hyperactivity disorder in Iranian population

Objectives: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition of childhood characterized by persistent symptoms of hyperactivity, inattention, and impulsivity. The objective of this study was to investigate the association of synaptosomal-associated protein of 25 kDa (SNAP-25) gene variants with ADHD.

Methods: A case-control study with a total of 150 children with ADHD (mean age 9.61; range 6–16; gender ratio 105m/45f) and 150 normal children (mean age 10.02; range 6–16; gender ratio 98m/52f) was conducted. Genomic DNA was extracted from peripheral blood of all samples and SNPs rs78428954 and rs3746544 located in SNAP-25 gene were genotyped.

Results: Our analysis indicated that there is no significant association between none of studied variants in SNAP-25 and ADHD.

Discussion: To our knowledge, it is the first report of SNAP-25 genotyping in Iranian patients with ADHD. Further investigations with larger populations are needed in order to clarify the exact role of SNAP-25 variations in susceptibility to ADHD.     

Is motor activity during cognitive assessment an indicator for feigned attention-deficit/hyperactivity disorder (ADHD) in adults?

Objectives: Several approaches, ranging from self-ratings of symptoms and impairments to objective neuropsychological testing, have been utilized during clinical evaluation in order to assess symptom and performance validity of individuals with attention-deficit/hyperactivity disorder (ADHD) in adulthood. Motor activity has not been considered yet in this context, which is surprising given that hyperactivity is a prominent characteristic of ADHD. Hence, the goal of the present study was to explore the incremental value of motor activity when assessing the credibility of individuals with adult ADHD at clinical evaluation.

Method: Forty-six patients diagnosed with ADHD took part in the study. A simulation design was performed, in which 152 healthy individuals were allocated to either a control condition (n = 36) or one of three simulation conditions (n = 116), the latter requesting participants to feign ADHD. All participants completed a self-rating scale of cognitive functioning and performed a computerized test for vigilance. Body movements were recorded during vigilance testing via a motion tracker attached to the back of the participant’s chair.

Results: Patients with ADHD reported significantly more pronounced cognitive complaints and performed significantly poorer on the vigilance test than control participants. Simulators of ADHD, as compared to genuine patients, showed excessively low performance on the vigilance test. However, neither self-ratings of cognitive functioning nor measures of motor activity were suitable to distinguish genuine from feigned ADHD. A hierarchical logistic regression model showed that motor activity had no incremental value in detecting feigned ADHD when vigilance test performance has already been considered.

Conclusions: Standard neuropsychological tests of vigilance may be useful to measure both performance and credibility of individuals with adult ADHD at clinical evaluation. In contrast, self-reports of symptoms and impairments, as well as measures of body movements, may not support the assessment of credibility in this context.     

The Impact of Intellectual Disability and Autism Spectrum Disorder on Restraint and Seclusion in Pre-Adolescent Psychiatric Inpatients

ABSTRACT

Introduction: Features of intellectual disability (ID) and/or autism spectrum disorder (ASD) may hinder responsiveness to interventions typically used during psychiatric hospitalization to manage severely disruptive behavior, and could increase the likelihood of experiencing restraint and/or seclusion (R/S). This study investigated the occurrence of R/S in psychiatrically hospitalized children rated by their treatment team as having ID and/or ASD and those who were rated as having neither.

Methods: Pre-adolescents (N = 777; M = 9.71; SD = 2.71; Range 5–12) consecutively admitted to an acute psychiatric hospital during a one-year period were assigned a consensus DSM-5 diagnosis of ID (n = 295), ASD (n = 48), Both (n = 77), or Neither (n = 361). R/S occurrences were recorded in terms of their frequency and duration.

Results:52% of patients experienced at least one R/S while hospitalized. The modal number of R/S events for this sample was 0, and for children who experienced any R/S, the mode was 2. Comparisons (ID, ASD, Both, Neither) showed statistically significant differences (p <.001) in R/S events. Children rated as meeting diagnostic criteria for ID (68%; M = 13.9), or Both ID and ASD (78%; M = 18.2), had elevated rates of R/S events compared to cases with Neither diagnosis (35%; M = 7.3). ASD alone (50%; M = 10.0) was not associated with an increase in R/S compared to cases with Neither diagnosis. Data on the duration of these events completely paralleled the frequency results.

Conclusion: Children who met DSM-5 criteria for ID had a greater risk of experiencing R/S during psychiatric hospitalization. To reduce the occurrence of R/S, interventions must be refined and staff specially trained to address the complexities of treating children with ID.     

Resting state vagal tone in attention deficit (hyperactivity) disorder: A meta-analysis

Objectives: To quantify evidence on resting-state vagal activity in patients with attention deficit hyperactivity disorder (ADHD) relative to controls using meta-analysis.

Methods: Three electronic databases (PubMed, PsycINFO, CINAHL Plus) were reviewed to identify studies. Studies reporting on any measure of short-term, vagally mediated heart rate variability during resting state in clinically diagnosed ADHD patients as well as non-ADHD healthy controls were eligible for inclusion.

Results: Eight studies reporting on 587 participants met inclusion criteria. Random-effect meta-analysis revealed no significant main effect comparing individuals with ADHD (n?=?317) and healthy controls (n?=?270) (Hedges’ g?=?0.06, 95% CI: 0.18–0.29, Z?=?0.48, P?=?0.63; k?=?8). Sub-group analysis showed consistent results among studies in adults (k?=?2) and children (k?=?6) with ADHD.

Conclusions: Unlike a variety of internalising psychiatric disorders, ADHD is not associated with altered short-term measures of resting-state vagal tone.     

Family appraisal of paediatric acquired brain injury: a social work clinical intervention trial

ABSTRACT

Objective: To compare the efficacy of a new intervention ‘Family Forward’ with ‘Usual Care’ social work practice in optimising family appraisal of a child’s acquired brain injury to ensure better adaptation during the inpatient rehabilitation phase of care and early transition home.

Research Design: Single site, prospective, sequential comparison group design.

Methods and Procedures: Families were recruited on admission to an inpatient rehabilitation service based at a tertiary paediatric hospital. The ‘Usual Care’ group (n = 22; 29 parents) recruitment, intervention and data collection were completed first (Phase 1), followed by the ‘Family Forward’ group (n = 25; 43 parents) (Phase 2). Parents/caregivers completed measures: (Impact of Event Scale- Revised: IES-R; Parents Experience of Childhood Illness and Brief Illness Perception Questionnaire: Brief IPQ) at the time of their child’s inpatient rehabilitation admission, inpatient rehabilitation discharge, and 6 weeks post-discharge.

Main Outcomes and Results: There were more children with traumatic brain injuries in the Family Forward group (n = 13) than Usual Care (n = 6) and the Family Forward group had a longer hospital admission (days, M = 56.4, SD = 46.1 vs. M = 37.5, SD = 16.4, p = 0.019). No significant group differences were found for family appraisal outcomes at any of the three time-points. Both groups reported reductions in trauma and grief responses, emotional experiences and perceptions of their child’s injury at post-intervention and follow-up. Both groups continued to have depleted emotional resources (PECI scale) at 6 weeks post-discharge.

Conclusions: The study contributes important insights into family appraisal experience in the early stages following paediatric acquired brain injury. In this context, ‘Family Forward’ needs to incorporate interventions that support and promote ongoing family appraisal as issues related to their child’s injury arise over time. Future research is needed to focus on whether the Family Forward approach does sustain family system adaptation (a key aim informing the design of the intervention) over the longer term.     

The probable role of adrenomedullin and nitric oxide in childhood attention deficit hyperactivity disorder

Background: The role of adrenomedullin hormone, which has been shown to be associated with many psychiatric disorders, in the etiology of ADHD and its relation to disease is not yet known.

Aim: In this study, it was aimed to compare plasma adrenomedullin and nitric oxide (NO) levels of newly diagnosed, treatment-naive patients with ADHD with healthy children.

Methods: A total of 45 children with ADHD and 45 healthy children were included. The Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS), a semi-structured interview, was applied to all cases by child and adolescent psychiatrist. Age and gender matched participants who admitted to the hospital for any other reasons without any psychiatric diagnosis according to K-SADS were selected as a control group. Sociodemographic data form and The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale-parental form were applied to the all groups. NO and adrenomedullin levels were analysed by ELISA method with specific commercial kits.

Results: There was no statistically significant difference in NO and adrenomedullin levels, neither between the groups nor ADHD subtypes. A positive correlation between adrenomedullin and NO levels was found in both the case (r?=?0.659) and the control groups (r?=?0.494).

Conclusions: Besides being the first study to evaluate adrenomedullin levels to elucidate the etiology of childhood ADHD as well as NO, significant differences was not found between the case and the control groups in terms of NO and adrenomedullin levels.     

Development of a version of the self-ordered pointing task: a working memory task for Brazilian preschoolers

Abstract

Objective: Working memory is a fundamental cognitive function and is predictive of outcomes and achievement in a wide range of domains from an early age. The focus of this study was to develop a computerized Brazilian version of the Self-Ordered Pointing Task (SOPT) for preschoolers and to provide initial normative and validation data for this task. Methods: The sample of the present study was composed of 248 children aged 3 (n = 41), 4 (n = 88) and 5 (n = 119) years from 13 private and public schools in Belo Horizonte. Children were evaluated with the SOPT and the Columbia Mental Maturity Scale (CMMS), a measure of intelligence, and their parents completed the Brazilian Criterion of Economic Classification (CCEB) to assess their SES. A subsample of parents of 184 children also filled the Child Behavior Checklist for Ages 11/2–5 years (CBCL 11/2–5), a measure of psychopathology. Results: A multiple regression analysis found chronological age, intelligence, and SES to be predictive of performance on the SOPT. Furthermore, five-year olds performed better than three- and four-year olds in the task. A difference between children in private and public kindergartens also emerged. Additionally, SOPT performance was negatively correlated with Internalizing, Externalizing, and Total psychopathological problems, as well as to several other psychopathological measures as accessed by the CBCL, although the correlations were small. Conclusion: Taken together, this study provides initial normative and validation data for the SOPT, but further validation studies are needed.     

Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits

Abstract

Purpose and aim: The overall aim of the present study was to examine quality of life in attention deficit hyperactivity disorder (ADHD) patients age ≥60 years. First, we compared older adults with ADHD to both healthy controls of the same age and younger adults with ADHD. Second, we examined executive functioning as a possible underlying factor for quality of life among older adults with ADHD.

Methods: The study included 158 participants in three groups: (1) older adults (60–75 years of age) with ADHD (n?=?42), (2) healthy controls of the same age (n?=?58), and (3) younger adults (age 18–45 years of age) with ADHD (n?=?56). The patients with ADHD were clinically-referred. Quality of life was examined through self-ratings and executive functioning was examined using both self-ratings and tests.

Results: Older adults with ADHD differed significantly from controls the same age on all aspects of quality of life, with large effect sizes. However, they showed similar levels of quality of life compared to younger adults with ADHD. The exception was psychological health, for which older adults displayed better quality of life compared to younger adults with ADHD. Executive deficits measured through self-ratings, especially working memory, were related to quality of life, sometimes also beyond the influence of ADHD symptom levels.

Conclusions: Older adults with ADHD show serious impairments in quality of life, that are comparable to the levels found for younger adults. Impairments may increase further as these individuals grow older and clinics need to meet the needs of this increasingly larger group of patients.     

The role of subjective cognitive complaints and depressive symptoms in social re-integration following stroke: a mediation explanation in a cross-sectional sample

Background: For long-term stroke survivors, objective neuropsychological impairments and subjective cognitive difficulties are common, and may contribute to ongoing difficulties in community reintegration. However, subjective cognitive complaints have been as much associated with low mood as with actual cognitive performance.

Objective: The objective of our study was to investigate the extent to which subjective cognitive complaints predicted community reintegration following a stroke, and whether this relationship would be mediated by emotional status.

Methods: Using a cross-sectional design, patients with a primary diagnosis of stroke (n = 102; age range 25–89 years) were recruited from the register of a neurological rehabilitation service if they were at least 6 months post-stroke and had been discharged home following the stroke. Exclusions included history of dementia, co-morbid psychiatric or neurological disorder, or significant aphasia. Assessments included the Subjective Cognitive Complaints Questionnaire, the Community Integration Questionnaire, and the Depression Anxiety and Stress Scale.

Results: Subjective cognitive complaints were common, with moderate to high levels of complaint most frequent for working memory (58.9%), and information processing speed (53%). Subjective cognitive complaints were significantly associated with social integration (r = ?.23, p < .05). However, examination of relationships using statistical mediation revealed that depressive symptoms fully mediated the relationship between subjective cognitive complaints and social integration.

Conclusions: Subjective cognitive complaints are common in long-term outcome following stroke and predict difficulty in community reintegration. However, this relationship is mediated by variation in emotional status. Therefore, addressing cognitive complaints through cognitive rehabilitation programs that include components to improve mood (for example, building self-efficacy or confidence) may also improve community reintegration post-stroke.     

Together at school intervention programme. A pilot study on the feasibility and perceived benefits of a programme focusing on improving socio-emotional skills among schoolchildren in Finland

The aim of the Together at School Intervention Programme developed for the Finnish school system was to improve socio-emotional skills and prevent psychosocial problems among children (7?12 years). The aim of this pilot study was to evaluate the feasibility, safety and perceived benefits of the programme in order to justify its large-scale implementation for a randomized controlled study. Altogether, 23 classrooms from Grades 1–6 (N = 549, n = 451 children) in four schools participated in the study. Informants were teachers (n = 23), head masters (n = 4), children (n = 451) and their parents. Data were collected by questionnaires at three time points. The different tools assessed were considered to be beneficial for the children by 92?100% of the teachers, and pleasant to participate in by 73?89% of the children. During the follow-up, emotional symptoms reduced significantly among boys. Bullying behaviour was significantly reduced according to both teachers and children. The findings of this pilot study were encouraging.     

Early psychosocial adversity and cortisol levels in children with attention-deficit/hyperactivity disorder

Previous studies suggest a different regulation of the hypothalamus–pituitary–adrenal axis (HPA-axis) with lower diurnal cortisol levels, especially in the morning, in children with attention-deficit/hyperactivity disorder (ADHD) compared with controls. Since exposure to foetal and childhood psychosocial adversity has been associated with both ADHD and HPA-axis functioning, such exposures may explain these low cortisol levels in ADHD via early programming of the HPA-axis. Thus, our main aim was to retrospectively study foetal and early childhood exposures to psychosocial adversity in children with ADHD and to relate these exposures to cortisol levels. Saliva samples were collected during a regular weekday in children, 6–17 years old, with clinically confirmed ADHD (n = 197) and non-affected comparisons (n = 221) for radioimmunoassay analysis of cortisol. Parental rating scales were used for categorising subtypes of ADHD and degree of exposure to adversity. Children with ADHD had more reports of at least one rated foetal adversity (p = 0.041) and childhood adversity (p < 0.001) than comparisons. The association between low morning cortisol levels and ADHD-symptoms remained when analyses were adjusted for adversities, age, sex, sampling time and symptoms of oppositional defiant disorder. No relation was found between exposures to foetal/childhood adversity and cortisol levels except for a positive relation between childhood adversity and cortisol morning increase in children with ADHD. The hypothesis that early adversity may influence the HPA-axis, leading to lower cortisol levels in children with ADHD, was not supported by our findings.     

Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial

Neurofeedback (NF) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder (ADHD). In a randomised controlled trial, NF training was found to be superior to a computerised attention skills training (AST) (Gevensleben et al. in J Child Psychol Psychiatry 50(7):780–789, 2009). In the present paper, treatment effects at 6-month follow-up were studied. 94 children with ADHD, aged 8–12 years, completed either 36 sessions of NF training (n = 59) or a computerised AST (n = 35). Pre-training, post-training and follow-up assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents. Follow-up information was analysed in 61 children (ca. 65%) on a per-protocol basis. 17 children (of 33 dropouts) had started a medication after the end of the training or early in the follow-up period. Improvements in the NF group (n = 38) at follow-up were superior to those of the control group (n = 23) and comparable to the effects at the end of the training. For the FBB-HKS total score (primary outcome measure), a medium effect size of 0.71 was obtained at follow-up. A reduction of at least 25% in the primary outcome measure (responder criterion) was observed in 50% of the children in the NF group. In conclusion, behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up. Though treatment effects appear to be limited, the results confirm the notion that NF is a clinically efficacious module in the treatment of children with ADHD.