Objective: To present the adaptations to treatment protocols made in a child and adolescent eating disorders (ED) unit during the eight-week confinement period mandated in response to the COVID-19 pandemic and examine clinical and treatment variables in the outpatient, day hospital, and inpatient care programs. Method: Description of the implementation of a combined teletherapy program for outpatient and day-hospital patients and the adaptations made to the inpatient protocol. Retrospective review of medical records and analysis of general and specific variables related to the pandemic and confinement. Results: We held 1,329 (73.10%) telehealth consultations and 489 (26.9%) faceto-face outpatient visits with 365 patients undergoing treatment in the outpatient clinic or day hospital. Twenty-eight (7.67%) were initial evaluations. Twenty-two patients were newly admitted and 68 ED-related emergencies were attended. Almost half of the children and adolescents studied experienced reactivation of ED symptoms despite treatment, and severe patients (25%) presented self-harm and suicide risk. Conclusions: The implementation of a combined teletherapy program has enabled continuity of care during confinement for children and adolescents with ED. Delivery of treatment to adolescents in the day hospital program posed the biggest challenge due to their greater degrees of severity and higher hospitalization rates. An adapted inpatient program should be maintained throughout confinement, as the need for hospitalization of children and adolescents with ED does not decrease with lockdown.
EMA is increasingly used to collect participant's information in their real environment and in real time. There are multiple studies focused on the evaluation of mood disorders in children and adolescents, but only a few of them used EMA protocols. Results found in this review showed a wide variability of works with different fields of study, methodological approaches, and EMA protocols. More than 60% of EMA studies in children and adolescents with mood disorders were conducted via phone call, showing high completion rates with data missing in 5 to 11.5% of the calls. Length of studies varied from a 4-day EMA protocol to a maximum of 8 weeks. Positive and negative affect, daily activities, and social context were the main EMA measures. Despite the limited number of studies using EMA in children and adolescents with mood disorders, EMA was useful in assessing mood symptoms in the moment and in patients' real-life environment. Studies also showed high completion and satisfaction rates. Although web pages and apps use have been increasing over the past years, the evidence base is still scarce. Future studies can facilitate understanding of EMA methodology among youth with mood disorders.
Ecological momentary assessment is an excellent tool for the measurement of different day-to-day domains in patients and capturing real-world and real-time data. The purpose of this review is to evaluate feasibility in current ecological momentary assessment studies on emotional and behavioral functioning, functional impairments, and quality of life patients with an attention-deficit/hyperactivity disorder diagnosis. This systematic review follows the recommendation of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines selecting articles published from January 1, 1990, up to the latest access on May 2018, identifying a pool of 23 eligible studies. Twenty-three studies demonstrate the validity of ecological momentary assessment methodology in evaluating different aspects of patients with attention-deficit/hyperactivity disorder. Fifteen studies focus on the child's or adolescent's daily behavior, while eight studies only focus on adults. The studies presented in this review monitored patients and their families over a maximum period of 28 days. We can conclude that ecological momentary assessment can be successfully implemented with attention-deficit/hyperactivity disorder patients to evaluate diverse backgrounds. However, more studies are needed with a longer monitoring period, especially in adolescents, to determine the effectiveness of ecological momentary assessment on patients with attention-deficit/hyperactivity disorder.
In the last few years, several computerized tasks have been developed to increase the objectivity of the diagnosis of attention-deficit hyperactivity disorder (ADHD). This article proposes the “running raccoon” video game to assess the severity of inattention in patients diagnosed with ADHD. Unlike existing tests, the proposed tool is a genuine video game in which the patient must make a raccoon avatar jump to avoid falling into different gaps. The distance to the gap is recorded for each jump. To evaluate the proposed game, an experiment was conducted in which 32 children diagnosed with ADHD participated. For each participant, the median and interquartile range of these distances were calculated, along with the number of omissions. Experimental results showed a significant correlation between the participants’ inattention (measured by the Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior rating scale (SWAN) inattention subscale) with each of these three measures. In addition to its accuracy, other benefits are its short duration and the possibility of being run on both standard computers and mobile devices. These characteristics facilitate its acceptance in clinical environments or even its telematic use. The obtained results, together with the characteristics of the video game, make it an excellent tool to support clinicians in the diagnosis of ADHD.
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