Self-esteem in adolescent patients with attention-deficit/hyperactivity disorder during open-label atomoxetine treatment: psychometric evaluation of the Rosenberg Self-Esteem Scale and clinical findings

To report on (1) psychometric properties of the Rosenberg Self-Esteem Scale (SES) studied in adolescents with ADHD, (2) correlations of SES with ADHD scale scores, and (3) change in patient-reported self-esteem with atomoxetine treatment. ADHD patients (12–17 years), treated in an open-label study for 24 weeks. Secondary analyses on ADHD symptoms (assessed with ADHD-RS, CGI, GIPD scales) and self-esteem (SES) were performed. One hundred and fifty-nine patients were treated. A dichotomous structure of the SES could be confirmed. Reliability and internal consistency were moderate to excellent. Highest coefficients were found for the correlation between SES and GIPD scores. Self-esteem significantly increased over time, accompanied by an improvement of ADHD symptoms and related perceived difficulties. The Rosenberg SES was shown to be internally consistent, reliable, and sensitive to treatment-related changes of self-esteem. According to these findings, self-esteem may be an important individual patient outcome beyond the core symptoms of ADHD.     

Health-related quality of life in ADHD: a pooled analysis of gender differences in five atomoxetine trials

Attention-deficit/hyperactivity disorder (ADHD) is associated with considerable impairment in health-related quality of life (HR-QoL). Atomoxetine has been found to improve HR-QoL in both children and adolescents. However, there is scarcity of data on gender differences in treatment responses to ADHD medications. This pooled analysis of five atomoxetine trials aimed to evaluate treatment differences with respect to HR-QoL and ADHD symptoms across genders. Data from 5 clinical atomoxetine trials (4 from Europe and 1 from Canada) with similar inclusion and exclusion criteria and similar durations (8- to 12-week follow-up) were included in the pooled analysis. All studies included the Child Health and Illness Profile-Child Edition (CHIP-CE) Parent Report Form. In addition, correlations between HR-QoL and ADHD core symptoms were compared between girls and boys. Data from 136 girls and 658 boys (mean age: 9.6 and 9.7 years, respectively) were pooled. Boys and girls were similarly impaired at baseline with minor differences in some of the subdomains. Treatment effect of atomoxetine was significant in both groups for the Risk Avoidance domain and its subdomains. No gender effect with both clinical and statistical significance was found for treatment outcome. Correlations between ADHD Rating Scale and CHIP-CE scores were similar in both genders and were generally low at baseline and moderate at endpoint and for the change from baseline to endpoint. Atomoxetine was effective in improving some aspects of HR-QoL in both genders without any significant differences across genders. Correlations between core symptoms of ADHD and HR-QoL were low to moderate in both boys and girls.     

"Rehabilitation schools for scoliosis" thematic series: describing the methods and results

Introduction and objectives

Physical deformities caused by adolescent idiopathic scoliosis (AIS) coupled with conservative treatment of AIS with orthesis unavoidably impacts on patients' quality of life (QoL). The present study aimed at evaluating the QoL in patients affected by AIS treated with brace. The study also sought to determine the ability of different QoL questionnaires to monitor QoL over the course of treatment.

Materials and methods

Data were collected in 108 consecutive patients (96 females, 16 males) affected by AIS admitted to the outpatient orthopaedic clinic of the Catholic University of the Sacred Heart in Rome (Italy). Patients were subjected to full-time (i.e., 22 hrs per day) conservative treatment with the progressive action short brace (PASB), the Lyon brace or a combination of PASB + Lyon brace. Three instruments were used for QoL determination: the Scoliosis Research Society 22 (SRS-22), Bad Sobernheim Stress Questionnaire (BSSQ) and the Brace Questionnaire (BrQ).

Results

A significant correlation was detected among the 3 scores (p < 0.001). The BrQ possesses a higher capacity to detect changes in QoL in relation to the patient gender, type of brace, curve severity at baseline and at the completion of treatment, and curve type. Overall, boys displayed a higher QoL than girls. In all 3 questionnaires, higher QoL scores were determined in patients treated with the PASB compared with those using the Lyon brace. QoL scores were significantly correlated with the curve severity. Higher QoL scores were obtained by participants with thoraco-lumbar curves as compared with those with other curves.

Conclusions

The 3 questionnaires are effective in capturing changes in QoL in AIS patients subjected to conservative treatment. However, the BrQ possesses a higher discriminatory capacity compared with the other questionnaires tested. PASB-based treatment is associated with better QoL than the Lyon bracing.     

Physical activity levels of normal-weight and overweight girls and boys during primary school recess

Objective: This study aimed to compare moderate‐to‐vigorous physical activity (MVPA) and vigorous physical activity (VPA) in normal‐weight and overweight boys and girls during school recess. Research Methods and Procedures: Four hundred twenty children, age 6 to 10 years, were randomly selected from 25 schools in England. Three hundred seventy‐seven children completed the study. BMI was calculated from height and weight measurements, and heart rate reserve thresholds of 50% and 75% reflected children's engagement in MVPA and VPA, respectively. Results: There was a significant main effect for sex and a significant interaction between BMI category and sex for the percent of recess time spent in MVPA and VPA. Normal‐weight girls were the least active group, compared with overweight boys and girls who were equally active. Fifty‐one boys and 24 girls of normal weight achieved the 40% threshold; of these, 30 boys and 10 girls exceeded 50% of recess time in MVPA. Eighteen overweight boys and 22 overweight girls exceeded the 40% threshold, whereas 8 boys and 8 girls exceeded the 50% threshold. Discussion: Overweight boys were significantly less active than their normal‐weight male counterparts; this difference did not hold true for girls. Even though nearly double the number of normal‐weight children achieved the 40% of MVPA during recess compared with overweight children, physical activity promotion in school playgrounds needs to be targeted not only at overweight but at other health parameters, as 40 overweight children met the 40% MVPA target proposed for recess.     

Planning Steps Forward in Development: In Girls Earlier than in Boys

The development of planning ability in children initially aged four and five was examined longitudinally with a retest-interval of 12 months using the Tower of London task. As expected, problems to solve straightforward without mental look-ahead were mastered by most, even the youngest children. Problems demanding look-ahead were more difficult and accuracy improved significantly with age and over time. This development was strongly moderated by sex: In contrast to coeval boys, four year old girls showed an impressive performance enhancement at age five, reaching the performance of six year olds, whereas four year old boys lagged behind and caught up with girls at the age of six, the typical age of school enrollment. This sex-specific development of planning was clearly separated from overall intelligence: young boys showed a steeper increase in raw intelligence scores than girls, whereas in the older groups scores developed similarly. The observed sex differences in planning development are evident even within a narrow time window of twelve months and may relate to differences in maturational trajectories for girls and boys in dorsolateral prefrontal cortex.     

Why Are Girls Less Physically Active than Boys? Findings from the LOOK Longitudinal Study

Background

A gender-based disparity in physical activity (PA) among youth, whereby girls are less active than boys is a persistent finding in the literature. A greater understanding of the mechanisms underlying this difference has potential to guide PA intervention strategies.

Methods

Data were collected at age 8 and 12 years (276 boys, 279 girls) from 29 schools as part of the LOOK study. Multilevel linear models were fitted separately for boys and girls to examine effects of individual, family and environmental level correlates on pedometer measured PA. Cardio-respiratory fitness (multi-stage run), percent fat (DEXA), eye-hand coordination (throw and catch test) and perceived competence in physical education (questionnaire) were used as individual level correlates. At the family level, parent’s support and education (questionnaire) were used. School attended and extracurricular sport participation were included as environmental level correlates.

Results

Girls were 19% less active than boys (9420 vs 11360 steps/day, p<0.001, 95%CI [1844, 2626]). Lower PA among girls was associated with weaker influences at the school and family levels and through lower participation in extracurricular sport. School attended explained some of the variation in boys PA (8.4%) but not girls. Girls compared to boys had less favourable individual attributes associated with PA at age 8 years, including 18% lower cardio-respiratory fitness (3.5 vs 4.2, p<0.001, CI [0.5,0.9]), 44% lower eye-hand coordination (11.0 vs 17.3, p<0.001, CI [5.1,9.0]), higher percent body fat (28% vs 23%, p<0.001, CI [3.5,5.7]) and 9% lower perceived competence in physical education (7.7 vs 8.4, p<0.001, CI [0.2,0.9]). Participation in extracurricular sport at either age 8 or 12 years was protective against declines in PA over time among boys but not girls.

Conclusion

Girls PA was less favourably influenced by socio-ecological factors at the individual, family, school and environmental levels. These factors are potentially modifiable suggesting the gap in PA between boys and girls can be reduced. Strategies aiming to increase PA should be multicomponent and take into consideration that pathways to increasing PA are likely to differ among boys and girls.     

Caregivers' attitudes and practices: influence on childhood body weight

Childhood excess weight is probably associated with, or reflected in, parental attitudes. The objective of this study was to study the relationships between childhood excess weight and parental attitudes. The study subjects were 53 boys and 56 girls, aged 6-10, regularly attending schools in Porto Alegre, south Brazil, and one of their parents or caregivers. Attitudes of the parents or caregivers were assessed by the Child Feeding Questionnaire (CFD). Weight and height of the children were measured, parents self-reported their weight and height and body mass indexes were calculated for both. The WHO criteria for overweight and obesity were used for the adults. The CDC criteria for overweight and risk for overweight were used for the corresponding children. Boys presented excess weight more often than girls. The parents of children with excess weight showed higher scores for perceived child weight, concern about child weight, restriction and monitoring. In logistic regression, excess weight in children was associated with perceived child weight, restriction and male sex; pressure to eat was negatively associated with excess BMI. In Porto Alegre, south Brazil, excess body weight in children aged 6-10 is associated with parental perceived child weight and concern about it, monitoring and restriction; being a boy increases the odds of being overweight.     

Effects of growth hormone on cognitive function

Whether growth hormone deficiency (GHD) and/or treatment in childhood and adolescence influences cognitive outcome in children with GHD or girls with Turner syndrome (TS) is controversial. Previous studies also suggest that quality of life (QoL) is reduced in adults with GHD, particularly in the areas of social isolation and fatigue. Baseline QoL scores were significantly lower in patients with GHD than in the general population of the same age, gender, and nationality. Unfortunately, few data are available describing QoL in children with GHD. TS is a genetic disorder characterized by short stature, gonadal dysgenesis, and a particular neurocognitive profile of normally developed language abilities (particularly verbal intelligence quotients) and impaired visual-spatial and/or visual-perceptual abilities. This study evaluated the effects of GH treatment on neurocognitive function in girls with TS who were enrolled in a long-term, double-blind, placebo-controlled trial of the effects of GH treatment on final adult height. Treatment duration ranged from 1 to 7 years. The major result of this study was the absence of GH treatment effects on cognitive function in girls with TS. GHD and/or treatment in childhood and adulthood influences cognitive and/or QoL outcomes in some but not all studies. This study did not support a role for GH in influencing the characteristic nonverbal neurocognitive deficits associated with TS. However, evaluation of QoL should be a part of the routine clinical management of patients with GHD or TS.     

Associations of Physical Activity and Sedentary Behavior with Academic Skills – A Follow-Up Study among Primary School Children

Background

There are no prospective studies that would have compared the relationships of different types of physical activity (PA) and sedentary behavior (SB) with academic skills among children. We therefore investigated the associations of different types of PA and SB with reading and arithmetic skills in a follow-up study among children.

Methods

The participants were 186 children (107 boys, 79 girls, 6–8 yr) who were followed-up in Grades 1–3. PA and SB were assessed using a questionnaire in Grade 1. Reading fluency, reading comprehension and arithmetic skills were assessed using standardized tests at the end of Grades 1–3.

Results

Among all children more recess PA and more time spent in SB related to academic skills were associated with a better reading fluency across Grades 1–3. In boys, higher levels of total PA, physically active school transportation and more time spent in SB related to academic skills were associated with a better reading fluency across the Grades 1–3. Among girls, higher levels of total PA were related to worse arithmetic skills across Grades 1–3. Moreover, total PA was directly associated with reading fluency and arithmetic skills in Grades 1–3 among girls whose parents had a university degree, whereas these relationships were inverse in girls of less educated parents.

Conclusions

Total PA, physically active school transportation and SB related to academic skills may be beneficial for the development of reading skills in boys, whereas factors that are independent of PA or SB may be more important for academic skills in girls.

Trial Registration

ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01803776","term_id":"NCT01803776"}}NCT01803776     

Atomoxetine Effects on Executive Function as Measured by the BRIEF-A in Young Adults with ADHD: A Randomized,Double-Blind,Placebo-Controlled Study

Objective

To evaluate the effect of atomoxetine treatment on executive functions in young adults with attention-deficit/hyperactivity disorder (ADHD).

Methods

In this Phase 4, multi-center, double-blind, placebo-controlled trial, young adults (18–30 years) with ADHD were randomized to receive atomoxetine (20–50 mg BID, N = 220) or placebo (N = 225) for 12 weeks. The Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) consists of 75 self-report items within 9 nonoverlapping clinical scales measuring various aspects of executive functioning. Mean changes from baseline to 12-week endpoint on the BRIEF-A were analyzed using an ANCOVA model (terms: baseline score, treatment, and investigator).

Results

At baseline, there were no significant treatment group differences in the percentage of patients with BRIEF-A composite or index T-scores ≥60 (p>.5), with over 92% of patients having composite scores ≥60 (≥60 deemed clinically meaningful for these analyses). At endpoint, statistically significantly greater mean reductions were seen in the atomoxetine versus placebo group for the BRIEF-A Global Executive Composite (GEC), Behavioral Regulation Index (BRI), and Metacognitive Index (MI) scores, as well as the Inhibit, Self-Monitor, Working Memory, Plan/Organize and Task Monitor subscale scores (p<.05), with decreases in scores signifying improvements in executive functioning. Changes in the BRIEF-A Initiate (p = .051), Organization of Materials (p = .051), Shift (p = .090), and Emotional Control (p = .219) subscale scores were not statistically significant. In addition, the validity scales: Inconsistency (p = .644), Infrequency (p = .097), and Negativity (p = .456) were not statistically significant, showing scale validity.

Conclusion

Statistically significantly greater improvement in executive function was observed in young adults with ADHD in the atomoxetine versus placebo group as measured by changes in the BRIEF-A scales.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00510276","term_id":"NCT00510276"}}NCT00510276     

Skeletal development of non-institutionalized children with low Intelligence Quotients

Children of both sexes with mild mental retardation show delays in skeletal maturation and cortical bone growth, but boys in general are more affected than girls. Skeletal age for both sexes is below normal in the younger age groups, but approaches normality at adolescence. None of the measures of IQ is significantly correlated with any of the regional measures of skeletal age in the hand-wrist. The approach toward normality of skeletal development in this population at adolescence is reflected in their normal time of first appearance of the adductor sesamoid. Anomalies of the hand-wrist reflect irregularities in comparing normal and low-IQ children. Only brachymesophalangy V displays significantly higher frequencies in the low-IQ groups. Due to the cross-sectional nature of the study and the different methods of classifying anomalies, little can be said about the other comparisons. Growth in cortical bone reflects a consistent trend for both the humerus and second metacarpal. While measures of total diameter and total cross-sectional area do appear to be below normal standards, the measures of the marrow do not. This finding accounts for a decreased cortical bone thickness and cross-sectional area in the low-IQ sample. All measures of the humerus correlate significantly with two IQ scores in the boys and all three scores in the girls. Measures of the total metacarpal and marrow area show significant correlations with the three IQ scores among low-IQ boys, while only measures of total metacarpal area show significant correlations with verbal IQ in low-IQ girls. The degree of mental deficiency, then, is only irregularly associated with deficits of bone size for age.     

The Kiddie-SADS allows a dimensional assessment of externalizing symptoms in ADHD children and adolescents

Objective of the study was the investigation of the psychometric properties of a scale derived from the Kiddie-SADS used for a dimensional assessment of externalizing symptoms in children and adolescents. The scale consists of 26 DSM-IV Kiddie-SADS items for attention deficit hyperactivity disorder (ADHD, 18 items) and oppositional defiant disorder (ODD, 8 items). Patients and their mothers were interviewed separately on the patients' symptoms during the last 2 weeks prior to interview. An ADHD-ODD sum score ranging between 0 and 26 was computed reflecting the number of fulfilled diagnostic criteria within the 2-week period under investigation. Interviews were videotaped and re-rated by an independent second rater. Additionally, mothers filled out two questionnaires on their children's symptoms (FBB-HKS, a German ADHD scale based on ICD-10 and DSM-IV criteria; strength and difficulties questionnaire, SDQ). We investigated 59 patients affected by AD(H)D according to DSM-IV recruited from our Department for Child and Adolescent Psychiatry (39 males, 20 females; mean age: M=9.66, SD=2.30). Inter-rater correlation regarding the ADHD-ODD scores was r=0.98 with no significant differences in mean sum scores between rater 1 and rater 2. Internal consistency of the ADHD-ODD scale was 0.85 (Cronbach's alpha). Item difficulties and discriminative power of the items also proved to be adequate. Convergent and discriminant validity were indicated by middle to high correlations with mother-ratings of the children's externalizing symptoms and a low correlation with ratings of internalizing symptoms. Factor analysis revealed a three-factor solution mainly covering inattentive, hyperactive and oppositional symptoms. In summary, ADHD and ODD sections of the Kiddie-SADS allow a reliable and valid dimensional assessment of externalizing symptoms in AD(H)D children and adolescents.     

Toward Meeting the Needs of Homeless People with Schizophrenia: The Validity of Quality of Life Measurement

Objective

To provide new evidence regarding the suitability of using quality of life (QoL) measurements in homeless people with schizophrenia, we assess the acceptability and psychometric properties of a specific QoL instrument (S-QoL 18) in a population of homeless people with schizophrenia, and we compare their QoL levels with those observed in non-homeless people with schizophrenia.

Methods

This multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. Two hundred and thirty-six homeless patients with schizophrenia were recruited over a 12 month-period. The S-QoL 18 was tested for construct validity, reliability, external validity and sensitivity to change. The QoL of the 236 homeless patients was compared with 236 French age- and sex-matched non-homeless patients with schizophrenia.

Results

The eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA = 0.035, CFI = 0.95, GFI = 0.99 and SRMR = 0.015). Internal consistency, reliability and sensitivity to change were satisfactory. External validity was confirmed via correlations between S-QoL 18 dimension scores and SF-36, symptomatology and recovery scores. The percentage of missing data did not exceed 5%. Finally, homeless patients had significantly lower QoL levels than non-homeless patients with schizophrenia.

Conclusions

These results demonstrate the satisfactory acceptability and psychometric properties of the S-QoL 18, suggesting the validity of QoL measurement among homeless patients with schizophrenia. Our study also reported that QoL levels in homeless patients with schizophrenia were dramatically low, highlighting the need for new policies to eradicate homelessness and tackle poverty.     

Treatment compliance or medication adherence in children and adolescents on ADHD medication in clinical practice: results from the COMPLY observational study

Although the efficacy and tolerability of ADHD medications have been investigated fairly extensively, there are very few data comparing the different types of medication (e.g. psychostimulants, non-stimulants) in terms of medication adherence. The primary research objective of the COMPLY observational study was to evaluate medication adherence (i.e. compliance) over 1 year in children and adolescents with ADHD in a routine clinical setting. COMPLY was a prospective 12-month, observational, open-label study that included children and adolescents, aged 6–17 years, with ADHD. Medication adherence (i.e. compliance) was measured using the Pediatric Compliance Self-Rating (PCSR) instrument and using items 1–4 of the Medication Adherence Rating Scale (MARS). A total of 504 patients were enrolled. At baseline, 252 patients (50.0 %) were prescribed non-stimulant (atomoxetine) medication and 247 patients (49.0 %) were prescribed psychostimulant medication. Both types of medication were prescribed concomitantly in five patients (1.0 %). After 12 months, 123 patients (48.8 %) were taking atomoxetine and 176 patients (71.3 %) were taking psychostimulants. Adherence (PCSR score ≥5) was present in both groups (atomoxetine: 67.5 %; psychostimulant: 74.2 %) throughout the observation period. MARS scores declined over time in both groups (atomoxetine: from 3.7 to 2.9; psychostimulant: from 3.6 to 3.1), indicating a deterioration in adherence. There was no statistically significant difference in terms of medication adherence between the two groups.     

What Time Periods of the Day Are Concerning for Parents of Children with Attention Deficit Hyperactivity Disorder?

Background/Aim

The questionnaire-children with difficulties (QCD) is a parent-assessed questionnaire designed to evaluate a child’s difficulties in functioning during specific time periods of the day. In this study, the QCD was applied to determine the time periods of the day that are concerning for the parents of children with attention deficit hyperactivity disorder (ADHD). The results were compared with those for a community sample.

Methods

Elementary and junior high school students with ADHD (243 boys, 55 girls) and a community sample of children (518 boys, 618 girls) were enrolled in this study. Their behaviors were assessed by the QCD, the ADHD-rating scale (ADHD-RS), and the Oppositional Defiant Behavior Inventory (ODBI). The effects of gender (boy/girl) and diagnosis (ADHD/community sample) on the total QCD score were analyzed across each school grade (elementary/junior high school). Correlation coefficients between QCD and ADHD-RS/ODBI scores were analyzed.

Results

The QCD score for the ADHD group was significantly lower than that for the community sample (P < 0.001). There were significantly strong correlations between “evening” and ADHD-RS and ODBI scores for all children with ADHD (r > 0.41, P < 0.001) and between “night” and inattention and oppositional symptoms for the girls with ADHD (r > 0.40, P < 0.001).

Conclusions

Parents reported that children with ADHD faced greater difficulties in completing basic daily activities compared with the community controls, particularly in the evening. Furthermore, these difficulties were related to the severity of ADHD symptoms. The parents’ perceptions depended on the gender, ADHD and oppositional symptoms, and the time period of the day. This study determined that children with ADHD face greater difficulties in daily functioning compared with community sample children, that these difficulties are time-dependent, and that these difficulties were particularly experienced in the evening.     

Prenatal androgen exposure and children's aggressive behavior and activity level

Some human behaviors, including aggression and activity level, differ on average for males and females. Here we report findings from two studies investigating possible relations between prenatal androgen and children's aggression and activity level. For study 1, aggression and activity level scores for 43 girls and 38 boys, aged 4 to 11 years, with congenital adrenal hyperplasia (CAH, a genetic condition causing increased adrenal androgen production beginning prenatally) were compared to those of similarly-aged, unaffected relatives (41 girls, 31 boys). Girls with CAH scored higher on aggression than unaffected girls, d = 0.69, and unaffected boys scored higher on activity level than unaffected girls, d = 0.50. No other group differences were significant. For study 2, the relationship of amniotic fluid testosterone to aggression and activity level was investigated in typically-developing children (48 girls, 44 boys), aged 3 to 5 years. Boys scored higher than girls on aggression, d = 0.41, and activity level, d = 0.50. However, amniotic fluid testosterone was not a significant predictor of aggression or activity level for either sex. The results of the two studies provide some support for an influence of prenatal androgen exposure on children's aggressive behavior, but not activity level. The within-sex variation in amniotic fluid testosterone may not be sufficient to allow reliable assessment of relations to aggression or activity level.     

Influence of parents' eating behaviors and child feeding practices on children's weight status

Objective : To investigate the effects of mothers’ and fathers’ eating behaviors, child feeding practices, and BMI on percentage body fat and BMI in their children. Research Methods and Procedures : Four hundred fifty‐eight parents (239 mothers, 219 fathers) were asked to complete two questionnaires: the Three‐Factor Eating Questionnaire and the Child Feeding Questionnaire, which measure dimensions of parent eating behavior and child feeding practices, respectively. Parent BMI was calculated from self‐reported height and weight; children's measures included BMI and percentage fat assessed by DXA. Regression analyses were used to analyze relationships between parents’ BMI and questionnaire scores and children's weight status. Results : One hundred forty‐three mothers and 68 fathers returned questionnaires, representing parents of 148 children 3 to 5 years old (78 boys). Children's weight was related to mothers’ BMI, but not fathers’. Girls had a greater BMI if either parent reported being overweight as a child, and both girls and boys were likely to be overweight if their mothers believed they had risky eating habits (fussiness, eating too much, etc.). Girls with fathers who were more controlling had a higher percentage fat; these fathers were also more concerned about their daughters’ future health. Discussion : Mothers exert a strong influence over their children's weight and seem to be more concerned about their children's eating behaviors; however, fathers play a role in imposing child feeding practices. Gender bias may be present in child feeding, as suggested by dissimilar effects of parent practices on the weight status of girls vs. boys. Fathers should be included in future studies analyzing parent feeding practices and children's weight outcome.     

Assessment of effects of atomoxetine in adult patients with ADHD: consistency among three geographic regions in a response maintenance study

A previous study (Upadhyaya et al. in Eur J Psychiatry 2013b; 27:185–205) reported that adults with attention-deficit/hyperactivity disorder (ADHD) demonstrated maintenance of response for up to 25 weeks after initially responding to atomoxetine treatment. In the present report, the consistency of treatment effect across three geographic regions (Europe, United States/Canada [US/Can], and Latin America [Latin Am]) was explored. Data were analyzed from a phase 3, multicenter, randomized, double-blind, maintenance-of-response (randomized withdrawal) trial of atomoxetine versus placebo in adults with ADHD. Patients were randomized to atomoxetine (N = 266) or placebo (N = 258) for 25 weeks. Consistency assessments included the interaction test, pairwise t tests, noninferiority, and the criteria from Basic Principles on Global Clinical Trials (Ministry of Health, Labour and Welfare of Japan 2007). Atomoxetine-treated patients maintained the improved ADHD symptoms relative to placebo-treated patients on the Conners’ Adult ADHD Rating Scale Investigator-Rated: Screening Version 18-Item (CAARS-Inv:SV) total score in all three regions (atomoxetine–placebo mean difference = ?4.55, ?3.18, and ?0.07 for Europe, US/Can, and Latin Am, respectively). For the Latin Am region, the mean change in total score (0.41) was notably smaller for the placebo group than for Europe (5.87) and US/Can (4.39). Similar results were observed for the CAARS-Inv:SV hyperactivity/impulsivity and inattention subscale scores. Overall, patients maintained the response with atomoxetine treatment compared to placebo; however, the magnitude of treatment effect differed among the regions studied, being numerically higher in the EU and US/Can than Latin Am. Trial registration http://www.clinicaltrials.gov/(NCT00700427).     

Individual differences in adolescent religiosity in Finland: familial effects are modified by sex and region of residence.

Data from 16-year-old Finnish twin pairs were used to estimate familial effects on religiosity and the modification of those effects by sex and residential region. The sample of 2265 twin boys and 2521 twin girls formed 779 monozygotic and 1614 dizygotic pairs, 785 of the same sex and 829 of opposite sex. We compared religiosity scores of twins living in more rural and traditional northern Finland with those living in the more urban and secular southern region. Girls had higher religiosity scores than did boys, and twins living in northern Finland had higher religiosity scores than those resident in southern Finland. Correlations for monozygotic twins were slightly higher than those for dizygotic twins, and covariance modeling found modest heritability of religiosity [11% (95% CI 0-24) for girls; 22% (95% CI 6-38) for boys], and substantial shared environmental effects [60% (95% CI 49-69) and 45% (95% CI 31-57)] among girls and boys, respectively. The correlation between shared environmental effects in boys and girls was estimated to be 0.84 (95% CI 0.73-0.99). In analyses distinguishing region of residence, girls living in southern Finland were found to have significantly higher unshared environmental effects than girls in northern Finland, while boys living in the urban south appeared to have lower shared environmental effects, and higher additive genetic effects, than boys living in the rural north.     

Correlates of objectively measured physical activity in obese children

The aim of this study was to identify potential correlates of objectively measured physical activity in a sample of obese children. A cross-sectional design was used to assess 137 5-9-year-old obese children (mean +/- s.d. age = 8.3 +/- 1.1 years; mean BMI z-score = 2.76 +/- 0.70; 58% girls) from two regional cities in New South Wales, Australia, before commencement in a treatment trial. Correlates examined included age, BMI z, parental BMI, perceived competence, health-related quality of life, daily minutes spent in small screen recreation (SSR), and fundamental motor skill (FMS) proficiency. Physical activity was assessed using accelerometers and values were calculated for % of monitored time spent in moderate- (MPA) and vigorous (VPA)-intensity physical activity and mean counts per minute (CPM). Analyses were conducted separately for boys and girls. Motor skill proficiency was significantly correlated with a number of physical activity variables for boys and girls. For boys, regression analysis revealed object-control proficiency predicted CPM (R(2) = 0.25) and age was a predictor of %MPA (R(2) = 0.56). Age and object-control skill proficiency were salient predictors of %VPA (R(2) = 0.34). For girls, age and daily minutes of SSR were the only significant predictors for CPM (R(2) = 0.13). Age was the sole predictor of %MPA (R(2) = 0.38) and %VPA (R(2) = 0.15). The targeting of FMSs at an early age should be tested in experimental studies as potential strategies to increase physical activity among obese children, particularly for boys. Interventions aimed at reducing sedentary behaviors among obese girls should also be considered.