• Parent training improved maternal wellbeing and reduced attention deficit hyperactivity disorder symptoms in children

      Baldwin, Laurence (2001)
      QUESTION: In 3 year old children with attention deficit hyperactivity disorder (ADHD), how effective are parent based therapies?DesignRandomised {allocation concealed}*, blinded (outcome assessors), controlled trial with 23 weeks of follow up.SettingCommunity based study in the UK.Patients78 three year old children (62% boys) who met the validated cut off for ADHD on the Parental Account of Childhood Symptoms (PALS) ADHD/Hyperkinesis scale and whose parents reported that the child's condition warranted treatment Exclusion criteria were serious mental illness or learning disability in a parent or a previous diagnosis of a mental health condition. 7 children withdrew but were included in the analysis.Intervention30 children were assigned to parent training (PT), 28 to parent counselling and support (PCS), and 20 to a waiting list control group. The PT group received coaching in child management techniques. The PCS group received non-directive support and counselling. Both treatments consisted of a structured 8 week programme for mothers, involving 8 one hour weekly visits to the child's home by a specially trained therapist.Main outcome measuresChild ADHD symptoms, mothers' wellbeing, and recovery defined as a PALS score < 15.65.Main resultsAnalysis was by intention to treat. ADHD symptoms were reduced (p < 0.0001) and mothers' sense of wellbeing was increased (p < 0.005) by PT relative to the PC S and control groups. More children in the PT group were considered recovered by the end of the trial than those in either the PCS or control groups (table). The recovery rate for those in the PCS group did not differ from that of the control group (table).ConclusionIn 3 year old children with attention deficit hyperactivity disorder, parent training improved symptoms and improved maternal wellbeing.*Information provided by the author.
    • Keep taking the tablets? Evidence-based approaches to AD(H)D. Part 1: The evidence

      Baldwin, Laurence (2002)
      Attention Deficit (Hyperactivity) Disorder (AD(H)D) has been recognised and treated in the United States for some considerable time. Until fairly recently the use of medication as a treatment within the United Kingdom was quite limited, and it is the move towards the increased use of medication which has sparked some of the present controversy. This has been fuelled by media reports, which are often themselves sensationalist and tend to take extreme positions. Some magazine reports, for example, have described the symptoms of AD(H)D in such broad terms that much of the child population could be described as fitting these criteria.
    • Keep taking the tablets? Evidence-based approaches to AD(H)D. Part 2: audit and changing practice

      Baldwin, Laurence (2002)
      In part one, Laurence Baldwin looked at the recent advances in the evidence for assessment and treatment of AD(H)D. In this article he reports on an audit based on this evidence and the consequent changes to a local Child and Adolescent Mental Health Services.
    • Attention deficit hyperactivity disorder is associated with poorer academic performance

      Sayal, Kapil (2008)
      Question:Is attention deficit hyperactivity disorder (ADHD) associated with poorer academic outcomes?Population:From a large birth cohort for whom school records were available through a contractual agreement with the city, 370 adolescents fulfilling criteria for ADHD (mean age 10.4 years; 75% male), and 740 age and gender matched controls (two for each case) without ADHD or any other psychiatric disorder were selected. Medical records for these participants were available through the Rochester Epidemiology Project. DSM-IV exclusion criteria: severe mental retardation, developmental disorder, schizophrenia or other psychiatric disorder.Setting:Rochester, Minnesota, USA. Participants enrolled in the January 1976 to December 1982 birth cohort.Prognostic factors:ADHD.Outcomes:Reading achievement (percentile rank on the California Achievement Score, measured every 2 years to mean age 13 years), absenteeism (percentage days absent per school grade level for each subject), grade retention (need to repeat one or more grades), and dropout from school prior to graduation, taken from school records.METHODSDesign: Retrospective cohort study.Follow-up period: From age 5 years until emigration, death, school graduation, or dropout.MAIN RESULTSBoth boys and girls with ADHD had significantly lower reading scores (measured on California Achievement Test) than controls (mean CAT score: 45 with ADHD vs 73 for controls; p<0.001) and significantly more days absent than controls across grade levels (p<0.001). Those with ADHD were significantly more likely than controls to have repeated a grade (HR 3; 95% CI 2.1 to 4.4; p<0.001) and to have dropped out from school (HR 2.7; 95% CI 1.8 to 3.9; p<0.001). Findings were similar with adjustment for age and gender.CONCLUSIONSADHD affects academic performance. Adolescents with ADHD have lower standardised reading achievement scores and higher rates of school absenteeism, school dropout and grade retention compared to matched controls.
    • Parent training interventions for attention deficit hyperactivity disorder

      Jones, Hannah F. (2009)
      This is the protocol for a review and there is no abstract. The objectives are as follows: To determine whether parent-training interventions are effective in reducing ADHD symptoms and associated problems (e.g. disruptive behaviour disorders or child-specific impairments such as learning difficulties) in children and young people aged 5-18 with ADHD, compared to controls with no parent-training interventions.;
    • Psychological impact of an adult ADHD diagnosis: "A blessing and a curse?"

      Young, Zoe; Tickle, Anna C.; Gillott, Alinda; Groom, Madeleine J. (2010)
      Background: Attention Deficit Hyperactivity Disorder (ADHD) is commonly thought of as a,childhood. disorder but is increasingly recognized as affecting adults. The aim of this study was to explore the psychological impact of receiving a diagnosis of ADHD in adulthood. Method: A qualitative study was conducted. Twelve adults (seven male, five female; aged 18-54) participated in semi-structured interviews, which were analyzed using thematic analysis. Results: Three master themes were identified with subthemes: (1) Looking back: different, faulty; relief and regret; reframing; (2) Looking inwards (with acceptance); and (3) Looking outwards: labeling: disability, stigma and social comparisons. Conclusion: The results highlighted a dilemma: diagnosis was necessary to access appropriate support and helpful to acknowledge (and potentially reframe) experiences, understand oneself better (including recognizing strengths) and foster a sense of belonging. However, after diagnosis there remains a struggle with the sense of self, feeling stigmatized, and the permanence of being or having ADHD forever.
    • Completed suicide, ideation and attempt in attention deficit hyperactivity disorder

      Impey, Matthew (2012)
      Objective: Attention deficit hyperactivity disorder (ADHD) and suicidal behaviour are common conditions with significant social and emotional morbidity. Although completed suicide in ADHD has been assessed in a previous meta-analysis, other domains of suicidal behaviour such as attempts and ideation have been documented only in individual studies. This review provides a comprehensive summary of the relationship between attention-deficit and suicidality.; Method: Electronic and manual literature search of MEDLINE, EMBASE and PSYCHINFO, using a range of search terms around suicidality, attention-deficit and hyperactivity.; Results: Twenty five papers were identified describing a relationship between ADHD and suicide. ADHD occurred more frequently in suicidal groups than controls, with most differences being statistically significant. The direction of results was consistent, with only one sample showing equivocal findings and one showing a reverse pattern. Attempts and ideation were more common in prediagnosed ADHD samples than controls. Three studies showed significant results only for men. Comorbidity had a large influence including delinquency and substance misuse.; Conclusion: There is a positive relationship between ADHD and risk to self. More focussed research needs to take place on younger populations and those without comorbidity. This review highlights the importance of thorough risk assessment in the attention-deficit population.; © 2011 John Wiley & Sons A/S.
    • Protocol evaluating the effectiveness of a school-based group programme for parents of children at risk of ADHD: The 'PArents, Teachers and CHildren WORKing together (PATCHWORK)' cluster RCT protocol

      James, Marilyn; Sampson, Christopher J. (2012)
      Introduction: Early intervention for childhood behavioural problems may help improve health and educational outcomes in affected children and reduce the likelihood of developing additional difficulties. The National Institute for Health and Clinical Excellence guidelines for attention deficit/hyperactivity disorder (ADHD), a common childhood behavioural disorder, recommend a stepped care approach for the identification and management of these problems. Parents of children with high levels of hyperactivity and inattention may benefit from intervention programmes involving behavioural management and educational approaches. Such interventions may be further enhanced by providing training and feedback to teachers about the strategies discussed with parents. In relation to children with high levels of hyperactivity, impulsiveness and inattention, we aim to test the feasibility and effectiveness of a parenting programme (with and without an accompanying teacher session) in primary schools. Methods and analysis: This clustered (at the level of school) randomised controlled trial (RCT) focuses on children in their first four school years (ages 4-8 years) in the East Midlands area of England. Parents will complete a screening measure, the Strengths and Difficulties Questionnaire, to identify children with high levels of hyperactivity/inattention. Three approaches to reducing hyperactivity and attention problems will be compared: a group programme for parents (parent-only intervention); group programme for parents combined with feedback to teachers (combined intervention); and waiting list control (no intervention). Differences between arms on the short version of Conners' Parent and Teacher Rating Scales Revised will be compared and also used to inform the sample size required for a future definitive cluster RCT. A preliminary cost-effectiveness analysis will also be conducted. Ethics and dissemination: The outcomes of this study will inform policy makers about the feasibility, acceptability and effectiveness of delivering targeted behavioural interventions within a school setting. The study has received ethical approval from the University of Nottingham Medical School Ethics Committee. Trial registration: ISRCTN87634685.
    • Knowledge and attitudes about attention-deficit/hyperactivity disorder (ADHD) and its treatment: The views of children, adolescents, parents, teachers and healthcare professionals

      Moldavsky, Maria; Sayal, Kapil (2013)
      Attention-deficit/hyperactivity disorder (ADHD) is a common neuro-developmental disorder that causes controversy; this may have a negative effect on the ability of families, teachers and healthcare professionals to achieve shared understanding and goals. This article reviews recent research of the knowledge and attitudes of children, adolescents, parents, teachers, healthcare professionals and the public about ADHD. Findings suggest that misconceptions about ADHD persist, and children with ADHD and their parents report stigmatizing experiences. Educational interventions to improve the knowledge of teachers about ADHD appeared to be effective in the short term. Parents and professionals working together in the diagnosis and treatment of children with ADHD may have different views about their roles in the shared decision-making process. Studies have reported both similarities and differences in parents' and professionals' views about the effectiveness of treatments for ADHD, but all stakeholders supported the principles of information-sharing and working in partnership.;
    • A small-scale randomized controlled trial of the self-help version of the New Forest Parent Training Programme for children with ADHD symptoms

      Daley, David (2013)
      The efficacy of a self-help parent training programme for children with attention deficit hyperactivity disorder (ADHD) was evaluated. The New Forest Parenting Programme Self-help (NFPP-SH) is a 6-week written self-help psychological intervention designed to treat childhood ADHD. Forty-three children were randomised to either NFPP-SH intervention or a waiting list control group. Outcomes were child ADHD symptoms measured using questionnaires and direct observation, self-reported parental mental health, parenting competence, and the quality of parent-child interaction. Measures of child symptoms and parental outcomes were assessed before and after the intervention. ADHD symptoms were reduced, and parental competence was increased by self-help intervention. Forty-five percent of intervention children showed clinically significant reductions in ADHD symptoms. Self-help intervention did not lead to improvements in parental mental health or parent-child interaction. Findings provide support for the efficacy of self-help intervention for a clinical sample of children with ADHD symptoms. Self-help may provide a potentially cost-effective method of increasing access to evidence-based interventions for clinical populations.
    • Motivational incentives and methylphenidate enhance electrophysiological correlates of error monitoring in children with attention deficit/hyperactivity disorder

      Groom, Madeleine J.; Liddle, Elizabeth B.; Liddle, Peter F.; Batty, Martin J.; Hollis, Chris P. (2013)
      BACKGROUND: Children with attention deficit hyperactivity disorder (ADHD) are characterised by developmentally inappropriate levels of hyperactivity, impulsivity and/or inattention and are particularly impaired when performing tasks that require a high level of cognitive control. Methylphenidate (MPH) and motivational incentives may help improve cognitive control by enhancing the ability to monitor response accuracy and regulate performance accordingly.
    • Transition to adult mental health services for young people with attention deficit/hyperactivity disorder (ADHD): A qualitative analysis of their experiences

      Swift, Katie D.; Marimuttu, Vic; Redstone, Lucy (2013)
      Background: There is little research on the process of transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). More recently, there is growing recognition that Attention Deficit/Hyperactivity Disorder (ADHD) may persist into adulthood requiring services beyond age 18. However, despite National Institute for Health and Clinical Excellence (NICE) Guidance which recommends specialist services for adults with ADHD, there is currently a lack of such services in the UK. The aim of the current study is to explore the experiences of young people with ADHD during transition from CAMHS to AMHS.; Method: Semi-structured qualitative interviews with ADHD patients accessing CAMHS clinics in Nottinghamshire were analysed using thematic analysis.; Results: Ten semi-structured interviews were transcribed and analysed. We found that patients' relationships with their clinician were a key factor in both their reported experience of CAMHS and the transition process. Perceived responsibility of care was also pivotal in how the transition process was viewed. Nature and severity of problems and patients expectations of adult services were also contributing factors in the transition process. The need for continued parental support was openly accepted and thought to be required by the majority of young people with ADHD during transition.; Conclusions: Timely preparation, joint working, good clinician relationships and parental support serve to facilitate the process of transition for young people with ADHD. Nature and severity of problems are perceived to impede or facilitate transition, with predominantly more 'complex presentations' with associated mental health problems more familiar to AMHS (e.g. self-harm, depression) making for smoother transitions to adult services. Transitions to AMHS were more difficult when ADHD was viewed as the main or sole clinical problem. Further exploration of young people's experiences of transition and their engagement with and experience of adult services is required to provide an overall picture of facilitators to successful transition and integration into adult services.;
    • 'Mind the gap' - mapping services for young people with ADHD transitioning from child to adult mental health services

      Hall, Charlotte L. (2013)
      Background: Once considered to be a disorder restricted to childhood, Attention Deficit/Hyperactivity Disorder (ADHD) is now recognised to persist into adult life. However, service provision for adults with ADHD is limited. Additionally, there is little guidance or research on how best to transition young people with ADHD from child to adult services.Method: We report the findings of a survey of 96 healthcare professionals working in children's (Child and Adolescent Mental Health Services and Community Paediatrics) and adult services across five NHS Trusts within the East Midlands region of England to gain a better understanding of the current provision of services for young people with ADHD transitioning into adult mental health services.Results: Our findings indicate a lack of structured guidelines on transitioning and little communication between child and adult services. Child and adult services had differing opinions on what they felt adult services should provide for ADHD cases. Adult services reported feeling ill-prepared to deal with ADHD patients, with clinicians in these services citing a lack of specific knowledge of ADHD and a paucity of resources to deal with such cases.Conclusions: We discuss suggestions for further research, including the need to map the national provision of services for adults with ADHD, and provide recommendations for commissioned adult ADHD services. We specifically advocate an increase in ADHD-specific training for clinicians in adult services, the development of specialist adult ADHD clinics and greater involvement of Primary Care to support the work of generic adult mental health services in adult ADHD management. © 2013 Hall et al.; licensee BioMed Central Ltd.
    • Pre-school hyperactivity/attention problems and educational outcomes in adolescence: Prospective longitudinal study

      Sayal, Kapil (2013)
      BACKGROUND: High levels of attentional and hyperactivity problems in school-aged children, even if subthreshold for attention-deficit hyperactivity disorder (ADHD), are associated with academic under-achievement. Few large-scale, community-based studies have investigated the relationship between pre-school and adolescence.
    • Teachers' recognition of children with ADHD: Role of subtype and gender

      Moldavsky, Maria; Sayal, Kapil (2013)
      Background: This study investigates the ability of primary school teachers to recognise Attention Deficit/Hyperactivity Disorder (ADHD), and the impact of subtype and child gender on recognition and proposed management. Method: Primary school teachers read one of four types of vignette describing the behaviour of a 9-year-old child: either a boy or a girl with inattentive or combined subtype of ADHD. Teachers were asked about their conceptualisation of the child's difficulties and their thoughts about need for specialist referral and other interventions. Results: Of 496 teachers, 99% identified the presence of a problem. Subtype (combined) of ADHD influenced teachers’ recognition of ADHD and agreement that medication might be helpful. Only 13% of teachers thought that medication might be helpful. Conclusions: Results suggest a need for better teacher awareness about inattentive subtype of ADHD.
    • Inattention and hyperactivity in children at risk of obesity: A community cross-sectional study

      Sayal, Kapil; Glazebrook, Cris (2013)
      OBJECTIVE: There is a link between the symptoms of hyperactivity/inattention and overweight in children. Less is known about the factors which might influence this relationship, such as physical and sedentary activity levels or exercise self-efficacy. The aim of this study is to examine the associations between the symptoms of hyperactivity/inattention and risk factors for adult obesity in a sample of children with barriers to exercise.
    • Computer-based cognitive training for ADHD: A review of current evidence

      Cortese, Samuele (2014)
      There has been an increasing interest in and the use of computer-based cognitive training as a treatment of attention-deficit/hyperactivity disorder (ADHD). The authors' review of current evidence, based partly on a stringent meta-analysis of 6 randomized controlled trials (RCTs) published in 2013, and an overview of 8 recently published RCTs highlights the inconsistency of findings between trials and across blinded and nonblinded ADHD measures within trials. Based on this, they conclude that more evidence from well-blinded studies is required before cognitive training can be supported as a frontline treatment of core ADHD symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.
    • Prevalence of obesity in attention-deficit/hyperactivity disorder: Study protocol for a systematic review and meta-analysis

      Cortese, Samuele (2014)
      Introduction: An increasing number of clinical and epidemiological studies suggest a possible association between attention-deficit/hyperactivity disorder (ADHD) and obesity/overweight. However, overall evidence is mixed. Given the public health relevance of ADHD and obesity/overweight, understanding whether and to what extent they are associated is paramount to plan intervention and prevention strategies. We describe the protocol of a systematic review and meta-analysis aimed at assessing the prevalence of obesity/overweight in individuals with ADHD versus those without ADHD. Methods and analysis: We will include studies of any design (except case reports or case series) comparing the prevalence of obesity and/or overweight in children or adults with and without ADHD (or hyperkinetic disorder). We will search an extensive number of databases including PubMed, Ovid databases, Web of Knowledge and Thomson- Reuters databases, ERIC and CINAHL. No restrictions of language will be applied. We will also contact experts in the field for possible unpublished or in press data. Primary and additional outcomes will be the prevalence of obesity and overweight, respectively. We will combine ORs using random-effects models in STATA V.12.0. The quality of the study will be assessed primarily using the Newcastle-Ottawa Scale. Subgroup meta-analyses will be conducted according to participants' age (children vs adults) and study setting (clinical vs general population). We will explore the feasibility of conducting meta-regression analyses to assess the moderating effect of age, gender, socioeconomic status, study setting, geographic location of the study (low-income, middle-income countries vs high-income countries), definition of obesity, method to assess ADHD, psychiatric comorbidities and medication status. Ethics and dissemination: No ethical issues are foreseen. The results will be published in a peer-reviewed journal and presented at national and international conferences of psychiatry, psychology, obesity and paediatrics. Registration: PROSPERO-National Institute of Health Research (NIHR) Prospective Register of Systematic Reviews (CRD42013006410).
    • Behavioral interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials across multiple outcome domains

      Daley, David; Cortese, Samuele (2014)
      OBJECTIVE: Behavioral interventions are recommended as attention-deficit/hyperactivity disorder (ADHD) treatments. However, a recent meta-analysis found no effects on core ADHD symptoms when raters were probably blind to treatment allocation. The present analysis is extended to a broader range of child and parent outcomes.
    • Does psychostimulant treatment in children with ADHD increase later risk of substance use disorder?

      Cortese, Samuele (2014)
      Psychostimulants are the first choice medication in children with attention-deficit/hyperactivity disorder (ADHD). Despite the proven high efficacy of psychostimulants, at least in the short term, for ADHD core symptoms, concerns continue to be raised on their adverse effects, including putative increased risk of substance use disorders (SUDs). A recent multicentre, case-control, longitudinal, prospective, European study by Groenman and colleagues found that treatment with psychostimulants in children with ADHD lowered the risk of SUDs in adolescence. However, this finding is at odds with other recent evidence concluding that ADHD children with and without medication treatment history did not significantly differ on any subsequent SUDs rates. In the present paper, we discuss the study by Groenman and colleagues in view of its methodological strengths and limitations, and we suggest possible implications for day-to-day clinical practice. Copyright © Cambridge University Press 2014.