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A systematic review of published and unpublished data on the use of long-acting medications in ADHD and hyperkinetic disorder is reported, giving effect sizes and numbers-to-treat for extended-release stimulant preparations and atomoxetine (ATX). A panel of experts from several European countries used the review to make recommendations about the use of these drugs in practice, and conclusions are reported: (1) Long-acting preparations should be available and used; (2) They should not replace short-acting drugs (which will be the initial treatment for many children for reasons of cost and flexibility of dosing). Individual clinical choice is needed. (3) Both ATX and extended-release preparations of stimulants should be available. The choice will depend upon the circumstances, and detailed recommendations are made. [ABSTRACT FROM AUTHOR]

The article focuses on the randomized, double-blind trial that compares the efficacy of atomoxetine and placebo to prevent relapse in a group of children with attention-deficit hyperactivity disorder (ADHD) in the U.S. The study revealed that atomoxetine shows positive response towards the treatment of children with ADHD. Researchers believe that long-term medication of atomoxetine will help lessen the symptoms of the disease.

Objective: Sleep problems are highly prevalent and impairing in adolescents with ADHD. However, their relation with co-occurring mental health problems is still unclear. This study assessed whether adolescents with ADHD, with and without self-reported sleep problems, differ from each other in co-occurring mental health problems, and whether they differ from adolescents without ADHD. Furthermore, we examined whether the adolescents with ADHD and self-reported sleep problems do indeed have more disturbed sleep than the other two groups and lastly, whether these sleep differences are moderated by co-occurring mental health problems., Method: Three groups of adolescents (13-17 years): 1) with ADHD and comorbid self-reported sleep problems (N = 56), 2) with ADHD but without self-reported sleep problems (N = 25), and 3) without ADHD (N = 56) were assessed. Group comparisons were done for symptoms of co-occurring mental health problems, self- and parent-reported sleep problems, and objective and subjective sleep parameters. Exploratively, moderating effects of co-occurring mental health problems on sleep differences between groups are examined., Results: Compared to those without self-reported sleep problems, adolescents with ADHD and comorbid self-reported sleep problems experienced significantly more co-occurring symptoms of mental health problems, especially depression. They also scored higher on all sleep problems, and had a longer sleep onset latency and lower sleep efficiency based on subjective and objective sleep measures. Depression and anxiety moderated objectively measured sleep differences., Conclusion: Co-occurring mental health problems, especially depressive symptoms, are more prevalent in adolescents with ADHD and sleep problems and partially moderate the relation with sleep. This indicates that when adolescents with ADHD present with sleep problems in clinical practice, it is essential to also assess symptoms and other mental health problems and vice-versa., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Saskia van der Oord reports financial support was provided by Research Foundation Flanders. Saskia van der Oord reports a relationship with MEDICE that includes: speaking and lecture fees. Marina Danckaerts reports a relationship with Takeda Pharmaceuticals USA Inc that includes: funding grants. Samuele Cortese reports a relationship with MEDICE that includes: speaking and lecture fees. Bianca E. Boyer is a co-developer and author of treatment manuals “Plan My Life”, “Solution Focused Treatment” and “My Sleep Plan”; she receives royalties for the sales of all interventions. Marina Danckaerts is participating in a Takeda-sponsored clinical trial in ADHD. Samuele Cortese has declared reimbursement for travel and accommodation expenses from the Association for Child and Adolescent Central Health (ACAMH) in relation to lectures delivered for ACAMH, the Canadian AADHD Alliance Resource, the British Association of Psychopharmacology, and from Healthcare Convention for educational activity on ADHD, and has received honoraria from MEDICE. Saskia Van der Oord declares an honorarium and reimbursement for travel expenses from MEDICE for a lecture on nonpharmacological treatment of ADHD. On behalf of the other authors, the corresponding author states that there is no conflict of interest. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: Although the incidence of mental health problems is highest in young people, the majority do not seek help. Reducing the discrepancy between need for care and access to services requires an understanding of the user perspective, which is largely lacking. This study aimed to examine preferences for mental health service attributes and their relative importance among young people, as well as the potential impact on actual help-seeking intentions., Methods: Youth aged 16-24 years (N = 258) participated in a discrete choice experiment. In addition to choosing which service would suit their needs most out of two service options in nine choice sets, participants were asked whether they would consult the chosen service in the case of mental health problems. Demographic information was also collected, as well as their current mental health status, experience with and perceived barriers to care. Panel mixed logit models were estimated., Results: Young people's preferences were mostly driven by the attribute 'format', with a preference for individual rather than group therapy. Other attributes, in order of importance, were 'wait times' (short), 'cost' (low), 'healthcare professionals' expertise' (particular experience with working with youth aged 12 to 25 years), and 'location' (house in a city). However, a majority of young people would not consult the service they had indicated, mainly due to attitudinal barriers such as wanting to deal with problems on their own (self-reliance)., Conclusions: Addressing psychological barriers to access care should be a priority in mental health policies. Furthermore, entry point services, in particular, should be able to provide the option of individual treatment., (© 2024 John Wiley & Sons Australia, Ltd.)

Children with ADHD are theorized to experience increased negative emotional responses to punishment, compared to typically developing (TD) children, resulting in altered behavioral responding (Amsel, 1992). However, this has not been empirically tested. The current study evaluated the effects of punishment and reward on the behavioral and emotional responding of children with and without ADHD. Fifty-three children with ADHD (64.15% boys) and 46 TD children (47.83% boys), age 6-12, completed a task in which they chose between playing two simultaneously available games. Reward was arranged symmetrically across the games; responses on one game were punished four times as often as responses on the other game. Children's negative and positive emotional expressions were assessed during task completion with facial expression coding. Results indicated both groups showed a preference for playing the less punished game. Children with ADHD took longer to respond after punishment and reward compared to TD children. Negative emotional expressions increased with time on task for those with ADHD, the opposite pattern was seen in TD children. Children with ADHD showed more positive emotional expressions overall. The effect of ADHD on increased response times after reward was statistically fully mediated by increased positive facial expressions. Findings indicate children with ADHD do not show an altered response bias under punishment compared to TD children, but their cumulative negative emotional responding may indicate problems with building frustration tolerance as hypothesized by Amsel (1992). Results are theoretically important as they suggest increased emotional responding in ADHD is associated with slower responding., Competing Interests: Compliance with Ethical Standards. Funding: Open access funding provided by the Okinawa Institute of Science and Technology Graduate University (OIST). This study was funded by G.0845.19 N of the Research Foundation Flanders (FWO) and internal subsidy funding from the Okinawa Institute of Science and Technology Graduate University. Conflict of Interest: Saskia van der Oord declares an honorarium and reimbursement for travel expenses from MEDICE for a lecture on non-pharmacological treatment of ADHD. Marina Danckaerts and Dagmar Van Liefferinge are participating in a Takeda-sponsored clinical trial in ADHD. All other authors have no conflict of interest. Ethical Approval: Ethical approval was obtained from the Social and Societal Ethics Committee, Faculty of Psychology and Educational Sciences at the KU Leuven, Belgium (G-2019 12 1922) and the Human Subjects Research Review Committee at the Okinawa Institute of Science and Technology (OIST) Graduate University, Japan (HSR-2021-003-2). Informed Consent: Written consent was obtained from parents and teachers and children gave assent to participate in the study., (© 2024. The Author(s).)

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. It is the most common neurodevelopmental disorder presenting to pediatric services, and pediatricians are often involved in the early assessment, diagnosis, and treatment of children with ADHD. The treatment of ADHD typically involves a multimodal approach that encompasses a combination of psychoeducation, parent/teacher training, psychosocial/psychotherapeutic interventions, and pharmacotherapy. Concerning pharmacotherapy, guidelines vary in drug choice and sequencing, with psychostimulants, such as methylphenidate and (lis)dexamfetamine, generally being the favored initial treatment. Alternatives include atomoxetine and guanfacine. Pharmacotherapy has been proven effective, but close follow-up focusing on physical growth, cardiovascular monitoring, and the surveillance of potential side effects including tics, mood fluctuations, and psychotic symptoms, is essential. This paper presents an overview of current pharmacological treatment options for ADHD and explores disparities in treatment guidelines across different European countries.   Conclusion: Pharmacological treatment options for ADHD in children and adolescents are effective and generally well-tolerated. Pharmacotherapy for ADHD is always part of a multimodal approach. While there is a considerable consensus among European guidelines on pharmacotherapy for ADHD, notable differences exist, particularly concerning the selection and sequencing of various medications. What is Known: • There is a significant base of evidence for pharmacological treatment for ADHD in children and adolescents. • Pediatricians are often involved in assessment, diagnosis and management of children with ADHD. What is New: • Our overview of different European guidelines reveals significant agreement in the context of pharmacotherapy for ADHD in children and adolescents. • Discrepancies exist primarily in terms of selection and sequencing of different medications., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age., Method: Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age., Results: The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable., Conclusion: Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SC reports collaboration on projects from the EU Seventh Framework Program and on clinical trials sponsored by Lundbeck, Otsuka, Janssen-Cilag, Angelini and Acadia. KKCM reports grants from the CW Maplethorpe Fellowship, the UK National Institute for Health and Care Research (NIHR), the EU Horizon 2020 Framework, and the Hong Kong Research Grant Council, and personal fees from IQVIA Holdings, outside the submitted work. CB reports collaboration on projects from the EU Seventh Framework Program and on clinical trials sponsored by Otsuka, Janssen-Cilag, Angelini and Acadia. JB has been in the past 3 years a consultant to / member of advisory board of / and/or speaker for Takeda, Medice, Angelini, Janssen, Boehringer-Ingelheim, and Servier. He is not an employee of any of these companies, and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, royalties. MD has received research funding from Takeda–Shire, outside the submitted work. RWD—For the past 3 years, he has no conflicts of interest to report. As a former company employee, he has been a stockholder of Eli Lilly & Co. FD reports collaboration as sub-investigator in clinical trials sponsored by Lundbeck as an independent rater in clinical trials sponsored by Servier and Acadia. BF has been a consultant or speaker for Abbvie, Actelion, Allergan, Almirall, Alnylam, Amgen, Astellas, Astrazeneca, Bayer, Biogen, Biopecs, Bioproject, Biotronik, BMS,Boehringer, Celgène, Daiichi-Sankyio, Ethypharm, Forestlab, Genevrier, Genzyme, Gilead, Grünenthal, GSK, Idorsia, IMS, Indivior, IQVIA, JNJ, Léo, Lilly, Lundbeck, Menarini, MSD, Novartis, Novonordisk, Otsuka, Pfizer, Pierre-Frabre, Recordati, Roche, SANOFI, Servier, Takeda, UCB, ViiV, and Wellmera. AH has received compensation for serving as consultant or speaker for Shire–Takeda and Medice, unrelated to this work. KKCM reports grants from the CW Maplethorpe Fellowship, the UK National Institute for Health and Care Research (NIHR), the EU Horizon 2020 Framework, and the Hong Kong Research Grant Council, and personal fees from IQVIA Holdings, outside the submitted work. CH reports research funding from the NIHR including the Health Technology Assessment SATURN trial (grant ref: NIHR128472) comparing methylpheidate with guanfacine for children and young people with ADHD and tics. CH was chair of the NICE Guideline (CG155) for psychosis and schizophrenia in children and young people; member of the NICE ADHD Guideline Update committee (NG87) and is a member of Eunethydis and the Europhean ADHD Guideline Group. SM reports speaker’s fee, travel support, and research support from Shire, outside the submitted work. AN reports research funding from the EU, the German Ministry of Health, and the German Federal Joint Committee, outside the submitted work. PN has been a consultant or speaker for Medice, Servier, and Egis Pharmaceuticals, outside the submitted work. ER received speaker’s fee and travel support from Shire, outside the submitted work. PN has been a consultant or speaker for Medice, Servier, and Egis Pharmaceuticals, outside the submitted work. ER received speaker’s fee and travel support from Shire, outside the submitted work. ESB has received in the last 3 years speakers fees from Takeda and Medice and research support from QBTech. AZ served in an advisory or consultancy role for Angelini, EduPharma, Servier; received conference support or speaker’s fee from Angelini and Janssen; participated in clinical trials conducted by Angelini, Janssen, Lundbeck, Otsuka, Roche, Sevier, and Shire; and received royalties from Giunti OS and Oxford University Press. ICKW reports research and educational funding from Amgen, Bristol Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, Takeda, the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, the Hong Kong Innovation and Technology Commission, the NIHR, the EU, and the Australian National Health and Medical Research Council, and the expert testimony payment from the Hong Kong Court of Final Appeal; outside the submitted work. TB served in an advisory or consultancy role for eye level, Infectopharm, Medice, Neurim Pharmaceuticals, Oberberg GmbH and Takeda. He received conference support or speaker’s fee by Janssen, Medice and Takeda. He received royalities from Hogrefe, Kohlhammer, CIP Medien, Oxford University Press; the present work is unrelated to these relationships. DC reports, in the past 3 years, a consultant, member of advisory board, or speaker role for Takeda–Shire, Medice, Novartis, and Servier. He has received royalties from Oxford University Press and Cambridge University Press; research support from the Australian National Health and Medical Research Council and the Royal Children’s Hospital Foundation; and funding for the current study from the European Commission. All other authors declare no competing interests.

Despite an increased prevalence of psychiatric morbidity, minor refugees resettled in Western host societies are less likely to access mental health care services than their native peers. This study aims to explore how a collaborative approach can be implemented to promote access to specialized mental health care. Collaborative mental health care embeds specialized intervention in primary care settings and emphasizes the inclusion of minority cultural perspectives through an interdisciplinary, intersectoral network. In this study, we analyze how such a collaborative approach can support access to specialized mental health care for refugee youth. The study presents findings from a qualitative multiple-case study ( n = 10 refugee patients), conducted in the setting of a psychiatric day program for young refugees that develops an intersectional, collaborative practice in supporting minor refugees' trajectory from referral to admission. Building on in-depth interviews, participant observation and case documents, within-case analysis and cross-case inductive thematic analysis identify the specific working mechanisms of a collaborative approach. The results indicate how this intersectoral approach addresses the interplay between traumatic suffering and both cultural and structural determinants of mental health. To conclude, a discussion identifies future research directions that may further strengthen the role of collaborative practice in promoting mental health care access for refugee youth.

Objective: Short-term RCTs have demonstrated that MPH-treatment significantly reduces ADHD-symptoms, but is also associated with adverse events, including sleep problems. However, data on long-term effects of MPH on sleep remain limited., Methods: We performed a 2-year naturalistic prospective pharmacovigilance multicentre study. Participants were recruited into three groups: ADHD patients intending to start MPH-treatment (MPH-group), those not intending to use ADHD-medication (no-MPH-group), and a non-ADHD control-group. Sleep problems were assessed with the Children's-Sleep-Habits-Questionnaire (CSHQ)., Results: 1,410 participants were enrolled. Baseline mean CSHQ-total-sleep-scores could be considered clinically significant for the MPH-group and the no-MPH-group, but not for controls. The only group to show a significant increase in any aspect of sleep from baseline to 24-months was the control-group. Comparing the MPH- to the no-MPH-group no differences in total-sleep-score changes were found., Conclusion: Our findings support that sleep-problems are common in ADHD, but don't suggest significant negative long-term effects of MPH on sleep., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AH has received compensation for serving as consultant or speaker for Shire–Takeda and Medice, unrelated to this work. KKCM reports grants from the CW Maplethorpe Fellowship, the UK National Institute for Health and Care Research (NIHR), the EU Horizon 2020 Framework, and the Hong Kong Research Grant Council, and personal fees from IQVIA Holdings, outside the submitted work. JB has been in the past 3 years a consultant, member of advisory board, or speaker for Takeda–Shire, Roche, Medice, Angelini, Janssen, and Servier. SC reports collaboration on projects from the EU Seventh Framework Programme and on clinical trials sponsored by Shire Pharmaceutical Company, Lundbeck, Otsuka, Janssen-Cilag, and Angelini. MD has received research funding from Takeda–Shire, outside the submitted work. RWD—For the past 3 years, he has no conflicts of interest to report. As a former company employee, he has been a stock holder of Eli Lilly & Co. BF has been a consultant or speaker for Abbvie, Actelion, Allergan, Almirall, Alnylam, Amgen, Astellas, Astrazeneca, Bayer, Biogen, Biopecs, Bioproject, Biotronik, BMS, Boehringer, Celgène, Daiichi-Sankyio, Ethypharm, Forestlab, Genevrier, Genzyme, Gilead, Grünenthal, GSK, Idorsia, IMS, Indivior, IQVIA, JNJ, Léo, Lilly, Lundbeck, Menarini, MSD, Novartis, Novonordisk, Otsuka, Pfizer, Pierre-Frabre, Recordati, Roche, SANOFI, Servier, Takeda, UCB, ViiV, and Wellmera. CH reports research funding from the NIHR including the Health Technology Assessment SATURN trial (grant ref: NIHR128472) comparing MPH with guanfacine for children and young people with ADHD and tics. CH was chair of the NICE Guideline (CG155) for psychosis and schizophrenia in children and young people; member of the NICE ADHD Guideline Update committee (NG87) and is a member of Eunethydis and the European ADHD Guideline Group. SM reports speaker’s fee, travel support, and research support from Shire, outside the submitted work. AN reports research funding from the EU, the German Ministry of Health, and the German Federal Joint Committee, outside the submitted work. PN has been a consultant or speaker for Medice, Servier, and Egis Pharmaceuticals, outside the submitted work. ER received speaker’s fee and travel support from Shire, outside the submitted work. ESB has received in the last 3 years speakers fees from Takeda and Medice and research support from QBTech. AZ served in an advisory or consultancy role for Angelini, EduPharma, Servier; received conference support or speaker’s fee from Angelini and Janssen; participated in clinical trials conducted by Angelini, Janssen, Lundbeck, Otsuka, Roche, Servier, and Shire; and received royalties from Giunti OS and Oxford University Press. ICKW reports research and educational funding from Amgen, Bristol Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, Takeda, the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, the Hong Kong Innovation and Technology Commission, the NIHR, the EU, and the Australian National Health and Medical Research Council, and the expert testimony payment from the Hong Kong Court of Final Appeal; outside the submitted work. DC reports, in the past 3 years, a consultant, member of advisory board, or speaker role for Takeda–Shire, Medice, Novartis, and Servier. He has received royalties from Oxford University Press and Cambridge University Press; research support from the Australian National Health and Medical Research Council and the Royal Children’s Hospital Foundation; and funding for the current study from the European Commission. All other authors declare no competing interests. TB served in an advisory or consultancy role for Eyelevel, Infectopharm, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg, Roche, and Takeda; received conference support or speaker’s fee from Jansen, Medice, and Takeda; and royalities from Hogrefe, Kohlhammer, CIP Medien, and Oxford University Press; outside the submitted work.

Objective: This study examined the effect of COVID-19 restrictions on the sleep and sleep hygiene of adolescents with ADHD and comorbid sleep problems and neurotypical adolescents (NT)., Method: Four groups (two ADHD and two NT) of in total 100 adolescents (50 ADHD and 50 NT) were included. One ADHD and NT group were tested during many COVID-19 restrictions, the other during few. MANCOVAs were implemented with ADHD diagnosis and level of COVID-19 restrictions as independent and sleep outcomes (subjective and objective total sleep time (TST) and sleep onset latency (SOL), sleep and sleep hygiene problems) as dependent variables., Results: Both groups had a shorter objective TST during the week during many COVID-19 restrictions. Furthermore, adolescents with ADHD had a shorter subjective SOL during the weekend when there were many COVID-19 restrictions, while the SOL of the NT group stayed the same., Conclusion: COVID-19 restrictions are related to the sleep of adolescents with and without ADHD. However, causality and underlying mechanisms need further investigation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MD is participating in a Takeda-sponsored clinical trial in ADHD. SVDO declares a honorarium and reimbursement for travel expenses from MEDICE for a lecture on non-pharmacological treatment of ADHD. All other authors have no conflict of interest.

Introduction: Although youth-friendly service characteristics have been previously identified, consensus among a representative group of stakeholders about which of these characteristics are truly relevant to the youth-friendliness of services is currently lacking. In our study, young adults, parents and professionals were consulted on this topic to reveal existing (dis)agreement. In addition, (dis)agreement on feasibility for implementation in clinical practice was also assessed., Methods: A mixed-method Delphi approach was used with three online questionnaire rounds and a physical meeting. Young adults (18-26 years) and parents were part of a public panel and professionals were allocated to the professional panel. In the rounds, participants were asked to rate the importance and feasibility of each item. Subsequently, the percentage agreement (% of participants giving a score of 7 or above on a 9-point Likert scale) within and across panels was calculated. Consensus was assumed to have been reached when at least 70% agreement was achieved. A thematic analysis of the qualitative data, obtained in the rounds and the physical meeting, was performed to identify overarching themes and characteristics of relevance to the youth-friendliness of services., Results: For 65% of the items included in the Delphi questionnaire, consensus on importance was reached within both panels. Participants showed more insecurity about the feasibility of these items, however. Our thematic analysis revealed reasons for disagreement between and within the panels., Conclusions: Our study revealed substantial between- and within-panel agreement on youth-friendly service characteristics. We recommend that the items for which consensus was reached should be used as a checklist in terms of youth mental health service development, design and delivery. The characteristics for which there was disagreement between and within the panels should inspire an ongoing trialogue between young adults, parents and professionals both on the individual level and the service level., Patient or Public Contribution: In this study, (parents of) young adults with lived experience were included as experts, including one of the coauthors. This coauthor contributed to the manuscript by having a final say about the included quotes., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Prominent theoretical accounts of attention-deficit/hyperactivity-disorder (ADHD) hypothesize that reinforcement learning deficits underlie symptoms of ADHD. The Dynamic Developmental Theory and the Dopamine Transfer Deficit hypothesis assume impairments in both the acquisition and extinction of behavior, especially when learning occurs under partial (non-continuous) reinforcement, and subsequently the Partial Reinforcement Extinction Effect (PREE). Few studies have evaluated instrumental learning in ADHD and the results are inconsistent. The current study investigates instrumental learning under partial and continuous reinforcement schedules and subsequent behavioral persistence when reinforcement is withheld (extinction) in children with and without ADHD., Methods: Large well-defined samples of children with ADHD (n = 93) and typically developing (TD) children (n = 73) completed a simple instrumental learning task. The children completed acquisition under continuous (100%) or partial (20%) reinforcement, followed by a 4-min extinction phase. Two-way (diagnosis by condition) ANOVAs evaluated responses needed to reach the learning criterion during acquisition, and target and total responses during extinction., Results: Children with ADHD required more trials to reach criterion compared to TD children under both continuous and partial reinforcement. After partial reinforcement, children with ADHD executed fewer target responses during extinction than TD children. Children with ADHD executed more responses than TD children during extinction, irrespective of learning condition., Conclusions: The findings demonstrate general difficulties in instrumental learning in ADHD, that is, slower learning irrespective of reinforcement schedule. They also show faster extinction following learning under partial reinforcement in those with ADHD, that is, a diminished PREE. Children with ADHD executed more responses during extinction. Results are theoretically important, with clinical implications for understanding and managing learning difficulties in those with ADHD, as they suggest poorer reinforcement learning and lower behavioral persistence., (© 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

ADHD is the most common neurodevelopmental disorder presenting to child and adolescent mental health, paediatric, and primary care services. Timely and effective interventions to address core ADHD symptoms and co-occurring problems are a high priority for healthcare and society more widely. While much research has reported on the benefits and adverse effects of different interventions for ADHD, these individual research reports and the reviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent and difficult to interpret. We have summarized the current evidence and identified several methodological issues and gaps in the current evidence that we believe are important for clinicians to consider when evaluating the evidence and making treatment decisions. These include understanding potential impact of bias such as inadequate blinding and selection bias on study outcomes; the relative lack of high-quality data comparing different treatments and assessing long-term effectiveness, adverse effects and safety for both pharmacological and non-pharmacological treatments; and the problems associated with observational studies, including those based on large national registries and comparing treatments with each other. We highlight key similarities across current international clinical guidelines and discuss the reasons for divergence where these occur. We discuss the integration of these different perspective into a framework for person/family-centered evidence-based practice approach to care that aims to achieve optimal outcomes that prioritize individual strengths and impairments, as well as the personal treatment targets of children and their families. Finally, we consider how access to care for this common and impairing disorder can be improved in different healthcare systems., (© 2021. Crown.)

Background: Methylphenidate is the most frequently prescribed medication for the treatment of ADHD in children and adolescents in many countries. Although many randomised controlled trials support short-term efficacy, tolerability, and safety, data on long-term safety and tolerability are scarce. The aim of this study was to investigate the safety of methylphenidate over a 2-year period in relation to growth and development, psychiatric health, neurological health, and cardiovascular function in children and adolescents., Methods: We conducted a naturalistic, longitudinal, controlled study as part of the ADDUCE research programme in 27 European child and adolescent mental health centres in the UK, Germany, Switzerland, Italy, and Hungary. Participants aged 6-17 years were recruited into three cohorts: medication-naive ADHD patients who intended to start methylphenidate treatment (methylphenidate group), medication-naive ADHD patients who did not intend to start any ADHD medication (no-methylphenidate group), and a control group without ADHD. Children with ADHD diagnosed by a qualified clinician according to the DSM-IV criteria and, in the control group, children who scored less than 1·5 on average on the Swanson, Nolan, and Pelham IV rating scale for ADHD items, and whose hyperactivity score on the parent-rated Strengths and Difficulties Questionnaire was within the normal range (<6) were eligible for inclusion. Participants were excluded if they had previously taken any ADHD medications but remained eligible if they had previously taken or were currently taking other psychotropic drugs. The primary outcome was height velocity (height velocity SD score; estimated from at least two consecutive height measurements, and normalised with reference to the mean and SD of a population of the same age and sex)., Findings: Between Feb 01, 2012, and Jan 31, 2016, 1410 participants were enrolled (756 in methylphenidate group, 391 in no-methylphenidate group, and 263 in control group). 1070 (76·3%) participants were male, 332 (23·7%) were female, and for eight gender was unknown. The average age for the cohort was 9·28 years (SD 2·78; IQR 7-11). 1312 (93·0%) of 1410 participants were White. The methylphenidate and no-methylphenidate groups differed in ADHD symptom severity and other characteristics. After controlling for the effects of these variables using propensity scores, there was little evidence of an effect on growth (24 months height velocity SD score difference -0·07 (95% CI -0·18 to 0·04; p=0·20) or increased risk of psychiatric or neurological adverse events in the methylphenidate group compared with the no-methylphenidate group. Pulse rate and systolic and diastolic blood pressure were higher in the methylphenidate group compared with the no-methylphenidate group after 24 months of treatment. No serious adverse events were reported during the study., Interpretation: Our results suggest that long-term treatment with methylphenidate for 2 years is safe. There was no evidence to support the hypothesis that methylphenidate treatment leads to reductions in growth. Methylphenidate-related pulse and blood pressure changes, although relatively small, require regular monitoring., Funding: EU Seventh Framework Programme., Competing Interests: Declaration of interests KKCM reports grants from the CW Maplethorpe Fellowship, the UK National Institute for Health and Care Research (NIHR), the EU Horizon 2020 Framework, and the Hong Kong Research Grant Council, and personal fees from IQVIA Holdings, outside the submitted work. AH has received compensation for serving as consultant or speaker for Shire–Takeda and Medice, unrelated to this work. TB served in an advisory or consultancy role for Eyelevel, Infectopharm, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg, Roche, and Takeda; received conference support or speaker's fee from Jansen, Medice, and Takeda; and royalities from Hogrefe, Kohlhammer, CIP Medien, and Oxford University Press; outside the submitted work. JB has been in the past 3 years a consultant, member of advisory board, or speaker for Takeda–Shire, Roche, Medice, Angelini, Janssen, and Servier. SC reports collaboration on projects from the EU Seventh Framework Programme and on clinical trials sponsored by Shire Pharmaceutical Company, Lundbeck, Otsuka, Janssen-Cilag, and Angelini. MD has received research funding from Takeda–Shire, outside the submitted work. RWD has received compensation for serving as consultant or speaker, or he or the institution he works for have received research support or royalties from: EU Seventh Framework Programme, US National Institute of Mental Health (NIMH), German Federal Ministry of Health–Regulatory Agency, German Federal Ministry of Education and Research, German Research Foundation, Volkswagen Foundation; Boehringer Ingelheim, Ferring, Janssen-Cilag, Lilly, Lundbeck, Otsuka, Servier, Shire, Sunovion–Takeda, and Theravance. He was a former employee in clinical CNS research of Eli Lilly until Aug 2008, and owns Eli Lilly stock (small part of the respective annual salary). BF has been a consultant or speaker for Abbvie, Actelion, Allergan, Almirall, Alnylam, Amgen, Astellas, Astrazeneca, Bayer, Biogen, Biopecs, Bioproject, Biotronik, BMS, Boehringer, Celgène, Daiichi-Sankyio, Ethypharm, Forestlab, Genevrier, Genzyme, Gilead, Grünenthal, GSK, Idorsia, IMS, Indivior, IQVIA, JNJ, Léo, Lilly, Lundbeck, Menarini, MSD, Novartis, Novonordisk, Otsuka, Pfizer, Pierre-Frabre, Recordati, Roche, SANOFI, Servier, Takeda, UCB, ViiV, and Wellmera. CH reports research funding from the NIHR including the Health Technology Assessment SATURN trial (grant ref: NIHR128472) comparing methylpheidate with guanfacine for children and young people with ADHD and tics. CH was chair of the NICE Guideline (CG155) for psychosis and schizophrenia in children and young people; member of the NICE ADHD Guideline Update committee (NG87) and is a member of Eunethydis and the Europhean ADHD Guideline Group. SM reports speaker's fee, travel support, and research support from Shire, outside the submitted work. AN reports research funding from the EU, the German Ministry of Health, and the German Federal Joint Committee, outside the submitted work. PN has been a consultant or speaker for Medice, Servier, and Egis Pharmaceuticals, outside the submitted work. ER received speaker's fee and travel support from Shire, outside the submitted work. ESB has received in the last 3 years speakers fees from Takeda and Medice and research support from QBTech. AZ served in an advisory or consultancy role for Angelini, EduPharma, Servier; received conference support or speaker's fee from Angelini and Janssen; participated in clinical trials conducted by Angelini, Janssen, Lundbeck, Otsuka, Roche, Sevier, and Shire; and received royalties from Giunti OS and Oxford University Press. ICKW reports research and educational funding from Amgen, Bristol Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, Takeda, the Hong Kong Research Grants Council, the Hong Kong Health and Medical Research Fund, the Hong Kong Innovation and Technology Commission, the NIHR, the EU, and the Australian National Health and Medical Research Council, and the expert testimony payment from the Hong Kong Court of Final Appeal; outside the submitted work. DC reports, in the past 3 years, a consultant, member of advisory board, or speaker role for Takeda–Shire, Medice, Novartis, and Servier. He has received royalties from Oxford University Press and Cambridge University Press; research support from the Australian National Health and Medical Research Council and the Royal Children's Hospital Foundation; and funding for the current study from the European Commission. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Adolescents with attention deficit hyperactivity disorder (ADHD) experience a more disrupted sleep and more sleep problems compared with typically developing adolescents. This is particularly concerning, because disrupted sleep is related to worsened clinical, neurocognitive and functional outcomes and leads to increased ADHD symptom impairment. Due to the specific difficulties adolescents with ADHD experience, a tailored sleep treatment is needed. Therefore, our lab developed a cognitive behavioural treatment-Sleep IntervEntion as Sympom Treatment for ADHD (SIESTA)-that integrates sleep training with motivational interviewing, and planning/organisational skills training with the aim of improving sleep problems in adolescents with ADHD., Methods and Analysis: A randomised, controlled, investigator-blinded monocentre trial is used to test whether SIESTA in combination with treatment as usual (TAU) for ADHD results in greater improvement in sleep problems than TAU only. Adolescents (aged 13-17 years) with ADHD and sleep problems are included. They complete measurements before treatment (pre-test), approximately 7 weeks after the pre-test (post-test), and approximately 3 months after the post-test (follow-up). The assessment includes questionnaires filled out by adolescents, parents and teachers. Additionally, sleep is assessed by actigraphy and sleep diaries at all time-points. Primary outcomes include objectively and subjectively measured sleep architecture (specified as total sleep time, sleep onset latency, sleep efficiency and number of awakenings), subjectively measured sleep problems and sleep hygiene. Secondary outcomes include ADHD symptoms, comorbidities and functional outcomes. To analyse the data, a linear mixed effects model will be used with an intent-to-treat approach., Ethics and Dissemination: The study activities, informed consent and assent forms have been approved by the Ethical Committee Research UZ/KU Leuven (study ID S64197). If proven effective, the intervention will be implemented throughout Flanders. Therefore, an advisory board consisting of societal partners in healthcare is appointed at the start of the project, giving advice throughout the project and assistance with implementation afterwards., Trial Registration Number: NCT04723719., Competing Interests: Competing interests: MD is participating in a Takeda-sponsored clinical trial in attention deficit hyperactivity disorder. All other authors have no conflict of interest., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This meta-analysis assesses cognitive functioning in children with acute lymphoblastic leukemia post-treatment who were treated with either chemotherapy-only (CT-only) or in combination with radiation therapy (CTRT)., Methods: The databases Pubmed and PsychInfo were searched between 1-1-2000 and 31-12-2021. Data were analyzed using Comprehensive Meta-Analysis (version 2)., Results: Mean weighted intelligence after treatment was 100.2 (number of studies n = 51, 95% CI: 98.8-101.5). For CT-only, it was 100.8 (95% CI: 99.5-102.2) and for CTRT 97.8 (95% CI: 95.9-100.2). Compared to recruited healthy controls, treated children had on average lower IQ scores (n = 23, mean difference -7.8, 95% CI: -10.7 to -5.0, p < 0.001). When looking only at studies using controls recruited from the patient's family, results remained significant (n = 5, mean difference -6.0, 95% CI: -8.6 to -3.5, p = 0.001). Meta-regressions aimed at identifying predictors of IQ after treatment failed to find an effect for sex or age. We could demonstrate an effect of time between diagnosis and IQ measurement for the CTRT treated patient (B = -0.26, 95% CI: -0.40 to -0.1, p = 0.002)., Conclusions: IQ scores of patients treated with CT-only or CTRT treatment regimens did not differ from the normative population. However, compared to recruited control groups, patients showed lower mean IQ scores. The Flynn effect and/or selection effects may play a role in this discrepancy. Considering time since diagnosis may have a significant impact on IQ, at least in CTRT treated patients, long-term clinical follow-up of neurocognitive development may be prudent to detect possible (late) neurocognitive effects., (© 2023 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.)

Background: Adolescence is characterized by an increase in the rate of sleep problems, which might be even more pronounced in adolescents with ADHD. This systematic review with meta-analysis aimed to compare sleep in adolescents with and without ADHD, including sleep parameters, both subjectively and objectively measured, sleep problems and sleep hygiene., Methods: Medline, CINAHL, PsycINFO, EMBASE, ERIC, Web of Science, and PubMed databases were searched for studies with case-control designs (published between 1980 and 2022) directly comparing sleep in adolescents (12-25 years) with ADHD to typically developing controls. Standardized mean differences were calculated and a random-effects model was implemented using RevMan., Results: Overall, 6974 titles/abstracts and 205 full texts were screened, resulting in 13 eligible studies. The sample sizes range from 35 to 9846 with in total 2465 adolescents with ADHD and 18,417 controls. The data suggests that adolescents with ADHD report significantly more disturbed subjective sleep parameters (e.g., total sleep time; n  = 7, SMD = 0.47, p  < .001) and experience more sleep problems compared to typically developing peers (e.g., daytime sleepiness; n  = 5, SMD = 0.54, p  = .01). Only few studies objectively measured sleep and no significant differences were found between both groups ( n  = 3) in any parameter. Differences in sleep hygiene could not be examined due to a limited number of studies., Conclusions: Adolescents with ADHD report significantly worsened subjectively sleep parameters and more sleep problems compared to controls. These findings are still preliminary as a limited number of studies was identified. Nevertheless, it is advised to routinely include sleep assessment in the ADHD diagnostic process. More research is needed with a focus on objective measurement and sleep hygiene in ADHD., Competing Interests: MD is participating in a Takeda‐sponsored clinical trial in ADHD. SC serves on the JCPP Advances Editorial Advisory Board. SC declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non‐profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. The remaining authors have declared that they have no competing or potential conflicts of interest., (© 2023 The Authors. JCPP Advances published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Hereditary connective tissue disorders are a broad group of congenital disorders that are characterized by a pathological weakness of the connective tissue as a result of an incorrect genesis, leading to multisystem complaints. We describe a 14-year-old patient with the hereditary connective tissue disorder Loeys-Dietz syndrome who was admitted to a child psychiatric crisis unit because of depressive and anxiety symptoms. A systematic literature search was carried out to analyze the prevalence of depressive and anxiety symptoms in individuals with hereditary connective tissue disorders Loeys-Dietz syndrome, Ehlers-Danlos syndrome and Marfan syndrome, to identify a possible association between these disorders and explanations for this. We conclude that there is an increased incidence of depression and anxiety symptoms in which pain, fatigue, social support and functioning, quality of life and functional limitations seem to play a role. There is a need for further research to determine exactly which factors contribute and how these can be targeted in prevention and treatment.

Background: The ADHD care path (www.ADHD-traject.be) is a web tool that provides evidence-based advice for the diagnosis and treatment of ADHD according to the standards for certified care instruments. An update of the 2016 instrument was imminent., Aim: This study aims to test the content of the care path against (inter)national quality guidelines and to update them to meet the current transparency requirements., Method: Part A consisted of a systematic literature search performed (PRISMA ) to identify (clinical) guidelines for ADHD and to assess their quality with the AGREE II instrument. Part B consisted of two phases: a full clinical content update based on the results from Part A, followed by a peer review.., Results: Of the 29 guidelines identified, 12 met the pre-established inclusion criteria, of which 2 were excluded from part B of the study after quality assessment. Numbered endnotes made a direct link between the international guidelines and the advice in the care path, clinical content changes were made, then a consensus version was reached through peer review., Conclusion: This is the first scientific contribution reporting on the update of a care instrument based on both a systematic literature review and a peer review with transparency on the clinical content changes. Based on this, the care path was certified according to the Belgian CEBAM standards.

Introduction: Maternal postnatal mental health problems may negatively impact child development. Postpartum research has mainly focused on the impact of maternal depression and anxiety due to their high prevalence (13-25 % and 10-18 %, respectively). However, maternal childbirth-related PTSD (CB-PTSD) could be another important risk factor in child development (estimated prevalence: 4.7 %)., Objective: We investigated whether maternal CB-PTSD (symptoms) are associated with a negative mother-child relationship and/or child developmental outcome for children aged 0-5 years. Furthermore, we examined whether maternal trauma-focused therapy can positively impact mother and child outcomes., Methods: We performed a systematic review by searching three databases (Embase, Medline, PsycInfo). Search terms involved: 'birth or delivery modes', 'PTSD psychological trauma', and 'child development or child behavior'. Two independent reviewers evaluated all eligible papers., Results: Thirty-five papers (30 samples) were included and qualitatively reported. Results suggest a negative association of maternal CB-PTSD (symptoms) with mother-infant attachment and child behavior. However, confounding factors may explain this association. The evidence on associations with breastfeeding, sleeping, socio-emotional development, and weight gain is insufficient. Research investigating the effect of maternal trauma-focused therapy on a child's outcome is scarce, contradictory, and of low quality., Conclusion: This systematic review suggests that maternal CB-PTSD may be associated with an increased number of problems in mother-infant attachment and child behavior, but other domains remain scarcely investigated and methodologic issues are present (cross-sectional study design, influence of confounding variables, sample representativeness, diversity in assessment tools). Our results support a multidisciplinary approach to providing early prevention and screening of the maternal mental health state., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objectives: This study aimed to describe the differences and similarities in the reaction of the healthcare worker involved in a patient safety incident or during the COVID-19 pandemic. We also compared the differences in support they need., Methods: A secondary data analysis was performed based on 2 cross-sectional survey studies. One study evaluated the impact of patient safety incidents on healthcare professionals, and the other evaluated the impact of COVID-19. Measurements on mental health reactions and an evaluation of the experienced support system were compared between 883 doctors and 1970 nurses working in different hospitals., Results: Anxiety, difficulties concentrating, doubting knowledge and skills, feeling on their own, feeling unhappy and dejected, feeling uncertain in team, flashbacks, hypervigilance, sleep deprivation, stress and wanting to quit profession were statistically higher in the COVID-19-related groups. Second victims tend to speak about it with their own/close colleagues, whereas healthcare workers working during the COVID-19 pandemic talk more often to their partner and friends. Only a small number talked to a psychologist, but the number who needed to talk to a psychologist but did not is higher than the number who did talk to a psychologist or used professional support in all 5 groups., Conclusions: The impact of the COVID-19 pandemic on the mental health of healthcare workers is larger than after being involved in a patient safety incident. There is the need for an adequate support system, and the mental health of all healthcare workers needs to be considered. Partners and friend play a more important role in the support experienced during the COVID-19 pandemic, and there is an important need for professional help., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Motivation is what moves us to act, what engages us in goal-directed behavior. The Self Determination Theory (SDT) is a motivational framework conceptualizing motivation-or internal motives-as a continuum of motivation qualities fueled by satisfaction of the three basic psychological needs Autonomy, Relatedness, and Competence. ADHD has been associated with motivational alterations that contribute to academic difficulties. However, ADHD theories and research are mainly focused on the effects of reinforcement on behavior, with little attention for the broader definition of motivation, that is, internal motives. Therefore, the main objective here was to introduce the SDT as theoretical framework within which we can develop relevant research questions about motivation in the field of ADHD., Method: To this end, we (i) present the SDT as a comprehensive motivational framework, and (ii) describe current motivation-related ADHD theories and research., Results: Based on this, we suggest how SDT can be used as a guiding framework in generating relevant research questions that can help broaden our understanding of the role motivation plays in individuals with ADHD., Conclusion: We conclude that ADHD research on motivation would benefit from (i) including internal motives as potential key mediators in the relation between environmental factors and behavior/symptoms; (ii) studying potential negative effects of external reinforcers intrinsic motivation, affect, and well-being. Finally, we conclude that this framework carries value for further development of clinical interventions for those with ADHD.

Functional magnetic resonance imaging studies have reported a diminished response in the brain's reward circuits to contingent cues predicting future monetary gain in adolescents with attention-deficit/hyperactivity disorder (ADHD). The situation with regard to monetary loss is less clear, despite recognition that both positive and negative consequences impact ADHD behaviour. Here, we employ a new Escape Monetary Loss Incentive task in an MRI scanner, which allows the differentiation of contingency and valence effects during loss avoidance, to examine ADHD-related alterations in monetary loss processing. There was no evidence of atypical processing of contingent or non-contingent monetary loss cues in ADHD - either in terms of ratings of emotional and motivational significance or brain responses. This suggests that the ability to process contingencies between performance and negative outcomes is intact in ADHD and that individuals with ADHD are no more (or less) sensitive to negative outcomes than controls. This latter finding stands in stark contrast to recent evidence from a similar task of atypical emotion network recruitment (e.g. amygdala) in ADHD individuals to cues predicting another negative event, the imposition of delay, suggesting marked specificity in the way they respond to negative events., (© The Author(s) 2021. Published by Oxford University Press.)

Background: Leukemia is the most common pediatric malignancy. Acute lymphoblastic leukemia (ALL) is the most commonly observed subtype., Aim: To assess cognitive functioning in children and adolescents with ALL post-treatment: chemotherapy-only (CT-only) or in combination with radiation therapy (CTRT). METHODS We searched in PubMed and PsycINFO (OvidSP). Relevant data were analyzed using statistical program Comprehensive Meta-Analysis (version 2)., Results: 44 studies were included in the overall meta-analysis with a total of 5059 patients. A weighted mean IQ of 100.1 (95% CI 99.1-101.0) was found overall after ALL treatment. In subanalyses, we found for CT-only a weighted mean IQ of 100.7 (95% CI: 99.5-101.9) and for CTRT-treatment a weighted mean IQ of 98.2 (95%100.7 (95% CI: 96.3-100.3). There was no significant difference from the normative control (mean: 100.0; SD: 15)., Conclusion: No significant cognitive sequelae were shown in childhood survivors of leukemia who were exposed to either CT-only or CTRT therapy. Prospective studies are needed with inclusion of pre-and post-treatment IQ measurements, ideally compared to age and socio-economic status matched control groups.

Objective: Although instrumental learning deficits are, among other deficits, assumed to contribute to attention-deficit/hyperactivity disorder (ADHD), no comprehensive systematic review of instrumental learning deficits in ADHD exists. This review examines differences between ADHD and typically developing (TD) children in basic instrumental learning and the effects of reinforcement form, magnitude, schedule, and complexity, as well as effects of medication, on instrumental learning in children with ADHD., Method: A systematic search of PubMed, PsyINFO, CINAHL, EMBASE+EMBASE CLASSIC, ERIC, and Web of Science was conducted for articles up to March 16, 2020. Experimental studies comparing instrumental learning between groups (ADHD versus TD) or a manipulation of reinforcement/medication within an ADHD sample were included. Quality of studies was assessed with an adapted version of the Hombrados and Waddington criteria to assess risk of bias in (quasi-) experimental studies., Results: A total of 19 studies from among 3,384 non-duplicate screened articles were included. No difference in basic instrumental learning was found between children with ADHD and TD children, nor effects of form or magnitude of reinforcement. Results regarding reinforcement schedule and reversal learning were mixed, but children with ADHD seemed to show deficits in conditional discrimination learning compared to TD children. Methylphenidate improved instrumental learning in children with ADHD. Quality assessment showed poor quality of studies with respect to sample sizes and outcome and missing data reporting., Conclusion: The review identified very few and highly heterogenous studies, with inconsistent findings. No clear deficit was found in instrumental learning under laboratory conditions. Children with ADHD do show deficits in complex forms of learning, that is, conditional discrimination learning. Clearly more research is needed, using more similar task designs and manipulations., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Negative reinforcement processes allow individuals to avoid negative and/or harmful outcomes. They depend on the brain's ability to differentiate; (i) contingency from non-contingency, separately from (ii) judgements about positive and negative valence. Thirty-three males (8-18 years) performed a cued reaction-time task during fMRI scanning to differentiate the brain's responses to contingency and valence during loss avoidance. In two conditions, cues indicated no -contingency between participants' responses and monetary loss - (1) CERTAIN LOSS (negative valence) of €0.20, €1 or €5 or (2) CERTAIN LOSS AVOIDANCE (positive valence). In a third condition, cues indicated a contingency between short reaction times and avoidance of monetary loss. As expected participants had shorter reaction times in this latter condition where CONDITIONAL LOSS AVOIDANCE cues activated salience and motor-response-preparation brain networks - independent of the relative valence of the contrast (CERTAIN LOSS or CERTAIN LOSS AVOIDANCE). Effects of valence were seen toward the session's end where CERTAIN LOSS AVOIDANCE cues activated ventral striatum, medial-orbitofrontal cortex and medial-temporal areas more than CERTAIN LOSS. CONDITIONAL LOSS AVOIDANCE trials with feedback indicating "success" activated ventral striatum more than "failure feedback". The findings support the hypothesis that brain networks controlling contingency and valence processes during negative reinforcement are dissociable., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Excessive crying and sleep problems affect up to 30% of infants and often coexist. Although usually benign and self-limiting, persistent crying, and sleep problems exceeding 6 months of age need attention as they may impair the mental health of the infant and its family. The source and the impact of these persistent regulatory problems is often not restricted to the infant, but extends to the parents and the parent-infant relationship. Clinical practice needs interdisciplinary and multi-method interventions focusing beyond regulatory problems of the infant but also on parental self-regulation and parent's co-regulatory responses toward the infant. Treating clinicians may encounter limitations of home-visits, outpatient, and pediatric residential settings when working with families in distress. We describe an infant mental health day-clinic treatment, drawing attention to this viable future direction. It offers a therapeutic climate based on forming a triangle of co-regulation between clinician, parent and infant to first help the parent and the infant settle down. This stress reduction restores parent-infant connectedness and parental learning and reflecting capacity. Clinicians then use established therapeutic modalities to support parental self- and co-regulatory skills which is important for the development of self-regulation in the infant. Experience with this treatment program suggests that a day-clinic setting facilitates interdisciplinary and integrative multi-method intervention, infant and parental stress reduction and integration of parental self- and co-regulatory skills in daily family life, improving overall outcomes. This perspective warrants further investigation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Singh, Danckaerts and Van den Bergh.)