The relations between DISC-IV DSM diagnoses of ADHD and multi-informant CBCL-AP syndrome scores

Background: Previous studies have examined the relation between attention problems (APs) obtained with the Child Behavior Checklist (CBCL) and attention deficit hyperactivity disorder (ADHD) assessed with the Diagnostic and Statistical Manual of Mental Disorders (DSM). We will examine this relation across sex using multi-informant data. Methods: Parents of 12 538 twins, aged 7, 10, and 12 years, and teachers of twins, aged 10 years, completed the questionnaires. The mothers of a sample of 283 boys and 291 girls who scored either low or high on longitudinal maternal CBCL-AP were interviewed. Results: Children with a low AP score obtained a negative ADHD diagnosis in 96% of cases. Children with a high AP score obtained a positive diagnosis in 36% (girls) and 59% (boys) of cases. The association between paternal and maternal AP ratings and ADHD was the same, whereas the association between teacher AP ratings and ADHD was low. Conclusions: The association between AP and ADHD is higher in boys than girls, possibly because of a bias toward the male manifestation of ADHD. © 2006 Elsevier Inc. All rights reserved

Análisis de productividad, estabilidad y resiliencia de cultivares de alfalfa en Uruguay y Argentina

Tribunal: Boggiano, Pablo; Reyno, Rafael; Astigarraga, LauraEl cambio climático ha incrementado tanto los déficits como los excesos hídricos, los cuales impactan en la producción de alfalfa (Medicago sativa L.). Con el objetivo de evaluar la estabilidad de producción y resiliencia de cultivares de alfalfa a los extremos climáticos, se analizó una base de datos con 15.115 medias de rendimiento provenientes de 129 ensayos de evaluación de cultivares. Se incluyeron un total de 12 sitios de Argentina y Uruguay, para el período 1994-2018. Se calcularon tres índices: productividad, estabilidad y resiliencia para 59 cultivares. Utilizando la caracterización climática, se calcularon, además, medias de resiliencia (i. e., resistencia) asociadas a sequías, excesos hídricos y a situaciones no relacionadas con estos. Se obtuvieron diferencias significativas entre cultivares para los índices de productividad y estabilidad. No se obtuvieron diferencias significativas entre cultivares para los índices de resiliencia. Productividad y resiliencia estuvieron positivamente correlacionados con el grado de reposo (GR) de los cultivares. Cultivares más productivos en general presentaron también mayores niveles de producción acumulada en años con rendimientos medios muy reducidos. Se hipotetiza que la ventana de activo crecimiento más prolongada que poseen los materiales de mayor GR permitiría compensar caídas en los rendimientos generadas por restricciones ambientales pasajeras, con crecimiento durante etapas en las que materiales de menor GR se encuentran aún latentes. Las bases de datos utilizadas presentaron ciertas limitantes de continuidad temporal y duración de los ensayos que pueden haber limitado la obtención de resultados más robustos en todas las variables analizadas. Las conclusiones no podrían ser extrapoladas a cultivos de alfalfa de una duración superior a los 3 o 4 años. Se evaluaron finalmente agrupamientos utilizados en la región según los niveles de latencia de los cultivares (intermedia y sin latencia). El agrupamiento que generó niveles más contrastantes en los índices calculados fue aquel que congrega cultivares de grados de reposo 6 y 7 como cultivares con latencia intermedia y cultivares de grados 8, 9 y 10 como cultivares sin latencia

Understanding the role of family management in ethnically diverse children with ADHD

Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental condition of childhood with a prevalence rate of 5 to 11% in the United States (Centers for Disease Control and Prevention [CDC], 2015). Family, especially caregivers, are considered an important and integral aspect to the care, management, and well-being of children with ADHD (Bussing & Lall, 2010; Cunningham, 2007; Davis, Claudiu, Palinkas, Wong, & Leslie, 2012; DeMarle, Denk, & Ernsthausen, 2003; Dishion & Stormshak, 2007). The literature suggests that the behavioral management by families is a key determinant in treatment outcomes (Bussing & Gary, 2001). In fact, prior research has shown greater improvement in childhood ADHD outcomes with active family engagement and participatory collaboration between health care providers and family caregivers as compared to children without strong family involvement (Power, Soffer, Cassano, Tresco, & Mautone, 2011). In American societies, however, major health disparities exist in ADHD symptom recognition, diagnostic rates, treatment acceptability, and service use as a result of a myriad of socioecological influences, especially for children from diverse racial and ethnic backgrounds (Eiraldi, Mazzuca, Clarke, & Power, 2006). Despite this knowledge, there is a paucity of research on: 1.) how caregivers from ethnically diverse families view ADHD, and 2.) how their views influence the behavioral management of childhood ADHD and subsequent outcomes, including children s level of functional impairment. Using socio-ecological theory to underscore child, family, school, healthcare, and community level factors, the purpose of this study is to understand how ethnically diverse caregivers manage childhood ADHD in their everyday lives and how family management factors influence children s level of functional impairment. Methods: Using an embedded concurrent nested design, the proposed research is a mixed methods study independently analyzing and then, integrating cross-sectional qualitative (n=50) and quantitative (n=50) data from ethnically diverse caregivers of children with ADHD. Participants are caregivers of children ages 5 to 12 years old with ADHD who live at least 50% of the time in the same household as their child. An eligible caregiver for this study is a biological or adoptive parent, legal guardian, grandparent, or family member, who views him or herself as assuming major responsibility for their child s care and lives in a primary residence within the city of interest. In this study, adequate representation of caregiver participants from different racial and ethnic backgrounds is ensured by using a stratified sampling plan using U.S. census data. Eligible and enrolled caregivers participate in a 60-90 minute in-person interview to complete surveys, including a demographic questionnaire, NICHQ Vanderbilt ADHD Assessment Scale, Family Management Measure (FaMM), and Impairment Rating Scale (IRS), and participate in a semi-structured interview with the lead investigator of the study. Guided by the Family Management Framework, caregiver interviews focus on key family management factors, such as the child s daily life, condition management ability, condition management effort, and view of condition impact, and the barriers and facilitators for each family management factor. This research is approved by the Institutional Review Board within the academic and health care institution in which the study takes place. Caregivers who complete the study receive a $40 Visa gift card, binder of ADHD information and resources, and thank you card for their participation. Results: After data collection and analysis is complete, the study findings will answer the following specific aims: 1) Qualitative:to explore how ethnically diverse caregivers manage ADHD in their everyday lives and understand the barriers and facilitators of family management; 2) Quantitative:to examine how child characteristics, family management factors, and caregiver and environmental characteristics influence children s level of functional impairment; and 3) Mixed-Methods: to integrate findings to explicate complementary themes and family management factors that influence the functional impairment of children with ADHD. Measurements are empirically validated and reliable instruments used in pediatric research. Proposed analytic techniques are described including content analysis, descriptive and inferential statistics, and data integration. Conclusion: By identifying the most salient family management factors that influence higher and lower levels of children s functional impairment, this study extends previous research on family management and ADHD in diverse populations and builds upon existing knowledge about cultural and family perspectives of children with ADHD. Within the conference theme of culturally-diverse health practices, this research provides transformative knowledge about how families understand and manage childhood ADHD within different cultural contexts and provides a launching point for future nursing research and implications for practice and policy. The knowledge gained from the study may lead into a program of research that aims to develop or adapt family-based interventions for culturally and ethnically diverse children with ADHD. Pediatric and mental health registered nurses and advanced practice nurses are at the forefront of implementing changes within nursing practice and nursing education regarding family and cultural perspectives, which may improve patient care outcomes for children with ADHD. Additionally, nurses are strong advocates for their patients, families, and communities, which can influence local, national, and international policy and decision-makers regarding the access, care, and services for childhood ADHD. Study limitations, methodological considerations, and final thoughts are addressed at the conclusion of this presentation

Genetic and environmental influences on the relation between attention problems and Attention Deficit Hyperactivity Disorder.

Objective: The assessment of symptoms of ADHD in children is usually based on a clinical interview or a behavior checklist. The aim of the present study is to investigate the extent to which these instruments measure an underlying construct and to estimate the genetic and environmental influences on individual differences in ADHD. Methods: Maternal ratings were collected on 10,916 twins from 5,458 families. Child Behavior Checklist (CBCL) ratings were available for 10,018, 6,565, and 5,780 twins at the ages 7, 10, and 12, respectively. The Conners Rating Scale (4,887 twins) and the DSM interview (1,006 twins) were completed at age 12. The magnitude of genetic and environmental influences on the variance of the three measures of ADHD and the covariance among the three measures of ADHD was obtained. Results: Phenotypic correlations range between .45 and .77. Variances and covariances of the measurements were explained mainly by genetic influences. The model that provided the best account of the data included an independent pathway for additive and dominant genetic effects. The genetic correlations among the measures collected at age 12 varied between .63 and 1.00. Conclusions: The genetic overlap between questionnaire ratings and the DSM-IV diagnosis of ADHD is high. Clinical and research implications of these findings are presented

The predictive validity of parent and teacher reports of ADHD symptoms

The objectives were to evaluate the ability of the Inattention and Hyperactivity-Impulsivity factors of the ADHD Rating Scale-IV to differentiate children with ADHD from a control group and to discriminate children with different subtypes of ADHD. Also, we sought to determine optimal cutoff scores on the teacher and parent versions of this scale for making diagnostic decisions about ADHD. In a sample of 92 boys and girls 6 to 14 years of age referred to a regional ADHD program, we assessed ADHD diagnostic status using categorical and dimensional approaches as well as parent- and teacher-report measures. Logistic regression analyses showed that the Inattention and Hyperactivity-Impulsivity factors of the ADHD Rating Scale-IV were effective in discriminating children with ADHD from a control group and differentiating children with ADHD, Combined Type from ADHD, Inattentive Type. Although both teacher and parent ratings were significantly predictive of diagnostic status, teacher ratings made a stronger contribution to the prediction of subtype membership. Using symptom utility estimates, optimal cutoff scores on the Inattention and Hyperactivity-Impulsivity scales for predicting subtypes of ADHD were determined

Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol.

BACKGROUND: An increasing number of schools in rural settings are implementing multi-tier positive behavioral interventions and supports (PBIS) to address school-climate problems. PBIS can be used to provide the framework for the implementation of evidence-based practices (EBPs) to address children\u27s mental health concerns. Given the large service disparities for children in rural areas, offering EBPs through PBIS can improve access and lead to better long-term outcomes. A key challenge is that school personnel need technical assistance in order to implement EBPs with fidelity and clinical effectiveness. Providing ongoing on-site support is not feasible or sustainable in the majority of rural schools, due to their remote physical location. For this reason, remote training technology has been recommended for providing technical assistance to behavioral health staff (BHS) in under-served rural communities. OBJECTIVES: The purpose of this study is to use the user-centered design, guided by an iterative process (rapid prototyping), to develop and evaluate the appropriateness, feasibility, acceptability, usability, and preliminary student outcomes of two online training strategies for the implementation of EBPs at PBIS Tier 2. METHODS: The study will employ a pragmatic design comprised of a mixed-methods approach for the development of the training platform, and a hybrid type 2, pilot randomized controlled trial to examine the implementation and student outcomes of two training strategies: Remote Video vs. Remote Video plus Coaching. DISCUSSION: There is a clear need for well-designed remote training studies focused on training in non-traditional settings. Given the lack of well-trained mental health professionals in rural settings and the stark disparities in access to services, the development and pilot-testing of a remote training strategy for BHS in under-served rural schools could have a significant public health impact. ETHICS AND DISSEMINATION: The project was reviewed and approved by the institutional review board. Results will be submitted to ClinicalTrials.gov and disseminated to community partners and participants, peer-reviewed journals, and academic conferences. TRIAL REGISTRATION: ClinicialTrials.gov, NCT05034198 and NCT05039164

Time-dependent and concentration -dependent upregulation of carbamazepine efflux transporter: a preliminary assessment from salivary drug monitoring

The aim of the present study was to detect efflux transporter induction at salivary glands. Six healthy volunteers were involved. On the first day subjects received a single carbamazepine (CBZ) dose of 400 mg. Couples of salivary samples (first and second fraction, S1 and S2) were collected throughout time after dosing. The following 6 days subjects received 200 mg every twelve hours, and morning pre-dose samples were collected.Colegio de Farmacéuticos de la Provincia de Buenos Aire

A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness

BackgroundCognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists.ObjectivesFriends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support.Materials and methodsFirst, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors.ResultsThe mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations.ConclusionRelatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support

Concurrent Validity of the Child Behavior Checklist DSM-Oriented Scales: Correspondence with DSM Diagnoses and Comparison to Syndrome Scales

This study used receiver operating characteristic (ROC) methodology and discriminative analyses to examine the correspondence of the Child Behavior Checklist (CBCL) rationally-derived DSM-oriented scales and empirically-derived syndrome scales with clinical diagnoses in a clinic-referred sample of children and adolescents (N = 476). Although results demonstrated that the CBCL Anxiety, Affective, Attention Deficit/Hyperactivity, Oppositional and Conduct Problems DSM-oriented scales corresponded significantly with related clinical diagnoses derived from parent-based structured interviews, these DSM-oriented scales did not evidence significantly greater correspondence with clinical diagnoses than the syndrome scales in all cases but one. The DSM-oriented Anxiety Problems scale was the only scale that evidenced significantly greater correspondence with diagnoses above its syndrome scale counterpart —the Anxious/Depressed scale. The recently developed and rationally-derived DSM-oriented scales thus generally do not add incremental clinical utility above that already afforded by the syndrome scales with respect to corresponding with diagnoses. Implications of these findings are discussed

Chiropractic care for paediatric and adolescent Attention-Deficit/Hyperactivity Disorder: A systematic review

<p>Abstract</p> <p>Background</p> <p>Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors.</p> <p>Objective</p> <p>The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD.</p> <p>Methods</p> <p>Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines.</p> <p>Results</p> <p>The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria.</p> <p>Conclusions</p> <p>To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD.</p