Cost-of-illness for non-underweight binge-eating disorders

Purpose This study examined economic costs associated with untreated eating disorders (EDs) characterised by regular binge eating in the absence of low weight. Both direct and indirect costs were assessed, reporting a limited societal perspective of economic impact as some costs were not included. Methods One hundred and twenty six adults seeking treatment for recurrent binge eating were asked to report impairment associated with an ED. Costs were calculated using 2017 prices, including an examination of variables associated with costs. Results Estimated societal costs for the year preceding assessment were £3268.47 (€3758.54) per person. In multivariate analyses, no reliable baseline associates of cost were identified. Conclusion The economic burden of EDs characterised by regular binge eating is significant, and underscores the need for efficacious and cost-effective treatments. Individuals with binge-eating disorders report work impairment and healthcare use that may cost the United Kingdom economy upwards of £3.5 billion (€4bn) per annum. Further studies should consider academic impairment and the economic impact of EDs on families. Level of evidence III: evidence obtained from well-designed cohort or case–control analytic studies.

Cost-of-illness for Non-underweight Eating Disorders

Purpose: This study examined economic costs associated with untreated eating disorders characterised by regular binge eating in the absence of low weight. Both direct and indirect costs were assessed, taking a partial societal perspective of economic impact.Methods: One-hundred and twenty-six adults seeking treatment for recurrent binge eating were asked to report impairment associated with an eating disorder. Total direct, indirect, and out-of-pocket costs were calculated using 2017 prices. Overall costs per individual were estimated, including an examination of variables correlated with costs.Results: Estimated costs for the year preceding assessment were £2,428.59 (€2,792.88) per person. Frequency of binge eating was associated with several elements of cost, and BMI was associated with productivity costs.Conclusion: The economic cost of eating disorders characterised by regular binge eating is significant, and underscores the need for efficacious and cost-effective treatments. Individuals with eating disorders report work impairment and healthcare usage that may cost the UK economy upwards of £2.6–3.5 billion (€3–4bn). Further studies should consider academic impairment and the economic impact on families.Level of evidenceLevel III: Evidence obtained from well-designed cohort or case-control analytic studies

Relationship between sluggish cognitive tempo and sleep, psychological, somatic, and cognitive problems and impairment in children with autism and children with ADHD

Sluggish cognitive tempo (SCT) is a topic of renewed interest. Much remains to be learned about its association with symptoms and diagnoses that have received little research attention, particularly sleep disturbance, somatic complaints, and autism. Our study is the first to explore the relationship between SCT and sleep, internalizing, externalizing, somatic, and cognitive problems, impairment, and demographics in large samples of children with autism, ADHD-Combined, and ADHD-Inattentive. Mothers rated 1,436 children with autism and 1,056 with ADHD without autism, 2 to 17 years, on the Pediatric Behavior Scale (PBS). Factor analysis yielded a 6-item SCT factor (sluggish/slow moving/low energy, stares/preoccupied/in own world, tires easily, in a fog/confused, drowsy/sleepy/not alert, and apathetic) plus 10 additional factors. SCT was distinct from but related to several factors and was associated with social and academic impairment. The strongest independent predictors of SCT were depression, sleeping more than normal, cognitive problems, autism, and somatic complaints. Scores on the remaining factors (sleep disturbance, attention deficit, impulsivity, hyperactivity, oppositional defiant disorder, conduct disorder, and anxiety) increased explained variance by less than 2%. Findings suggest that SCT is not simply sluggish cognitive tempo, as the name implies, and is a complex construct with behavioral, affective, emotional, cognitive, and somatic components and associations. Given that 49% of children with autism had SCT, SCT symptoms should be considered in all children being evaluated for autism, as well as for ADHD-C and ADHD-I (with SCT percentages of 31% and 40%). Assessing and treating SCT is especially important because of its association with impairment.

Pediatric Sleep–Wake Disorders

This chapter reviews pediatric sleep–wake disorders, with a particular focus on evaluation and treatment of sleep disturbances comorbid with primary psychiatric disorders and commonly prevalent primary sleep disorders in the pediatric population. The sleep disturbances due to primary sleep disorders can often result in symptoms and behaviors suggestive of a psychiatric condition such as inattention, poor impulse control, academic impairment, mood changes, fatigue, and excessive daytime sleepiness. It is important that the pediatric clinician assesses the youth presenting with sleep and psychiatric symptomatology for presence of primary sleep disorders. Consultation with a sleep physician for further evaluation and treatment is recommended if a primary sleep disorder is suspected. More evidence-based treatments are needed for primary insomnia and sleep disturbances comorbid with primary psychiatric disorders in pediatric population.

The Association of Executive Functioning With Academic, Behavior, and Social Performance Ratings in Children With ADHD

This study investigated the association of a performance-based measure of executive functioning (EF) with academic, social, and behavioral performance ratings in a convenience sample of 153 children aged 5 to 12 (78% male, 83% Caucasian) diagnosed with attention-deficit/hyperactivity disorder (ADHD). Multivariate regression showed that above and beyond age and ADHD severity, poorer EF performance was uniquely associated with more impairment in reading, written expression, and math by teacher report, and more impairment in the overall school and reading domains by parent report. ADHD symptoms were more strongly associated with ratings of impairment in social relationships, organized peer activities, and classroom behaviors than EF performance. Age did not moderate the findings, but younger children were rated as having more trouble with participation in organized activities by parents, as more likely to disrupt class by teachers, and to have problematic relationships with peers by parents and teachers. EF and academic performance appeared worst in the groups seen as highly symptomatic and impaired by both parents and teachers, and by teachers only. EF deficits may be a specific risk factor for academic impairment in children with ADHD.

Associations of intellectual ability, inhibitory control, impulsiveness, cognitive flexibility and functional impairment in adults with ADHD Symptoms

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with persistent levels of inattention, hyperactivity or impulsivity. Recommendations for ADHD diagnosis involve: six or more symptoms (or five considering adults), early childhood onset, presence of symptoms in two or more contexts and presence of functional impairment. Cognitive deficits, that affect inhibitory control, cognitive flexibility and impulsiveness, are present in ADHD and affect the course of the disorder. On the other hand, intellectual skill is a factor of protection to improve the development in people with ADHD. This article explores how traits relate to functional impairments are relevant to ADHD description in terms of behavioral expression of the cognitive profile. Method: Forty-nine adults, between 20 and 68 years old, with symptoms of inattention and hyperactivity/impulsivity compatible with ADHD, with more than 4 years of schooling and absence of chronic illness, took part of this study. We collected data using screening instruments (ASRS-18, MMSE, and WASI) and main instruments (FDT, BIS-11, and EPF-ADHD). Results: The results have shown that higher intellectual indexes were associated with lower frequencies of academic impairment, while higher impulsivity levels, cognitive flexibility difficulties and inhibitory control, were associated with academic and social impairment. Conclusion: The results show that cognitive deficits were associated to impairment, in different life areas, of people with ADHD, and that some factors, as intellectual abilities, may prevent impairment in ADHD.