Article de recherche Comment les enfants et adolescents avec le trouble déficit d'attention/hyperactivité (TDAH) vivent-ils le confinement durant la pandémie COVID-19 ?How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak?

People with attention-deficit/hyperactivity disorder (ADHD) have difficulties sustaining their attention on external tasks. Such attentional lapses have often been characterized as the simple opposite of external sustained attention, but the different types of attentional lapses, and the subjective experiences to which they correspond, remain unspecified. In this study, we showed that unmedicated children (ages 6-12) with ADHD, when probed during a standard go/no-go task, reported more mind blanking (a mental state characterized by the absence of reportable content) than did control participants. This increase in mind blanking happened at the expense of both focused and wandering thoughts. We also found that methylphenidate reverted the level of mind blanking to baseline (i.e., the level of mind blanking reported by control children without ADHD). However, this restoration led to mind wandering more than to focused attention. In a second experiment, we extended these findings to adults who had subclinical ADHD. These results suggest that executive functions impaired in ADHD are required not only to sustain external attention but also to maintain an internal train of thought.

Objective: Preliminary evidence suggests a comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obesity. This study was carried out to identify the clinical characteristics of obese adolescents with a higher probability of ADHD and advance the understanding of the potential factors underlying the comorbidity between obesity and ADHD. We evaluated the association between ADHD symptoms and bulimic behaviors, depressive and anxiety symptoms, degree of obesity, pubertal stage, age and gender in a clinical sample of obese adolescents. Design: Cross-sectional study. Subjects: Ninety-nine severely obese adolescents aged 12-17 years. Measurements: Subjects filled out the Bulimic Investigatory Test, Edinburgh, the Beck Depression Inventory and the State-Trait Anxiety Inventory for Children. Their parents completed the Conners Parent Rating Scale, which assesses ADHD symptoms. The degree of overweight was expressed as body mass index-z score. Puberty development was clinically assessed on the basis of Tanner stages. Results: Bulimic behaviors were significantly associated with ADHD symptoms after controlling for depressive and anxiety symptoms. The degree of overweight, pubertal stage, age and gender were not significantly associated with ADHD symptoms. Conclusion: Obese adolescents with bulimic behaviors may have a higher probability to present with ADHD symptoms independently from associated depressive or anxiety symptoms. The degree of overweight, pubertal stage, age and gender might not be useful for detecting obese adolescents with ADHD symptoms. Therefore, we suggest systematic screening for ADHD in obese adolescents with bulimic behaviors. Further studies are needed to understand which specific dimension of ADHD primarily accounts for the association with bulimic behaviors. Future research should also investigate the causal link between bulimic behaviors and ADHD and explore potential common neurobiological alterations. This may lead to a better understanding of the effectiveness of stimulants for the treatment of bulimic behaviors in obese subjects.

Recent studies have reported a deterioration in children's mental health since the start of the COVID-19 pandemic in 2020, with an increase in anxiety and mood disorders. 1 Rates of suicide ideation and suicide attempts among children were also higher when COVID-19-related stressors were heightened in 2020. 2,3 We aimed to better assess temporal trends in suicide attempts among children while adjusting for annual and seasonal fluctuations. We conducted a cross-sectional study of surveillance data collected over the past 10 years at the Robert Debré Hospital in Paris, France, which is one of the largest pediatric centers in Europe. MethodsThis cross-sectional study included all children aged 15 years or younger who attempted suicide and were admitted to the pediatric emergency department of Robert Debré Hospital between January 2010 and April 2021. The study comprised 830 children, with a mean (SD) age of 13.5 (1.5) years and a 1:4 ratio of boys to girls. A suicide attempt was defined as a nonfatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. 4 Deaths by suicide were not included in the analysis because those data were not available in real time.For this study, we conducted a robust seasonal-trend decomposition using locally estimated scatterplot smoothing analysis on the bimestrial time series of all suicide attempts in the 2010 to 2021 surveillance data. 5 The number of suicide attempts observed at time t was decomposed as (1) a seasonal component accounting for the variations observed during the year, (2) a long-term trend, and (3) a remainder. In the absence of atypical events, the remainder should be centered and uncorrelated and should have a constant variance.This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. The independent ethics committee of the Assistance Publique-Hôpitaux de Paris Health Data Warehouse approved the study protocol. Informed consent was not required, in accordance with French law regarding the retrospective use of monocentric anonymized routine data. ResultsThe deseasonalized time series results showed that the number of suicide attempts among children decreased from 12.2 at the lowest level (July to August) in 2019, to 7.8 during the first lockdown period (March to April) in 2020 in France (−36%; Figure; Table ). However, the number of suicide attempts among children increased substantially from the lowest and highest levels of 12.2 (July to August) and 22.5 (November to December) in 2019, to 38.4 just before the second lockdown initiation (September and October) and 40.5 (early November to December) in 2020 (+116% and +299%, respectively). This aberrant dynamic of suicide attempts was independent from its annual seasonality and its trend over the 10-year period, as illustrated by the significant remainder Author affiliations and article information are listed at the end of this article.

Meta-analyses have been extensively used to evaluate the efficacy of neurofeedback (NFB) treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. However, each meta-analysis published in the past decade has contradicted the methods and results from the previous one, thus making it difficult to determine a consensus of opinion on the effectiveness of NFB. This works brings continuity to the field by extending and discussing the last and much controversial meta-analysis by Cortese et al. ( 1 ). The extension comprises an update of that work including the latest control trials, which have since been published and, most importantly, offers a novel methodology. Specifically, NFB literature is characterized by a high technical and methodological heterogeneity, which partly explains the current lack of consensus on the efficacy of NFB. This work takes advantage of this by performing a Systematic Analysis of Biases (SAOB) in studies included in the previous meta-analysis. Our extended meta-analysis (k = 16 studies) confirmed the previously obtained results of effect sizes in favor of NFB efficacy as being significant when clinical scales of ADHD are rated by parents (non-blind, p -value = 0.0014), but not when they are rated by teachers (probably blind, p -value = 0.27). The effect size is significant according to both raters for the subset of studies meeting the definition of “standard NFB protocols” (parents' p -value = 0.0054; teachers' p -value = 0.043, k = 4). Following this, the SAOB performed on k = 33 trials identified three main factors that have an impact on NFB efficacy: first, a more intensive treatment, but not treatment duration, is associated with higher efficacy; second, teachers report a lower improvement compared to parents; third, using high-quality EEG equipment improves the effectiveness of the NFB treatment. The identification of biases relating to an appropriate technical implementation of NFB certainly supports the efficacy of NFB as an intervention. The data presented also suggest that the probably blind assessment of teachers may not be considered a good proxy for blind assessments, therefore stressing the need for studies with placebo-controlled intervention as well as carefully reported neuromarker changes in relation to clinical response.

BackgroundThe aim of this work is to estimate the French frequencies of dispensed psychotropic prescriptions in children and adolescents. Prevalence estimations of dispensed prescriptions are compared to the frequencies of use of psychotropic reported by 17 year-old adolescents.MethodsPrescription data is derived from national health insurance databases. Frequencies of dispensed prescriptions are extrapolated to estimate a range for the 2004 national rates. Self-report data is derived from the 2003 and 2005 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption.ResultsThe prevalence estimation shows that the prevalence of prescription of a psychotropic medication to young persons between 3 and 18 years is about 2.2%.In 2005, the self-report study (ESCAPAD) shows that 14.9% of 17 year-old adolescents took medication for "nerves" or "to sleep" during the previous 12 months. The same study in 2003 also shows that 62.3% of adolescents aged 17 and 18 reporting psychotropic use, took the medication for anxiety and 56.8% to sleep. Only 49.7% of these medications are suggested by a doctor.ConclusionThis study underlines a similar range of prevalence of psychotropic prescriptions in France to that observed in other European countries. Nevertheless, the proportion of antipsychotics and benzodiazepines seems to be higher, whereas the proportion of methylphenidate is lower.Secondly, a disparity between the prevalence of dispensed prescriptions and the self-report of actual use of psychotropics has been highlighted by the ESCAPAD study which shows that these treatments are widely used as "self-medication".

E even at low doses and by the nasal route can decrease tiredness in healthy persons; this is accompanied by a substantial increase in blood pressure and orthostatic hypotension exposing individuals in case of intensive physical exercise to cardiovascular risks. No clear evidence of abuse liability in healthy drug naive subjects was observed.

Taken together, these results suggest that oculomotor abilities are poor in children with ADHD, which may correlate with deficits in inhibitory mechanisms. Treatment with MPH improves oculomotor performances through adaptive strategies, which may involve brain structures related to cognitive inhibition.