Family Context and ADHD Symptoms in Middle Childhood: an Explanatory Model

Recent research suggests that Attention Deficit Hyperactivity Disorder (ADHD) may be influenced by interactions between the individual and their social context. This study examined the predictive value of family context variables and attentional control levels on child ADHD symptoms. A new explanatory model of the relationship amongst these variables was also tested. A sample of 754 families with children aged 7 to 11 was assessed through the Conners Parent Rating Scale, the Haezi-Etxadi Family Assessment Scale, and the Attention Network Test. Path analysis models showed a predictive association between children ADHD symptoms and Social Support Network, Parental Stress, Parental Self-efficacy, Attentional Control and being male. Furthermore, a stronger Social Support Network was associated with greater Parental Self-efficacy, a variable that predicted Parental Stress levels and children ADHD symptoms. In conclusion, a new multi-influence model of variables linked to ADHD symptomatology during mid-childhood is provided, which may be useful to support the design of family interventions.

Study to Find the Effect in Combined Protocol of Aquatic Therapy and Play Therapy in Attention Deficit Hyperactive Disorder in School Going Children from 7 – 10 Years to Improve the Quality of Life

The Objective of the Study: The aim of this study is to see the effect of combined protocol on aquatic and play therapy for children with ADHD based on inattention, hyperactivity, impulsivity, and anxiety. Background: Attention Deficit Hyperactivity Disorder (ADHD) is a severe threat to public health that affects a huge number of children and typically continues into adulthood. It is characterized by persistent lack of attention, hyperactivity, and impulsivity that impairs growth and performance. Children with ADHD are usually treated with a combination of pharmacological and non - pharmacological treatments, including academic, psycho-social, and behavioral aid, as well as aquatic therapy and play therapy. Aquatic therapy and play therapy, on the other hand, are ways in which the kid is provided the chance to undergo growth in the most optimum conditions. The goal of this study is to see how effective aquatic therapy and play therapy are in raising the standard of living of children aged 7 to 10 who have attention deficit hyperactivity disorder. Methods: The design of the present study is quasi-experimental. Tools used for the study: Data were collected through Conner’s parent’s rating scale, pediatric balance scale, and hand-eye coordination scale as pre and post-test and the treatment group received aquatic therapy and play therapy for eight sessions. Results: Conner's parent rating scale, pediatric balance scale, and hand-eye coordination test were used to compare before and after results. Conner's parent rating scale had a difference between the means of 21, a standard deviation of 4.79, and a paired-t-test value of 23.98. The pediatric balance scale's mean difference was 19, the standard deviation was 3.82, and the paired-t significance level was 27.20. The average difference in the hand-eye coordination test was 11, with a standard deviation of 1.67 and a paired-t-test score of 36.02. Conclusion: According to the findings, using aquatic therapy and play therapy to help children with ADHD pay close attention, reduce hyperactivity, and manage impulsive behavior was beneficial. Play therapy and aquatic therapy are also good ways to have some exercise. This increased energy utilization causes them to be less impulsive and hyperactive over the rest of the day.

Socio-demographic and clinical correlates of parenting style among parents having ADHD children: a cross-section study

Background ADHD affects 7.8% of the school-aged population, making it one of the most common childhood brain illnesses. It is characterized by abnormally high levels of inattention, activity, and impulsivity at a young age. Being a parent of a child with ADHD is a real challenge, as the parents tend to be more disapproving, critical, and provide more impulse control directions; such parenting style can have an impact on the illnesses course, accentuate its signs and symptoms, and lead to secondary development of co-morbid psychiatric and behavioral problems. This makes the parent-child effect a matter of clinical importance that needs to be carefully assessed and managed. We aimed to estimate the sociodemographic and clinical correlates of parenting attitudes among parents having ADHD children. This cross-sectional study included 48 ADHD children from both sexes, aged from 6 to 12 years old, and their parents. In our study, we applied the Stanford-Binet Intelligence Scale 5th edition, the Conner’s Parent Rating Scale-revised, the parenting style as perceived by children questionnaire, and the Fahmy and El-Sherbini questionnaire for the measurement of socioeconomic status. Results Mothers of ADHD children had significantly lower scores of over-protections parenting style than the fathers; the current study showed a significant increase in total parenting scores and warmth/support in mild ADHD cases than in moderate and severe ones, and there is a significant increase in the mother’s positive parenting style toward ADHD children with lower levels of social problems, mild cases, and older age. There is a significant increase of positive parenting style toward ADHD children exerted by post graduated, professionally working, and high social class fathers and by working mothers among rural residents and high social class mothers. There is a positive correlation between IQ and a mother’s warmth/support. Conclusion ADHD children with mild symptoms, higher social functioning of the child, high socioeconomic level of the family, better education, and professional occupations of parents were associated with positive parenting style.

Non-verbal cognitive development, learning, and symptoms of PTSD in 3- to 6-year-old refugee children

As IQ tests are commonly used as key assessment method, we address the question whether our commonly used standardized IQ tests are appropriate for children from families of diverse cultures and different educational levels in a refugee population. We examined 109 refugee children aged 3–7 years (M = 5.10 years, SD = 1.25) with the “Kaufman Assessment Battery for Children “ (KABC-II; Kaufmann & Kaufmann, 2015) on a language-free scale (Scale of Intellectual Functioning, SIF) and learning performance (subtest Atlantis). With a non-verbal IQ of 81.5 (SD = 18.01), the population mean of the refugee children is more than one standard deviation lower than the mean of the German norm population. Standardized scores follow the normal distribution and are not correlated to any of the assessed markers of adversity (flight duration, time spent in Germany, child PTSD in parent rating, parental symptom load, and parental education level).Conclusion: The interpretation of IQ test results for refugee children should be done cautiously as results may underestimate their cognitive capacity. Environmental factors, such as high illiteracy among parents in this study, the lack of institutional education of children and high lifetime stress, may explain our findings.Trial registration: DRKS00021150. What is Known:• There is a high pervasiveness for the use of standardized IQ tests in the German health and education system to determine eligibility for special education and social services. What is New:• Refugee children score significantly lower than German children in a language-free IQ test. As results are normally distributed and not correlated to any of the assessed markers of adversity, the low scores in the refugee group might be due to missing formal education.

Coenzyme Q10 in the Treatment of Attention Deficit Hyperactivity Disorder in Children: A Randomized Controlled Trial

Background: Attention Deficit Hyperactivity Disorder is a common child neurobehavioral disorder whose pathogenesis is not completely understood. However, some evidence indicates a crucial link between this disorder and the degree of oxidative stress. Coenzyme Q10 (ubiquinol) is an antioxidant that may play a significant role in the treatment of Attention Deficit Hyperactivity Disorder. Objective: To assess the safety and efficacy of coenzyme Q10 as an add-on drug treatment for attention deficit hyperactivity disorder. Method: Sixty children, aged 6–16 years, with attention deficit hyperactivity disorder, non-responders to atomoxetine treatment for 6 months, were included in this double-blind, randomized, and controlled study. Group 1 received atomoxetine plus coenzyme Q10, and group 2 received atomoxetine plus placebo for 6 months. Follow-up by CONNERS parent rating scale questionnaire (CPRS-48) was performed before and after 1, 3, and 6 months of treatment, and any drug-related side effects were reported. Results: The addition of coenzyme Q10 to atomoxetine in group 1 improved symptoms in a shorter time with minimal adverse effects. Group 1 showed improvement of about 33.87% in CPRS-48 total score versus 18.24% in group 2. There was a statistically significant decrease in CPRS-48 total score and its three subscales (learning problems, impulsive hyperactive subscale, and 10-items hyperactivity index) in group 1 versus group 2 after six months of treatment (p-value <0.001). Conclusion: Coenzyme Q10 has an important role as an add-on drug treatment for attention deficit hyperactivity disorder by improving symptoms, particularly hyperactivity, and in minimizing atomoxetine adverse effects.

Frequency of Attention Deficit Hyperactivity Disorder (ADHD) in children aged 6-11 years old in the city of Piranshahr

Background. One of the most common childhood disorders is attention-deficit/hyperactivity disorder (ADHD). This study aimed to determine the prevalence of ADHD in children aged 6-11 years in Piranshahr city (Iran). Methods. This descriptive-analytical study involved six hundred primary school students (300 girls and 300 boys) in Piranshahr city who were enrolled in the study using stratified random sampling. The frequency of ADHD was assessed using the short form of the Conners Teacher and Parent Rating Scale. Results. The frequency of inattention and hyperactivity indices in girls were respectively 13% and 15%, per Conners Parents Rating Scale, and 14.6% and 16.6% per Conners Teacher Rating Scale, while the frequency of ADHD index was 6.33% and 8.66%, respectively. The frequency of inattention and hyperactivity indexes in boys were respectively 11% and 17% per Conners Teacher Rating Scale, and 20.6% and 24.6%, respectively, per Conners Parents Rating scale, whereas the frequency of ADHD index was based on parents and teacher was 5.6% and 18.3%, respectively. Conclusion. This study showed that the prevalence of children prone to ADHD in the Piranshahr region is relatively high in comparison with other regions of the country. Therefore, it is necessary to study this disorder in the identity card of children at the entrance to kindergartens and schools to identify the patients, so through timely and appropriate intervention, its important complications in adolescence and adulthood can be prevented.

Associations of Maternal Adverse Childhood Experiences with Behavioral Problems in Preschool Children

Investigations have found maternal adverse childhood experiences (ACEs) cause an intergenerational danger to their children’s health. However, no study has investigated the effects of maternal ACEs on behavioral problems of preschool children in China and gender differences on these effects. This paper aims to investigate the role of maternal ACEs on behavioral problems of preschool children in China and explore gender differences as related to these behavioral problems. Stratified cluster sampling method was used to select 7318 preschool children from 12 districts in Hefei city, China. A questionnaire survey was conducted to collect information on maternal exposure to ACEs and Conners’ Parent Rating Scales. Logistic regression was used to analyze the relationship between maternal ACEs and children’s behavioral problems. The prevalence of behavioral problems in preschool children was 16.0%, while it was higher among girls (18.4%) than boys (13.92%) (χ2 = 27.979, p < 0.001). The rate of behavioral problems in children in the group of mothers with ACEs was higher than those without ACEs (all p < 0.05). Maternal ACEs were associated with increased risk of the behavior problems in preschool children (adjusted OR 2.91, 95% CI 2.45–3.45), and no gender difference (in girls 3.01, 2.38–3.81, in boys 2.79, 2.17–3.58, respectively) was found. Maternal ACEs were associated with increased risk of each type of the behavioral problems of preschool children, except that maternal emotional neglect was not associated with psycho-physical problems, impulse-activities, and anxiety. The only gender differences found were higher conduct problems related to maternal emotional abuse and ACEs and higher anxiety related to maternal physical abuse and community violence in girls compared with boys. Mothers exposured to ACEs are more likely to have children with behavioral health problems in preschool period. Further research is needed to explore the mechanisms by which maternal ACEs influence children’s behavioral problems.

The negative psychological impact of COVID-19 pandemic on mothers of children with attention deficit hyperactivity disorder (ADHD): a cross-section study

Background ADHD is an important cause for psychiatric care as one of the most prominent neurodevelopmental conditions. Being an ADHD child’s parent is a daunting and sometimes stressful job that becomes more challenging during the COVID-19 pandemic and its negative consequences. This cross-sectional study was applied to 54 mothers of ADHD children and adolescents; the data of the ADHD children and adolescents have been registered before the lockdown on their regular follow-up visits on the child and adolescent’s clinic of the psychiatry department. Data of the study were collected through an electronic Google form included a COVID-19 questionnaire, The Depression, Anxiety, and Stress Scale—21 Items (DASS-21) (Arabic version), and Conners’ Parent Rating Scale Revised-short version (CPRS-48). We aimed to assess symptoms of anxiety, depression, and stress symptoms among the mothers of ADHD children and adolescents during COVID-19 outbreaks and determine the relationship between these symptoms and the changed circumstances that occurred by the COVID-19 pandemic, also with the behavioral problem of their children that may deteriorate by their mothers’ psychological state. Results Most of our participants were from the low socioeconomic class and were married. In total, 29.6% of the mother of ADHD children had confirmed COVID-19 cases among their family members, while 11.1% of our subjects lost a family member due to this epidemic, 22% of our sample lost their work because of COVID-19. We found that the COVID-19 pandemic has a big financial drawback on the family of our participants by a percentage of 31.5%. We noticed that 48.1% of our sample documented domestic violence toward them compared to before COVID-19. A total of 92.6% of the mothers who participated in our study assessed the period of change and restrictions as being very demanding. We found that 74.1% of ADHD patients were not compliant with their medications than before the epidemic. Also, we found that the mothers of ADHD children have bigger challenges in managing the child’s meals, structured activities, and sleep compared to before COVID-19. We showed that 53.7% of the mothers had depressive symptoms, 61% had anxiety symptoms, and 53.7% had stress symptoms. These symptoms were statistically associated with the lost family member due to COVID-19, the financial drawbacks of the COVID-19 outbreak, and the domestic violence toward mothers, compared to before COVID-19, the non-compliance of their children on the medications compared to before COVID-19, the presence of confirmed COVID-19 cases among family members, mother’s assessment of the period of change and restrictions as being very demanding compared to before COVID-19, and the non-compliance of their children on the medications compared to before COVID-19 as well as the increased behavioral symptoms of their children. Conclusion COVID-19 pandemic has psychological influences on mothers of children with ADHD. A significant number of them may have depression, anxiety, and stress symptoms that could affect their children’s compliance with the medication and, consequently, their symptomatology.

Investigation of quality of life in obese adolescents: the effect of psychiatric symptoms of obese adolescent and/or mother on quality of life

Objectives The present study assessed the obese adolescents’ health-related quality of life (HRQoL) based on both adolescent-reported and maternal-reported questionnaires to clarify adolescent-related psychiatric factors, maternal psychiatric factors, and body mass index (BMI) percentile variables that independently affect the quality of life (QoL). Methods A total of 190 adolescents (120 females and 70 males) were included in the study. The impact of clinical and psychiatric factors on the Pediatric Quality of Life Inventory-Child Version (PedsQL-C) scores was analyzed using hierarchical linear regression methods. Results The final models showed that only the Revised Child Anxiety and Depression Scale-Child Version major depressive disorder scores negatively predicted the physical, psychosocial, and total health scores of the PedsQL-C. The psychosocial scores of the PedsQL-P were negatively predicted by the Strengths and Difficulties Questionnaire emotional, and Conners’ Parent Rating Scale-Revised-Short Form (CPRS-R-S) attention-deficit/hyperactivity disorder (ADHD) index scores. The PedsQL-P total scores were negatively predicted by the CPRS-R-S ADHD index scores. Conclusions The findings of this study indicate that the adolescents’ psychiatric symptoms and BMI percentile played a significant role in the PedsQL subscale functioning of obese adolescents compared to maternal psychiatric symptoms.

A-37 Interactions between in-Utero Stress Exposure, Externalizing Behavior, and Psychophysiology in Young Children

Objective The current study examines the associations between low resting heart rate (HR), low electrodermal activity (EDA), and externalizing behavior (EB) in children 1–5 years old through the following measures: baseline 1 (B1) HR, startle period HR, and recovery-stage HR HR, EDA amplitude and skin conductance responses (SCR). We also investigate whether in-utero stress (exposure to Hurricane Sandy) moderates these relationships. Method A subsample of 206 children was drawn from a NIMH longitudinal study, the Stress in Pregnancy Study, that follows offspring from in-utero to 6 years of age. HR and EDA data was collected during a startle-probe paradigm. Mean age of the participants was 3.89 years. Approximately 52% were female and 50.5% were Hispanic. Participants’ EB was assessed by the Behavioral Assessment Screening for Children Version-2 parent rating scales. Externalizing symptoms were trichotomized (high, medium, and low). Results One-way ANOVA showed that three EB groups differed in baseline-HR (p = 0.034), startle-HR (p = 0.006), and recovery-stage HR (p = 0.008) in 4-year olds. EDA was not significantly different between EB groups. Furthermore, Hurricane Sandy exposure significantly and marginally significantly moderates the relationship between EB and amplitude (b = 3.0344, p = 0.044) and EB and SCR (b = 1.5629, p = 0.056), respectively. Hurricane Sandy exposure did not moderate the relationship between EB and HR. Conclusion Externalizing problem symptom groups significantly differ in HR, but not EDA. Hurricane Sandy exposure moderates the relationship between EB and EDA, but not EB and HR. Results suggest that HR and EDA are differentially susceptible to environmental influence. Results can guide biologically informed treatments/screeners for EB in children.