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Background: Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth. Methods: Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers. Results: Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population. Conclusions: Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services. [ABSTRACT FROM AUTHOR]

This study aimed to explore the potential mediating role of sleep quality in the effect of physical activity (PA) intervention for improving executive functions (EFs) in children with attention-deficit hyperactivity disorder (ADHD). Participants aged 6 to 12 years old with a formal ADHD diagnosis were recruited from a local hospital. A total of 80 eligible children with ADHD were randomized to an intervention group for 12 consecutive weeks of PA training (three times per week, 60 min per session) (n = 40; Mage = 8.37, 75% boys) or a wait-list control group (n = 40; Mage = 8.29, 80% boys). Three core EFs (inhibitory control, working memory, and cognitive flexibility) were assessed by neurocognitive tasks, and sleep quality was measured by the Chinese version of the Pittsburgh Sleep Quality Index. The bootstrapping method was used to test PA intervention effects on EFs and on potential variables of sleep quality after intervention and to test whether there were indirect effects of the intervention on EFs via mediators of sleep. The results showed that the PA intervention had a direct effect on sleep latency reduction (β = − 0.26, 95%CI − 0.47 to − 0.06) and cognitive flexibility improvement (decrease in completion time) (β = − 0.30, 95%CI − 0.50 to − 0.09). Furthermore, change in sleep latency significantly mediated the effects of PA intervention on cognitive flexibility (β = − 0.084, 95%CI − 0.252 to − 0.001). The findings suggest that sleep latency could be a crucial behavioral mediator of PA intervention in improving cognitive flexibility among children with ADHD. [ABSTRACT FROM AUTHOR]

Growing evidence indicates that family-based mind-body therapy programs (FMBTs) act as an important alternative for attention-deficit/hyperactivity disorder (ADHD) treatment in the youth with minimal side-effects. Moreover, FMBTs contribute to improving the family functioning of those affected by ADHD. To summarize and analyze the benefits and mechanisms, an extensive literature search of the EBSCOhost, PubMed, Web of Science, and Scopus databases was conducted to identify eligible studies. Fifteen studies published between 2010–2023 were reviewed. The included FMBTs were implemented with 850 children/adolescents and 996 parents/caregivers, of whom 201 parent couples attended the programs together with their children. All included FMBTs adopted mindfulness/meditation as the core practice to enhance the participants' mental focus and attention, and were designed for long-term engagement, with six including parent–child joint session(s). Positive changes were observed in both children and adolescents, including improvements in ADHD symptoms, behavioral problems, executive function, and school performance. Additionally, parents experienced positive changes in ADHD traits/symptoms, mental health, and parenting behaviors. Furthermore, FMBTs were found to enhance family functioning by delivering mindful strategies to family, restoring psychological capacity and interpersonal skills in family members, and improving parent–child relationships. The reviewed FMBTs demonstrated high levels of feasibility and participant satisfaction. The factors and issues potentially influencing the effectiveness and feasibility of FMBTs are also discussed. The findings indicate that FMBT holds promise as an ADHD treatment option in home settings. Future efforts may focus on optimizing the design of FMBTs to better address the diverse needs of families in varying circumstances. [ABSTRACT FROM AUTHOR]

Evidence of inequality in the utilisation of mental health care (MHC) by adolescents in Nordic countries is mixed. This study aims to investigate if there are socioeconomic differences in the utilisation of MHC, while accounting for adolescents' mental health status. We analysed a cohort of 3517 adolescents, followed from 7 to 9th grade (ages 13–16), to examine the association between parental socioeconomic position (SEP: education and disposable income), adolescents' estimated needs, and the utilisation of MHC (defined as visits to secondary psychiatric care or receipt of psychotropic medication). Logistic and negative binomial regression models, with mental health status as moderator, were used to predict utilisation during each grade. Lower SEP predicted higher odds of utilising MHC in adolescents with no/mild symptoms (e.g., odds ratio, OR = 1.33, 95% CI 1.04–1.72, lower vs highest education), but not in those with moderate-to-severe symptoms (estimates close to one and non-significant). This pattern was largely explained by treatment of attention deficit hyperactivity disorder/autism spectrum disorders (ADHD/ASD) in boys. For girls with severe symptoms, lower SEP predicted reduced odds of utilising MHC for other mental disorders (OR = 0.48, 95% CI 0.25–0.92, lower education), and fewer outpatient visits when in contact with such care, although non-significant (incidence rate ratio, IRR = 0.51, 95% CI 0.25–1.05, lowest vs highest income). Our findings suggest a more equitable use of MHC for treating ADHD/ASD, but not other mental disorders such as depression and anxiety, particularly among girls. [ABSTRACT FROM AUTHOR]

Objective: Child-oriented psychotherapies, such as Attention Process Training (APT), target ADHD symptoms directly, whereas family-oriented interventions, like Parent Management Training (PMT), address its functional impairments. The aim of this study was to compare the effectiveness of APT and PMT in treating ADHD symptoms. Method: This research was a randomized controlled trial in which 45 children (26 females and 19 males, with a mean age of 8.47 ± 1.66 years) with ADHD were selected conveniently and assigned randomly to one of three groups (PMT = 15, APT = 15, and CTRL = 15). The groups had no significant differences in ADHD severity. The PMT children were managed with parenting techniques. Children in the APT group practiced attention techniques, while children in the control group did not receive any intervention. Ritalin was prescribed to all the children in the three groups. The score on the Conners Parenting Rating Scale-Revised: Short form was the outcome variable. Results: Both interventions decreased ADHD symptoms severity more than the control group. Howver, the reduction in the APT group was more than in the PMT group (P-value < 0.001). The scores of 40% of the APT group and 80% of the PMT group did not fall below the cut-off point. In the APT group after the intervention, the inattention subscale was significantly lower than the hyperactivity subscale, while in the PMT group, the hyperactivity subscale was lower. The effect sizes of APT and PMT were 2.18 and 2.09, respectively. Conclusion: For ADHD, psychological interventions are crucial in addition to medication. According to the results of this study, APT is more effective for inattention symptoms, while PMT is more effective for hyperactivity symptoms. When selecting psychotherapy, the subtype of ADHD should be taken into account. Treatment sessions must also be completed according to intervention protocols. [ABSTRACT FROM AUTHOR]

Background: Integrating behavioral health services into pediatric primary care can improve access to care, especially for children marginalized by poverty and racial/ethnic minority status. In primary care, a common presenting concern is attention-deficit/hyperactivity disorder (ADHD). Services in primary care for marginalized children with ADHD typically include medication alone; therapy to improve skills and build relationships is less available. This study evaluates the effectiveness of a behavioral intervention offered through primary care for marginalized families coping with ADHD (Partnering to Achieve School Success, PASS) compared to treatment as usual (TAU). Method: Three hundred participants will be randomly assigned to PASS or TAU. Participants include children ages 5 to 11 who have ADHD and are from economically marginalized families. PASS is a personalized, enhanced behavioral intervention that includes evidence-based behavior therapy strategies and enhancements to promote family engagement, increase caregiver distress tolerance, and provide team-based care to improve academic and behavioral functioning. TAU includes services offered by primary care providers and referral for integrated behavioral health or community mental health services. Outcomes will be assessed at mid-treatment (8 weeks after baseline), post-treatment (16 weeks), and follow-up (32 weeks) using parent- and teacher-report measures of service use, child academic, behavioral, and social functioning, parenting practices, family empowerment, and team-based care. Mixed effects models will examine between-group differences at post-treatment and follow-up. Analyses will examine the mediating role of parenting practices, family empowerment, and team-based care. Subgroup analyses will examine differential effects of intervention by child clinical characteristics and socioeconomic factors. Discussion: This study is unique in targeting a population of children with ADHD marginalized by low socioeconomic resources and examining an intervention designed to address the challenges of families coping with chronic stress related to poverty. Trial registration: This study was registered on clinicaltrials.gov (NCT04082234) on September 5, 2019, prior to enrollment of the first participant. The current version of the protocol and IRB approval date is October 4, 2023. Results will be submitted to ClinicalTrials.gov no later than 30 days prior to the due date for the submission of the draft of the final research report to the Patient-Centered Outcomes Research Institute. [ABSTRACT FROM AUTHOR]

Traditional pharmacological treatments, although effective, often carry potential side effects, which positions art therapy and music therapy as promising non-pharmacological alternatives to alleviate symptoms and improve social, cognitive, and emotional skills without the associated risks. Through a review in the SCOPUS and WOS databases following the PRISMA protocol, a total of 80 articles were analyzed through a series of determined categories and subcategories of analysis. The aim of this study is to evaluate and synthesize the existing evidence on the efficacy and applicability of art therapy and music therapy in the treatment of children with autism spectrum disorder (ASD), hyperactivity disorder (HSDD), developmental language disorders, and language learning difficulties, identifying best practices and key areas for future research. Among the main findings is that art therapy and music therapy have a significant impact on symptomatology, behavior, and communication as well as social, cognitive, and emotional skills in the pediatric populations studied. These therapies are highly valued by the participants with a large majority recognizing their adaptability to different educational and clinical contexts. It is concluded that these therapies have a high potential as viable alternatives or complements to traditional pharmacological treatments, justifying their application and further study in broader therapeutic contexts. [ABSTRACT FROM AUTHOR]

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Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder characterized by impairing inattention and/or hyperactivity and impulsivity in children and adults. Although medications have been available to treat ADHD symptoms for decades, many are stimulant formulations. Stimulants, such as amphetamine and methylphenidate, are available in more than two dozen formulations, but all have similar adverse effects and carry a risk of misuse and dependence. In the United States (US), several nonstimulants are available to treat ADHD. Two, including atomoxetine and viloxazine extended-release (ER), are approved by the Food and Drug Administration for the treatment of ADHD in children and adults. Two others, clonidine ER and guanfacine ER, are only approved for children and adolescents in the US. Several other compounds are under investigation. Drugs in Phase 3 trials include centanafadine, solriamfetol, and L-threonic acid magnesium salt. Efficacy and safety data for nonstimulants is presented. Although many effective formulations for the treatment of ADHD are available, more than 33% of children and 50% of adults discontinue treatment during the first year. The lack of individual drug response and tolerability are reasons many stop treatment. The development of new nonstimulants may offer hope for patients who need medication alternatives. [ABSTRACT FROM AUTHOR]

Context: Effective treatment of attention-deficit/hyperactivity disorder (ADHD) is essential to improving youth outcomes. Objectives: This systematic review provides an overview of the available treatment options. Data sources: We identified controlled treatment evaluations in 12 databases published from 1980 to June 2023; treatments were not restricted by intervention content. Study selection: Studies in children and adolescents with clinically diagnosed ADHD, reporting patient health and psychosocial outcomes, were eligible. Publications were screened by trained reviewers, supported by machine learning. Data extraction: Data were abstracted and critically appraised by 1 reviewer and checked by a methodologist. Data were pooled using random-effects models. Strength of evidence and applicability assessments followed Evidence-based Practice Center standards. Results: In total, 312 studies reported in 540 publications were included. We grouped evidence for medication, psychosocial interventions, parent support, nutrition and supplements, neurofeedback, neurostimulation, physical exercise, complementary medicine, school interventions, and provider approaches. Several treatments improved ADHD symptoms. Medications had the strongest evidence base for improving outcomes, including disruptive behaviors and broadband measures, but were associated with adverse events. Limitations: We found limited evidence of studies comparing alternative treatments directly and indirect analyses identified few systematic differences across stimulants and nonstimulants. Identified combination of medication with youth-directed psychosocial interventions did not systematically produce better results than monotherapy, though few combinations have been evaluated. Conclusions: A growing number of treatments are available that improve ADHD symptoms and other outcomes, in particular for school-aged youth. Medication therapies remain important treatment options but are associated with adverse events. [ABSTRACT FROM AUTHOR]

Background: This study examines the cognizance and perception of physiotherapy intervention in ADHD amongst clinical physiotherapy students in a tertiary institution and, also, determines the relationship of the study variables on the socio-demographic characteristics. Methods: This study is a cross-sectional survey and employed a convenient sampling technique to recruit 137 respondents. A cognizance and perception questionnaire was used as the survey instrument to obtain data. Descriptive statistics of frequency, mean, and standard deviation were used to analyse the socio-demographic characteristics. Spearman rank correlation was used to analyse the relationship amongst the variables of cognizance of attention-deficit/hyperactivity disorder (COG-ADHD), perception of attention-deficit/hyperactivity disorder (PERCEP-ADHD), cognizance of physiotherapy intervention (COG-PT_ITV), and perception of physiotherapy intervention (PERCEP-PT_ITV). The Mann-Whitney U test was used to test the influence of socio-demographic characteristics of age and the level of study on the cognizance and perception of ADHD. Variables having a p-value < 0.05 were considered statistically significant. Result: The majority of the respondents (63.5%) had high cognizance of physiotherapy intervention for ADHD, while the majority of the respondents (60.6%) had a fair perception of physiotherapy intervention for ADHD. A significant proportion of respondents (26.3%) had no source of information on ADHD before the study. Cognizance of ADHD significantly correlated with perception of ADHD, ADHD, perception of physiotherapy intervention in ADHD, and cognizance of physiotherapy intervention in ADHD. There were significant positive correlations between gender and cognizance of physiotherapy intervention in ADHD and between the level of study and perception of ADHD. Conclusion: Respondent's perception of physiotherapy intervention in ADHD was relatively low; in contrast, their cognizance was relatively satisfactory. Strengthening their cognizance and perception is paramount. [ABSTRACT FROM AUTHOR]

This study explores the integration of large language models (LLMs), like ChatGPT, to improve attention deficit hyperactivity disorder (ADHD) treatments. Utilizing the Delphi method for its systematic forecasting capabilities, we gathered a panel of child ADHD therapy experts. These experts interacted with our custom ChatGPT through a specialized interface, thus engaging in simulated therapy scenarios with behavioral prompts and commands. Using empirical tests and expert feedback, we aimed to rigorously evaluate ChatGPT's effectiveness in therapy settings to integrate AI into healthcare responsibly. We sought to ensure that AI contributes positively and ethically to therapy and patient care, thus filling a gap in ADHD treatment methods. Findings show ChatGPT's empathy, adaptability, and communication strengths, thereby highlighting its potential to significantly improve ADHD care. The study points to ChatGPT's capacity to transform therapy practices through personalized and responsive patient care. However, it also notes the need for enhancements in privacy, cultural sensitivity, and interpreting nonverbal cues for ChatGPT's effective healthcare integration. Our research advocates for merging technological innovation with a comprehensive understanding of patient needs and ethical considerations, thereby aiming to pioneer a new era of AI-assisted therapy. We emphasize the ongoing refinement of AI tools like ChatGPT to meet ADHD therapy and patient care requirements more effectively. [ABSTRACT FROM AUTHOR]

Objectives: Approximately 30% of children diagnosed with attention-deficit/hyperactivity disorder (ADHD), the most prevalent mental health disorder in children worldwide, do not respond to conventional pharmaceutical treatments. Previous studies of homeopathic treatment for ADHD have been inconclusive. The objectives of this study were to determine if there (a) is an overall effect of homeopathic treatment (homeopathic medicines plus consultation) in the treatment of ADHD; (b) are any specific effects the homeopathic consultation alone in the treatment of ADHD; and (c) are any specific effects of homeopathic medicines in the treatment of ADHD. Design: The design was a randomized double-blind placebo-controlled clinical trial. Setting/Location: Toronto, Canada. Subjects: Children aged 6–16 years diagnosed with ADHD. Interventions: Participants were randomized to one of three arms: Arm 1 (Remedy and Consultation); Arm 2 (Placebo and Consultation); or Arm 3 (Usual Care). Outcome Measures: Primary Outcome was the change of CGI-P T score between baseline and 28 weeks. Results: There was an improvement in ADHD symptoms as measured by the Conner 3 Global Index-Parent T-score in the two groups (Arms 1 and 2) that received consultations with a homeopathic practitioner when compared with the usual care control group (Arm 3). Parents of the children in the study who received homeopathic consultations (Arms 1 and 2) also reported greater coping efficacy compared with those receiving usual care (Arm 3). There was no difference in adverse events among the three study arms. Conclusions: In this study, homeopathic consultations provided over 8 months with the use of homeopathic remedy was associated with a decrease in ADHD symptoms in children aging 6–16 years when compared with usual treatment alone. Children treated with homeopathic consultations and placebo experienced a similar decrease in ADHD symptoms; however, this finding did not reach statistical significance when correcting for multiple comparisons. Homeopathic remedies in and of themselves were not associated with any change in ADHD symptoms. Clinical Trial Registration: This trial was registered on ClinicalTrials.gov; NCT02086864. [ABSTRACT FROM AUTHOR]

Background: Limited research exists regarding the effectiveness of electroencephalogram (EEG) neurofeedback training for children with cerebral palsy (CP) and co‐occurring attention deficits (ADs), despite the increasing prevalence of these dual conditions. This study aimed to fill this gap by examining the impact of neurofeedback training on the attention levels of children with CP and AD. Methods: Nineteen children with both CP and co‐occurring ADs were randomly assigned to either a neurofeedback or control group. The neurofeedback group received 20 sessions of training, lasting approximately 1 h per day, twice a week. Theta/beta ratios of the quantitative electroencephalography (QEEG) recordings were measured pre‐training and post‐training in the resting state. The Continuous Performance Test (CPT), the Test of Visual Perceptual Skills—3rd Version (TVPS‐3) and the Conners' Parent Rating Scale (CPRS) were measured at pre‐ and post‐training. Results: The neurofeedback group showed both decreased theta/beta ratios compared with control group (p = 0.04) at post‐training and a within‐group improvement during training (p = 0.02). Additionally, the neurofeedback group had a trend of decreased omission rates of the CPT (p = 0.08) and the visual sequential memory and the visual closure subscores in the TVPS‐3, compared with the control group (p = 0.02 and p = 0.01, respectively). Conclusions: The results suggested that children with CP and co‐occurring AD may benefit from neurofeedback training in their attention level. Further research is needed to explore long‐term effects and expand its application in this population. [ABSTRACT FROM AUTHOR]

Past research suggests behavioral treatments are effective for challenging behavior in children and young adults with neurodevelopmental disorders, such as autism spectrum disorder (ASD). However, access to these services can be limited and require substantial resources. To address this issue, the current study provides a programmatic description of an individualized parent-mediated service model targeting moderate challenging behavior. In the program, therapists coached parents to implement functional analyses and individualized function-based treatment packages. Forty-one families of children and young adults with neurodevelopmental disorders participated. Most clients (75.6%) met all admission treatment goals and parents reported significant decreases in frequency and severity of challenging behaviors at discharge. Parents also reported less stress at discharge. Outcomes of the study suggest this parent-mediated treatment model is a viable option to treating moderate challenging behavior in children and young adults with intellectual and developmental disorders. [ABSTRACT FROM AUTHOR]

Children with attention deficit/hyperactivity disorder (ADHD) struggle with executive functioning (EF). While physical activity (PA) benefits EF, little is known about the impact of specific activities like standing. The purpose of this study was to evaluate the feasibility of performing a rigorous experimental study to compare the effects of walking and standing on EF in children with ADHD. Six areas of feasibility were assessed: recruitment, randomization, treatment adherence, retention, acceptability of the intervention, and implementation. A randomized pilot study using three parallel conditions compared the effects of two modes of activity on EF in children 6–11 with ADHD. While there were no significant differences between walking and standing for EF, analyses suggest that it is feasible to compare effects of standing vs. walking on EF among children with ADHD. This study supports the feasibility of undertaking a larger scale study to evaluate the effect of standing on EF in children with ADHD. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset disorder characterized by pharmacological and non-pharmacological interventions. Despite the available treatment options and prevention measures, conventional treatments have several limitations. Digital therapeutics (DTx) like EndeavorRx® is an emerging alternative to overcome these limitations. EndeavorRx® is the first FDA-approved, game-based DTx approved for the treatment of pediatric ADHD. We investigated the effects of game-based DTx in randomised controlled trials (RCTs) on children and adolescents with ADHD. In this systematic review and meta-analysis, we searched PubMed, Embase, and PsycINFO databases up to January 2022. The protocol was registered (CRD42022299866). The assessor was defined as parents and teachers. The primary outcome was differences in inattention reported by the assessor, and the secondary outcome was differences in hyperactivity and hyperactivity/impulsivity reported by the assessor and the relative comparisons between game-based DTx, medicine, and control with indirect meta-analysis. Game-based DTx improved inattention more than the control upon assessment by assessors (standard mean difference (SMD) 0.28, 95% confidence interval (CI) 0.14–0.41; SMD 0.21, 95% CI 0.03–0.39, respectively), while medication improved inattention more than game-based DTx (SMD − 0·62, 95% CI − 1·04 to − 0·20) upon assessment by the teacher. Game-based DTx improved hyperactivity/impulsivity than the control upon assessment by assessors (SMD 0.28, 95% CI 0.03–0.53; SMD 0.30, 95% CI 0.05–0.55, respectively), and medication improved hyperactivity/impulsivity significantly than game-based DTx upon assessment by the teacher. Hyperactivity has not been reported extensively. As a result, game-based DTx had a more significant effect than the control, however medication was more effective. [ABSTRACT FROM AUTHOR]

In their recent examination of the Monitoring the Future (MTF) data, McCabe et al. (Journal of Child Psychology and Psychiatry, 2023) address the complex, longstanding, and clinically valuable questions of whether and how stimulant medication treatment for adolescents with ADHD relates to their risk for substance use. Here, we expand on the authors' interpretations of their nuanced findings of increased risk for illicit stimulant use and non‐prescribed stimulant medication use for youth with later age of medication treatment initiation and shorter treatment duration. We particularly focus on highlighting tangible clinical implications, and we recommend ways future research can build on the authors' findings to further clarify this important issue. [ABSTRACT FROM AUTHOR]

In addition to the core symptoms defining ADHD, affected children often experience motor problems; in particular, graphomotor movements including handwriting are affected. However, in clinical settings, there is little emphasis on standardized and objective diagnosing and treatment of those difficulties. The present study investigated for the first time the effects of methylphenidate as well as physiotherapeutic treatment on objectively assessed graphomotor movements compared to a control condition, i.e. parental psychoeducation, in 58 children (mean age: 9.52 ± 1.91 years) newly diagnosed with ADHD in an outpatient clinic for child and adolescent psychiatry. Families were invited to join one of the treatment groups. Before and after 8 weeks of treatment, children performed six different tasks on a digitizing tablet which allowed the objective analysis of three important kinematic parameters of graphomotor movements (fluency, velocity, and pen pressure) in different levels of visual control and automation. Graphomotor movement fluency and velocity improves over time across the groups, especially in tasks with eyes closed. We did not find clear evidence for beneficial effects of methylphenidate or physiotherapeutic treatment on children's overall graphomotor movements suggesting that treatments need to be better tailored towards specific and individual deficits in graphomotor movements. [ABSTRACT FROM AUTHOR]

Recent widely publicized shortages in the U.S. supply of first-line medications for treatment of attention-deficit/hyperactivity disorder (ADHD) are thought to reflect increases in public awareness, help seeking, and treatment. ADHD is one of the most common neurodevelopmental disorders and is typically identified in childhood. In adulthood, ADHD symptoms are less likely to include hyperactivity, but inattention, impulsivity, and emotional dysregulation are common. Clinical evaluation of symptomatic adults who were not diagnosed as children requires corroboration of ADHD diagnostic symptoms in childhood and careful differentiation of ADHD from frequently co-occurring psychiatric and substance use disorders. Treatment of adult ADHD can result in improved functioning across multiple dimensions and comorbid disorders. Existing guidelines and consensus statements recommend an integrated approach to treating ADHD and all existing comorbid disorders, prioritizing the disorder that is creating the most difficulty for the individual. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 8–11.] [ABSTRACT FROM AUTHOR]

Background: Developing effective non-pharmacological therapies for Attention Deficit Hyperactivity Disorder (ADHD) is important. We gauged the likelihood that undergraduates would participate in a trial of tai chi as an intervention for ADHD, and evaluated attitudes toward complementary and alternative medicine (CAM). Methods: We collected survey responses from 47 undergraduates with ADHD and 49 healthy controls, measuring their likelihood of participating in trials of tai chi and other non-pharmacological therapies, along with attitudes toward CAM. We examined the relationship between diagnosis, CAM attitudes, and willingness to participate in a trial. Results: Undergraduates with ADHD showed greater acceptance of CAM therapies. Thirty two percent of students with ADHD expressed strong willingness to participate in a tai chi trial. Conclusion: These results support the feasibility of a trial of tai chi as therapy for undergraduates with ADHD, and suggest this population is receptive toward CAM. Future research should examine why interest in CAM is greater among students with ADHD. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is a common presenting concern in primary care. This study examined the relationship between pediatric residency training program characteristics and residents' ADHD knowledge, attitudes, and comfort in providing ADHD services. Given the familiarity that pediatric chief residents have with the training and experiences within their residency programs, a 30-item survey was mailed to pediatric chief residents. A total of 100 residents returned their surveys (response rate 49.5%) and were included in the descriptive quantitative and thematic qualitative analyses. The majority of participants rated their ADHD knowledge as at least average. However, approximately half of the participants were comfortable with screening, and less than half were comfortable with managing stimulant medication or behavioral treatments. Participants emphasized the importance of interprofessional collaboration, clinical experiences, and integrated ADHD education throughout training. These results emphasize the importance of improved training in screening, diagnosing, and managing ADHD to increase resident comfort regarding these practices. [ABSTRACT FROM AUTHOR]

We have examined the effect of atomoxetine and Xiaoer Huanglong granules combined with psycho-behavioral modification therapy on attention-deficit/hyperactivity disorder children. Children diagnosed with attention-deficit/hyperactivity disorder were treated with atomoxetine + Xiaoer Huanglong granules (control group) or atomoxetine + Xiaoer Huanglong granules and received psycho-behavioral modification therapy (treatment group). The results show that the treatment group presented a higher overall response rate and a shorter duration of hyperactivity, inattention, and emotional instability than the control group (P < 0.05). After treatment, higher correct scores and serum levels of glial cell line-derived neurotrophic factor, lower error scores and error rate, as well as lower Abbreviated Symptom Questionnaire and Swanson, Nolan, and Pelham, version IV Scale scores, were observed in the treatment group (P < 0.05). Moreover, the incidence of adverse reactions in both groups was similar (P > 0.05). To sum up, atomoxetine, Xiaoer Huanglong granules, and psycho-behavioral modification therapy can effectively improve the learning concentration of attention-deficit/hyperactivity disorder children. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD) are often accompanied by sleep problems influencing social, emotional and cognitive functioning in everyday activities. Aim: The aim of this study was to investigate whether the use of a weighted blanket has a positive impact on sleep and everyday activities in individuals with ADHD and/or ASD. Material and methods: The study included 85 individuals diagnosed with ADHD and/or ASD, 48 children aged <17 (57%) and 37 adults >18 years (44%), who were prescribed with a weighted blanket. The participants responded via a telephone interview. Results: Findings demonstrated that a weighted blanket improved abilities related to falling asleep, sleeping the whole night, and relaxing during the day. Using a weighted blanket improved morning/evening daily routine, including preparing/going to sleep and waking up in the morning. Conclusions: Weighted blankets showed positive impact on falling asleep, sleeping the whole night, and relaxing during the day, and they were used frequently by children and adults with ADHD and/or ASD. Findings indicate that a weighted blanket improved morning/evening routine, however this research area needs further investigation using both subjective and objective parameters. [ABSTRACT FROM AUTHOR]

Autistic youth have an increased risk of mental health problems. Despite the efficacy of various psychotherapeutic approaches for autistic youth, they often do not receive these interventions. Research is needed to identify patterns of effective treatment for autistic youth and whether they differ from those used for youth with other neurodevelopmental conditions (e.g., attention-deficit hyperactivity disorder; ADHD). We compared clinicians' (N = 557) knowledge, confidence and practices when treating autistic youth and youth with ADHD. Although ratings were moderately high overall and similar interventions were used for both groups, clinicians were significantly less knowledgeable and confident when supporting autistic clients compared to clients with ADHD. Thus, improving clinician perspectives may help facilitate treatment for autistic youth with mental health problems. [ABSTRACT FROM AUTHOR]

The predominance of the psychodynamic approach is often put forward to explain the delay in diagnosis and treatment of attention-deficit disorder with hyperactivity (ADHD) reported in France. A bibliometric study of abstracts, articles, or letters authored by French researchers may provide objective insight into this issue. Online electronic databases were searched without any date limits for documents related to ADHD, and allocated to the AllFR group when all authors had an affiliation in France or to the notAllFR group when at least one author had an affiliation in France. Publications expressing any psychodynamic point of view on the causes and/or treatment of ADHD were identified. A total of 747 documents were analyzed: 417 were exclusively indexed in SCOPUS, and 418 were allocated to the AllFR group. Compared with documents in the notAllFR group, documents in the AllFR group were written by a smaller number of authors (median 3 vs. 6, p <0.002), more frequently evoked psychodynamic concepts (10.45% vs. 1.67%, p <0.001), and less frequently acknowledged the persistence of ADHD in adulthood (29.10% vs. 42.14%). The psychodynamic approach was likely to rely on case reports of fewer than three children. Any serious review of the literature should pool documents from several online databases, especially SCOPUS. In publications by only French authors, the psychodynamic approach seems predominant and the persistence of ADHD in adulthood is overlooked. This may concur with the excessive delay observed in the diagnosis and treatment of children and adults in France compared to other European countries. [ABSTRACT FROM AUTHOR]

Obsessive compulsive disorder (OCD) affects up to 4% of children and adolescents (Nazeer et al., 2020). Childhood OCD impairs overall quality of life, particularly in familial, social and academic settings. For individuals with OCD, obsessions — unwanted, intrusive thoughts, images, or impulses that cause distress are subsequently reduced by compulsions — behaviors that are designed to assuage the distress of the obsessions, according to set rules or senses of completion (American Psychiatric Association, 2013). Common obsessions surround core fears of harm avoidance, disgust and/or a sense of incompleteness, leading to common compulsions of repeating, checking, avoidance, and/or other rituals. [ABSTRACT FROM AUTHOR]

The clinical validity of the distinction between ADHD and ASD is a longstanding discussion. Recent advances in the realm of data-driven analytic techniques now enable us to formally investigate theories aiming to explain the frequent co-occurrence of these neurodevelopmental conditions. In this study, we probe different theoretical positions by means of a pre-registered integrative approach of novel classification, subgrouping, and taxometric techniques in a representative sample (N = 434), and replicate the results in an independent sample (N = 219) of children (ADHD, ASD, and typically developing) aged 7–14 years. First, Random Forest Classification could predict diagnostic groups based on questionnaire data with limited accuracy—suggesting some remaining overlap in behavioral symptoms between them. Second, community detection identified four distinct groups, but none of them showed a symptom profile clearly related to either ADHD or ASD in neither the original sample nor the replication sample. Third, taxometric analyses showed evidence for a categorical distinction between ASD and typically developing children, a dimensional characterization of the difference between ADHD and typically developing children, and mixed results for the distinction between the diagnostic groups. We present a novel framework of cutting-edge statistical techniques which represent recent advances in both the models and the data used for research in psychiatric nosology. Our results suggest that ASD and ADHD cannot be unambiguously characterized as either two separate clinical entities or opposite ends of a spectrum, and highlight the need to study ADHD and ASD traits in tandem. [ABSTRACT FROM AUTHOR]

Objectives: Caregiver beliefs about the causes of attention-deficit/hyperactivity disorder (ADHD) may influence caregiver intentions to let children with ADHD receive treatment. In this survey study, we intended to determine the proportion of caregivers who attribute the overemphasis of the education system on child academic performance as the etiology of their children's ADHD and the factors related to this attribution. Methods: In total, 213 caregivers of children with ADHD participated in this study and were asked whether they regarded the overemphasis of the education system on child academic performance as the etiology of their children's ADHD. Affiliate stigma was assessed using the Affiliate Stigma Scale. Each caregiver rated their child's ADHD and oppositional defiant disorder symptoms using the short Chinese version of the Swanson, Nolan, and Pelham, Version IV Scale. The depression and anxiety of the caregivers were assessed using the Beck Depression Inventory and Beck Anxiety Inventory, respectively. Results: The results were found that 58 (27.2%) caregivers regarded the overemphasis of the education system on child academic performance to be the etiology of their children's ADHD. Affiliate stigma of caregivers was significantly associated with caregiver attribution (p < 0.05). Caregiver depression (p < 0.01) and anxiety (p < 0.01) were significantly associated with caregiver attribution of the etiology of ADHD in bivariate logistic regression analysis models; the associations became nonsignificant after the effect of affiliate stigma being considered. Conclusion: Health professionals should consider caregiver-attributed etiologies when they are developing intervention programs for enhancing the mental health of caregivers and their children with ADHD. [ABSTRACT FROM AUTHOR]

We investigated the viability of spectral filters as an adjunctive treatment for adults with both ADHD and visual processing difficulties. Fifty-nine adults (age 18-50), diagnosed with both ADHD and visual stress received either spectral filters (n = 39) or no intervention (n = 20) to address visual processing difficulties. We administered the MOXO d-CPT, a computer based continuous performance test, before the intervention and one hour after the intervention to assess any short-term change in the participants' attention profile. We used the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) before and 3–6 months after the intervention to assess any long-term intervention impact after 3–6 months. The intervention group had significant short- and long-term improvements in overall attention compared to the control group (X2(1, N = 59) = 20.10, p <.001). On the DSM-5, 49% of participants with short term and 64% with long-term intervention no longer met criteria for an ADHD diagnosis. Findings suggest that spectral filters may be an adjunctive treatment for many adults suffering from perceptually-based attention issues common to visual stress and ADHD. [ABSTRACT FROM AUTHOR]

Introduction: Attention deficit hyperactivity disorder is very common in athletes. This study aims to investigate the impact of transcranial electrical stimulation of alternating current on response inhibition and selective attention in athletes with ADHD. Methods: The present study was quasi-experimental with a pretest, posttest, and follow-up design with the control group. The statistical population was 160 elite athletes with ADHD aged 9 to 11 years (60 girls and 100 boys). Of these, 120 athletes with ADHD were randomly selected and assigned to three groups of 40: control, sham, and tACS. First, a pretest was done, and then all subjects in the sham and experimental groups received F3 (Anodal) and F4 (Cathodic) fake and real stimulations, respectively, with a current of 1 mA (10 Hz) for 15 minutes in 10 sessions. The control group did not receive any intervention, then each group was re-examined. A follow-up test was done after two weeks. The Continuous Performance Test (CPT) and Stroop were used in this study. For data analysis, Mixed ANOVA, one-way ANOVA, and Benferroni's post hoc test were used with using SPSS version 21 statistical software (P≤0.05). This study is approved sport sciences Reserch Institute with ethical registration code IR.SSRI.REC.1401.1361.Parents gave written informed consent form. Results: The results showed that tACS was effective in the response inhibition and selective attention of athletes with ADHD and led to the improvement of response inhibition and selective attention of these subjects. Conclusions: Based on the findings, the tACS protocol of 1 mA can be used as an effective treatment to improve inhibition and selective attention of athletes with ADHD. [ABSTRACT FROM AUTHOR]

Introduction: Attention deficit hyperactivity disorder among adults has been associated with deficits in executive functioning and poor quality of life. The purpose of this study is to examine feasibility of the Cognitive Functional Remote Group intervention among adults with attention deficit hyperactivity disorder. Method: Mixed-method feasibility study. Five adults with attention deficit hyperactivity disorder received 16 weekly sessions of Cognitive Functional Remote Group. Results: The target population was easily recruited and showed interest in the treatment. All participants completed the intervention and were moderately-very highly satisfied with different aspects of the intervention. Additionally, pre–post measures demonstrated high rates of clinically significant improvements in the quality of life measure and less so in executive functioning. Three central themes emerged from qualitative analyses of participants experiences relating to (a) Identity development through group process ; (b) Occupation-based learning of self-awareness and cognitive functional strategies and (c) Feedback on group setting and content and relating to advantages and disadvantages of remote (Zoom) format. Conclusion: This study supported Cognitive Functional Remote Group feasibility among adults with attention deficit hyperactivity disorder. Quantitative findings point to the responsiveness of quality-of-life measures. Qualitative findings suggest gains in identity development, awareness and acquisition of cognitive functional strategies through occupation-based learning in a telerehabilitation group therapy format. Further controlled studies are warranted. [ABSTRACT FROM AUTHOR]

Treatment of the ADHD types (hyperactive-impulsive, inattentive, and combined) in children has rarely been studied separately, although their prognostic courses differ widely. In addition, data show that improvements in hyperactivity/impulsivity are hard to achieve. Thus, we focused on treatments tailored to hyperactivity/impulsivity. We examined meta-analyses and systematic reviews within the inter- and intra-individual treatments and found that psychoeducation and training for parents, school-based interventions, reinforcement strategies, and neurofeedback consistently showed small to moderate effect sizes in reducing hyperactivity/impulsivity in children. Conversely, emotional self-regulation, social skills, and cognitive trainings showed unsatisfactory results. In summary, we found that the quality of usual care can be surpassed when the designated interventions are purposefully combined into a multimodal treatment program. [ABSTRACT FROM AUTHOR]

The article evaluates recent research on combined treatment for ADHD in children, emphasizing the importance of psychosocial interventions alongside medication, particularly in addressing functional impairments. Topics include the dosing and sequencing of combined treatment, the impact on functional outcomes and the need for individualized approaches based on child and family characteristics.

Rates of ADHD diagnosis vary across regions in many countries. However, no prior study has investigated how much within-country geographic variation in ADHD diagnoses is explained by variation in ADHD symptom levels. We examine whether ADHD symptom levels explain variation in ADHD diagnoses among children and adolescents using nationwide survey and register data in Norway. Geographical variation in incidence of ADHD diagnosis was measured using Norwegian registry data from the child and adolescent mental health services for 2011–2016. Geographical variation in ADHD symptom levels in clinics' catchment areas was measured using data from the Norwegian mother, father and child cohort study for 2011–2016 (n = 39,850). Cross-sectional associations between ADHD symptom levels and the incidence of ADHD diagnoses were assessed with fractional response models. Geographical variation in ADHD diagnosis rates is much larger than what can be explained by geographical variation in ADHD symptoms levels. Treatment in the Norwegian child and adolescent mental health services is free, universally available upon referral, and practically without competition from the private sector. Factors beyond health care access and unequal symptom levels seem responsible for the geographical variation in ADHD diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: Although schema therapy has been predominantly applied to treat personality disorders, interest into its application in other clinical disorders is growing. Central to schema therapy are Early Maladaptive Schemas (EMS) and Schema Modes. Since existing EMS and Schema Modes were primarily developed in the context of personality disorders, their relevance for clinical disorders is unclear. Methods: We conducted a systematic review of the presence of EMS and Schema Modes in clinical disorders according to DSM criteria. Per disorder, we evaluated which EMS and Schema Modes were more pronounced in comparison with clinical as well as non‐clinical control groups and which EMS and Schema Modes were most highly endorsed within the disorder. Results: Although evidence concerning EMS was scarce for several disorders, and only few studies on Schema Modes survived inclusion criteria, we identified meaningful relationships and patterns for EMS and Schema Modes in various clinical disorders. Conclusions: The present review highlights the relevance of EMS and Schema Modes for clinical disorders beyond personality disorders. Depending on the theme of the representation, EMS act as vulnerabilities both across diagnoses and for specific disorders. Thus, EMS and resulting Schema Modes are potential, valuable targets for the prevention and treatment of clinical disorders. [ABSTRACT FROM AUTHOR]

Objectives: To provide an updated systematic review of randomized controlled studies for the efficacy of cognitive behavioural therapy (CBT) in treating adults with attention‐deficit/hyperactivity disorder (ADHD). Design: Meta‐analysis. Methods: PROSPERO registration: CRD42021273633. The methods used aligned with the PRISMA guidelines. Database searches identified CBT treatment outcome studies eligible for conducted meta‐analysis. Treatment response was summarized by calculating the standardized mean differences for changes in outcome measures for adults with ADHD. Measures included core and internalizing symptoms and were assessed on the basis of self‐reporting and investigator evaluation. Results: Twenty‐eight studies met the inclusion criteria. This meta‐analysis indicates that CBT for adults with ADHD was effective in reducing both core and emotional symptoms. Decreases in depression and anxiety were predicted by the reduction of core ADHD symptoms. An increase in self‐esteem and quality of life were also observed for adults with ADHD who were received CBT. Adults who received either individual or group therapy significantly exhibited a greater reduction of symptoms than those who received active control intervention, received treatment as usual, or were on the treatment waitlist. Traditional CBT was equally effective in reducing core ADHD symptoms but outperformed other CBT approaches in reducing emotional symptoms among adults with ADHD. Conclusions: This meta‐analysis offers cautiously optimistic support for the efficacy of CBT in treating adults with ADHD. The additional reduction of emotional symptoms demonstrates the potential of CBT in adults with ADHD who are at higher risk for depression and anxiety comorbidities. [ABSTRACT FROM AUTHOR]

Behavioral parent training (BPT) is an evidence-based treatment for children with attention-deficit/hyperactivity disorder (ADHD). Stimulus control techniques (antecedent-based techniques, e.g., clear rules, instructions) and contingency management techniques (consequent-based techniques, e.g., praise, ignore) are the most common ones that are being taught to parents in BPT. However, research into the additive effects of these techniques is scarce. In this replicated single-case experimental ABC phase design, including six children on stable medication for ADHD (8–11 years) and their parents, the added efficacy of consequent-based techniques on top of antecedent-based techniques was evaluated. After a baseline period (phase A), we randomized the commencement time of two sessions parent training in antecedent-based techniques and two sessions parent training in consequent-based techniques for each child. Children's behaviors were assessed by daily parent ratings of selected problem behaviors and an overall behavior rating. Although visual inspection showed that behavior improved for most children in both phases, randomization tests did not demonstrate the added efficacy of the consequent-based techniques on top of the antecedent-based techniques. Limitations of the study and recommendations for future single-case experiments in this population are discussed. [ABSTRACT FROM AUTHOR]

ADHD is a prevalent neurodevelopmental disorder that affects children's behavior, academic performance, and social interactions. This review aims to evaluate the existing evidence for Sandplay therapy, a nonverbal psychodynamic approach, as a complementary treatment for children with ADHD. Ten studies suggest Sandplay therapy improves ADHD symptoms, such as hyperactivity, impulsivity, and inattention, through symbolic expression, play, and mindfulness. Despite its promise, ethical and practical considerations, including therapist training and treatment cost, must be addressed. Further research is needed to determine long-term effectiveness and optimal patient population for this treatment, which may benefit children unresponsive to or experiencing side effects from traditional treatments. [ABSTRACT FROM AUTHOR]

Anorexia Nervosa (AN) and Attention Deficit Hyperactivity Disorder (ADHD) are frequent mental disorders in child and adolescent psychiatry. Comorbidity of these disorders is, however, rare among minors. Thus, little is known about their mutual impact on illness development as well as diagnostic and therapeutic influencing factors. We report the case of a 10-year old girl with AN and massive underweight. At the age of 5, ADHD had been diagnosed. Application of ADHD-specific medication had been refused by her caregiver. As of 3rd grade, hyperkinetic symptoms were significantly reduced, which was later linked to beginning AN-induced weight loss. At inpatient admission, no clinically relevant ADHD-related symptoms were present. Accompanying weight gain, rather 'sudden' appearance of attention difficulties, motoric hyperactivity and impulsivity were reported, widely impairing our patient's schoolwork and further daily life. Methylphenidate medication showed good clinical response and tolerability. We hypothesize that the former massive underweight had suppressed ADHD-specific behaviour. AN with significant weight loss could possibly mask hyperkinetic symptoms in children. Thus, sufficient clinical diagnostics and intense monitoring during ED treatment are required. Physicians and therapists should be sensitized for interactions in the joint occurrence of these mental disorders among minors. [ABSTRACT FROM AUTHOR]

To alleviate the symptoms of attention deficit/hyperactivity disorder (ADHD) in children and reduce the side effects of psychostimulants, parents are opting for complementary and alternative medicine as a therapeutic option. Korean medicine (KM) has been used by Korean medicine doctors (KMDs) to treat ADHD with herbal medication and acupuncture. This study aimed to conduct a cross-sectional survey on the clinical practice patterns of KM for ADHD in children targeting KMDs. The questionnaire included aspects related to patient characteristics, diagnosis, treatment modalities, and perceptions regarding KM. Questionnaires were distributed to all KMDs via e-mail, and the online surveys were conducted from 1 to 15 February 2023. A total 2.1% of KMDs (n = 537/25,574) completed the survey. The predominant diagnostic pattern identification employed was "depressed liver qi transforming into fire" (19.8%). Herbal medicine (HM) was the most common treatment (44.2%). The most frequently used HM prescriptions were Ondam-tang (16.9%), Eokgan-san (15.7%), and Sihogayonggolmoryeo-tang (14.4%). KMDs recognized HM as the most effective among the KM treatments (54.3%). The results of this study elucidate the current clinical practice patterns of KM for ADHD. Based on these findings, a treatment protocol can be developed to provide optimized KM treatment services to patients with ADHD. [ABSTRACT FROM AUTHOR]

There is an increasing interest in non-pharmacological treatments for children with attention-deficit/hyperactivity disorder (AD/HD), especially digital techniques that can be remotely delivered, such as neurofeedback (NFT) and computerized cognitive training (CCT). In this study, a randomized controlled design was used to compare training outcomes between remotely delivered NFT, CCT, and combined NFT/CCT training approaches. A total of 121 children with AD/HD were randomly assigned to the NFT, CCT, or NFT/CCT training groups, with 80 children completing the training program. Pre- and post-training symptoms (primary outcome), executive and daily functions were measured using questionnaires as well as resting EEG during eyes-closed (EC) and eyes-open (EO) conditions. After 3 months of training, the inattentive and hyperactive/impulsive symptoms, inhibition, working memory, learning and life skills of the three groups of children were significantly improved. The objective EEG activity showed a consistent increase in the relative alpha power in the EO condition among the three training groups. Training differences were not observed between groups. There was a positive correlation between pre-training EO relative alpha power and symptom improvement scores of inattention and hyperactivity/impulsivity, as well as a negative correlation between pre-training inattention scores and change in EO relative alpha. This study verified the training effects of NFT, CCT, and combined NFT/CCT training in children with AD/HD and revealed an objective therapeutic role for individual relative alpha activity. The verified feasibility and effectiveness of home-based digital training support promotion and application of digital remote training. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: The objective of this article was to provide an overview of the development and recommendations from the Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). The guideline aims to promote accurate and timely identification and diagnosis, and optimal and consistent treatment of ADHD. Methods: Development integrated the best available evidence with multidisciplinary clinical expertise and the preferences of those with lived experience, underpinned by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The 23 guideline development group members included psychiatrists, paediatricians, general practitioners, psychologists, speech pathologists, occupational therapists, educators, Indigenous psychologists, and people with a lived experience; with two independent chairs and a methodologist. Where appropriate, evidence reviews from the National Institute for Health and Care Excellence (NICE) 2018 'Attention Deficit Hyperactivity Disorder: Diagnosis and Management' guideline were updated. Fifty prioritised clinical questions were addressed in 14 systematic reviews (new and updated from NICE 2018) and 28 narrative reviews. Results: The 113 clinical recommendations apply to young children (5 years and under), children, adolescents and adults. They provide guidance for clinicians on identification, screening, diagnosis, multimodal treatment and support, including pharmacological and non-pharmacological interventions. The guideline and supporting information are available online: https://adhdguideline.aadpa.com.au/ Conclusions: The guideline was approved by the National Health and Medical Research Council (NHMRC) of Australia and relevant medical and allied health professional associations. It is anticipated that successful implementation and uptake of the guideline by organisations, health care providers and other professionals will increase delivery of evidence-based treatment and improve health outcomes for the more than 800,000 Australians with ADHD. [ABSTRACT FROM AUTHOR]

Educators are key in advising doctors and parents on whether to medicate pupils with attention deficit hyperactivity disorder (ADHD). Here, using a semi-structured in-depth interview and grounded theory, we ask how 138 Israeli teachers and headmasters perceive their role in parents' decisions to medicate. Generally, teachers refrain from persuading parents to use medication and some even talk them out of it. There is, however, a gradual escalation in educators' attitudes towards persuading parents to medicate when educators consider the difficulties flowing from ADHD. When these difficulties find expression mainly in pupils' achievements, persuasion is usually indirect, manifested in hints to parents about the need to medicate. When problematic if not violent behaviour manifests, stronger persuasive tactics are used, such as summoning parents to meetings and suspending pupils. Many educators do not regard these sanctions against parents who resist medicating their children as unfair pressure but do admit that they are meant to persuade parents to allow medication. Thus, Israeli educators send a bivalent message. The system's approach explicitly upholds parents' right to decide on their own. The other voice is manifested in de facto policy, especially when the behaviour of the pupil with ADHD is improper. [ABSTRACT FROM AUTHOR]