ObjectiveWe investigated the impact of clown-care on pain in 45 children with cerebral palsy who underwent recurrent Botulinum-toxin injections (age 7.04± 4.68 years). Participants were randomized to receive either clown (n = 20) or standard (n = 25) -care.MethodsPain Visual-Analogue-Scale (range 1–5) was reported before and after procedures. Pain assessment was lower for children undergoing Botulinum-toxin injections with clown-care (2.89± 1.36) compared to standard-care (3.85± 1.39; p = 0.036) even though pain anticipated prior to procedures was similar (~3).FindingsChildren who underwent the first procedure with clown-care reported lower pain even after they crossed-over to the following procedure which was standard (p = 0.048). Carryover effect was more prominent in injection-naïve children (p = 0.019) and during multiple procedures (p = 0.009). Prior pain experience correlated with pain in subsequent procedures only when first experience was standard-care (p = 0.001).ConclusionsClown-care alleviated pain sensation during Botulinum-toxin injections and initial clown-care experience reduced pain during subsequent injections even though clowns were not present.Trial registrationclinicaltrials.gov ID # NCT01377883.

Risk taking is commonly attributed to individuals with attention deficit hyperactivity disorder (ADHD). This study investigated whether adolescents with ADHD would choose to take greater risks on a probabilistic task in which contingencies are explicitly presented. Adolescents with and without ADHD, aged 13 to 18 years, performed a modified version of the Cambridge Gambling Task. The subjects with ADHD risked smaller sums and chose the unfavorable outcomes more frequently than did the controls but had the same speed of decision and risk adjustment. The results indicate that their poor decisions were not due to impulsivity or insensitivity to the concept of probability and that increased risk taking is not always associated with ADHD. Moreover, in situations that do not demand learning of contingencies, ADHD may be associated with decreased, rather than increased, risk taking.

Numerous studies indicate deficient time estimation in individuals with attention-deficit/hyperactivity disorder (ADHD). Several hypotheses have been raised to explain this deficit including delay aversion, vulnerability to nontemporal distractions, deficient working memory, as well as pure deficit in temporal processing. To test the different hypotheses, adults with or without ADHD performed a prospective time-estimation task under different conditions: with or without nontemporal distraction; and with or without increased load of working memory. Such design was used to rule out the effect of motor control and to manipulate the hypothesized mechanisms of working memory and attention to nontemporal stimuli. The authors report that compared with the control group, adults with ADHD showed greater and more variable deviation in time estimation. In addition, the magnitude of time estimation was affected by allocation of attention to nontemporal stimuli and by load of working memory. The intraindividual variability of time estimation was only partially accounted for by load of working memory. These findings suggest that the ADHD-associated deficit in prospective time estimation is not attributable to special attention to nontemporal stimuli or compromised working memory.

The centrality of executive function deficits (EFD) in attention deficit/ hyperactivity disorder (ADHD) is well accepted albeit EFD is not synonymous with ADHD. The purpose of the present study was to examine the extent to which ADHD and EF overlap and to validate the Hebrew version of the Behavioral Rating Inventory of Executive Functions (BRIEF). Parents of 178 children with and without ADHD completed the BRIEF and the ADHD-Rating Scale. Significant differences were found between groups on each scale even after controlling for the other scale. Internal consistency analysis supported the reliability of the Hebrew version of the BRIEF. We conclude that ADHD and Executive Dysfunctions do not completely overlap.

Sydenham's chorea (SC) is, thought to be an autoimmune neuropsychiatric disorder that may have a prolonged fluctuating course. In some children, associated psychiatric symptoms such as depression, anxiety and obsessive-compulsive symptoms are unresponsive to neuroleptic therapy and may cause significant disability. We describe two adolescents with no prior neuropsychiatric disorders who developed SC and psychiatric symptomatology that did not respond to conventional psychiatric drugs: a 13-year-old boy with hallucinations and a 14-year-old girl with abulia. They received immunosuppressive therapy for 1 year. Hallucinations in the boy resolved following the yearlong regimen of corticosteroids and did not recur during the 5-year follow-up period. The abulia resolved after 14 weeks of prednisone treatment but recurred several months later; further treatment with prednisone and azathioprine resulted in complete resolution of the abulia over the next year. This report of immunosuppressive-responsive psychiatric symptoms in SC suggests an underlying autoimmune disorder causing behavioral changes and offers a therapeutic option in neuroleptic resistant cases.