Diane Purper-Ouakil

Background: In the 5 years since the publication of the original ADHD International Consensus Statement, a great deal of new evidence has emerged. This updated consensus statement reflects the current state of the science with respect to ADHD, with a goal of reducing misconceptions and stigma around the disorder.Methods: Studies eligible for inclusion were published between January 1, 2021 and July 1, 2025 and were either: 1) large cohort studies of 2000 or more participants, or 2) meta-analyses of at least 5 studies or 2000 participants in which publication bias was considered. Eligible studies were summarized and consolidated by theme. Manuscript contents were reviewed and approved by 118 authors from 29 countries and 6 continents.Results: Two hundred and fifty empirically-supported statements were generated from these studies, offering readers an up-to-date understanding of the most robust findings in the areas of prevalence, how genes and environmental factors shape ADHD, psychiatric and somatic comorbidities, cognitive and neurological differences among individuals with ADHD, functional outcomes, and treatments for the disorder. Conclusions: Many of the conclusions of the original Consensus Statement are supported, but this update adds important nuance to some findings as a result of more recent evidence. It also highlights a few areas in which the balance of findings has shifted in the last 5 years, providing a transparent overview of the current scientific state of the field.

Terminology used to describe neurodevelopmental conditions is increasingly contested, reflecting tensions between medical and neurodiversity-informed frameworks. While a growing body of research has examined terminology preferences within autism, comparable empirical work focusing specifically on Attention Deficit/Hyperactivity Disorder (ADHD) remains notably limited. We examined ADHD-related language preferences among adults with lived experience across three languages and four countries. An online cross-sectional survey was completed by 2,340 adults with lived experience of ADHD: 359 English-speaking (United Kingdom), 1,749 French-speaking (France), and 232 Dutch-speaking (Belgium and the Netherlands). Linear mixed-effects models were used to test the effects of term, spoken language, and their interaction, with participant as a random intercept. Preferences varied by spoken language. English- and Dutch-speaking participants favoured neurodiversity-aligned terms (e.g., “neurodivergent person”, “brain difference”, “traits”), whereas French-speaking participants more strongly endorsed medicalised descriptors (e.g., “person with ADHD”, “disorder”, “symptoms”). However, explicitly deficit-oriented terms (e.g., “abnormal”, “deficits”) were broadly opposed across spoken languages. There is no cross-language consensus on ADHD terminology and even within one language preferences vary substantially. These findings caution against the use of universal, prescriptive guidance and underscore the need for culturally and linguistically sensitive language in research, clinical, and policy contexts.

Background: Children and adolescents with Attention‐Deficit/Hyperactivity Disorder (ADHD) often show increased emotional dysregulation (ED) and internalizing emotional problems (iEP). However, the predictive and moderating role of these emotional difficulties in the treatment of ADHD—particularly regarding pharmacological (methylphenidate, MPH) and non‐pharmacological approaches (neurofeedback at home, NF@home)—remains understudied. This study aims to evaluate the effectiveness of MPH and NF@home in reducing iEP/ED in children with ADHD and to assess the predictive role of iEP/ED and neuropsychological executive function (EF) measures in treatment outcomes. Methods: The per‐protocol sample included 146 children (7–13 years) diagnosed with ADHD (inattentive or combined type). iEP was measured with the Strengths and Difficulties Questionnaire (SDQ), ED via a dysregulation profile, and EF using the BRIEF and Continuous Performance Test (CPT). ADHD symptoms were assessed using the ADHD Rating Scale IV. Participants were randomized to either the MPH group ( n = 59) or the NF group ( n = 87), which included NF _SMR ( n = 72) and NF _TBR ( n = 15), based on individual Theta/Beta‐Ratio (TBR). Mixed‐model analyses considered symptom severity at baseline, age, gender, IQ, and study center as covariates. Results: All intervention groups showed significant changes in iEP, but with different effects regarding parent (NF _SMR : d = −0.396, 95% CI [−0.574, −0.217]; NF _TBR : d = −0.367, 95% CI [−0.747, 0.013]; MPH: d = −0.409, 95% CI [−0.603, −0.215]) and teacher ratings (NF _SMR : d = −0.211, 95% CI [−0.405, −0.017]; NF _TBR : d = −0.639, 95% CI [−1.06, −0.222]; MPH: d = −0.142, 95% CI [−0.340, 0.056]). There was no between‐intervention effect, supported by non‐inferiority analyses. For ED, we also found significant effects for all interventions; however, significantly more pronounced effects were obtained for MPH. Moreover, both prediction models indicated a limited predictive value. Conclusions: The findings suggest non‐inferiority of NF versus MPH treating iEP within an ADHD sample. However, due to limited predictive value, no clear clinical guidance can yet be drawn regarding personalized treatment recommendations. Further studies are needed to confirm and extend these findings.

Background: Sex differences in adolescent mental disorders are well documented, but less is known about how these differences evolve during the transition to adulthood, particularly during the shift from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS), a critical period marked by vulnerability to discontinuity of care. Objective: To examine sex-specific differences in psychiatric symptom profiles and clinical trajectories during the CAMHS–AMHS transition using data from the European MILESTONE project, a 2-year longitudinal study. Methods: A cohort of 1004 adolescents (aged 17–19) in CAMHS was assessed at baseline (T1), 9 months (T2), 15 months (T3) and 24 months (T4). Measures included the Child Behavior Checklist/Adult Behavior Checklist, Health of the Nation Outcome Scales for Children and Adolescents, and the Specific Level of Functioning Scale. Multilevel modelling included sex, diagnosis and time point as covariates, testing three-way interactions for differential trajectories. Findings: Males showed higher symptom severity and impairment across measures, particularly in anxiety/somatic/trauma, eating disorder/obsessive-compulsive disorder (ED/OCD) and schizophrenia. Females exhibited better functioning. Significant sex differences emerged in internalising symptoms (eg, anxiety/somatic/trauma, autism spectrum disorder (ASD)), externalising symptoms (eg, attention deficit hyperactivity disorder (ADHD)), overall psychopathology (eg, ADHD, personality disorder/conduct disorder/substance use disorder) and functioning (eg, ED/OCD, schizophrenia spectrum disorder). Conclusions: Sex-related differences in symptom severity, diagnosis and functioning persist across the CAMHS–AMHS transition, with males generally more impaired and females showing better adaptive outcomes. Clinical implications: Identifying sex-specific trajectories can enhance personalised transitional care, reduce misdiagnosis and guide targeted interventions—especially for under-recognised presentations such as ADHD/ASD in females and ED in males. Trial registration number: ISRCTN83240263 .

Importance: Problematic use of the internet (PUI) behaviors, including problematic gaming, social media use, smartphone use, and general internet use, have been increasingly studied worldwide. So far it is unclear what the global prevalence of PUI is. Objective: To critically appraise existing systematic reviews and meta-analyses on the prevalence of PUI behaviors and generate aggregated global prevalence estimates across different manifestations and definitions. Data Sources: MEDLINE (Ovid), Embase (Ovid), Scopus, Web of Science, CINAHL, and the Cochrane Review Library were searched for relevant articles from database inception to the most recent available search prior to manuscript preparation. Searches targeted systematic reviews and meta-analyses reporting prevalence for PUI-related behaviors. Study Selection: Systematic reviews and meta-analyses of observational studies reporting prevalence estimates for problematic gaming, problematic internet use, problematic smartphone use, problematic social media use, or sexting were included. Scoping reviews were retained for descriptive synthesis only. Data Extraction and Synthesis: An umbrella review methodology was used. Data extraction and methodological appraisal were conducted using AMSTAR-2 to assess the quality of included systematic reviews up to February 2026. Primary studies included in each review were extracted and pooled using random-effects meta-analysis. Analyses were conducted to estimate pooled prevalence with 95% confidence intervals (CIs) and heterogeneity across non-overlapping primary studies. Small-study effects were examined. Main Outcomes and Measures: Global pooled prevalence estimates for PUI behaviors, including problematic gaming, problematic internet use, problematic smartphone use, problematic social media use, and sexting. Results: Eleven reviews (10 systematic reviews and 1 scoping review) met inclusion criteria, representing data from 3 145 428 individuals, of whom 3 030 023 were included in pooled prevalence analyses. Across regions, pooled prevalence estimates were 6% (95% CI, 5%–7%) for problematic gaming, 16% (95% CI, 15%–17%) for problematic internet use, 32% (95% CI, 28%–35%) for problematic smartphone use, and 23% (95% CI, 19%–28%) for problematic social media use. Substantial heterogeneity (I ² > 99%) was observed across primary studies, reflecting variation in study methodologies, sampled populations, and definitions of PUI behaviors. Conclusions and Relevance: PUI behaviors appear to affect a substantial proportion of the global population. However, methodological concerns were common, with 9 of 10 systematic reviews rated as having low or critically low confidence according to AMSTAR-2. Evidence remains concentrated in East Asia and Europe, and many reviews combine heterogeneous populations and sampling strategies. Additional high-quality epidemiological research, including underrepresented regions is needed to refine prevalence estimates, clarify risk factors, and support the development of standardized criteria for PUI behaviors. Key Points: Question: What is the global prevalence of problematic use of the internet (PUI) behaviors across major subtypes, based on an umbrella review of existing reviews and a meta-analysis of nonoverlapping primary studies? Findings: In this umbrella review of 11 reviews and random-effects meta-analysis of 753 nonoverlapping primary studies including 3 030 023 individuals, pooled prevalence estimates were 6% for problematic gaming, 16% for problematic internet use, 32% for problematic smartphone use, and 23% for problematic social media use. Findings indicated substantial between-study heterogeneity, and most included systematic reviews were rated low or critically low in methodological quality. Meaning: These findings suggest that PUI behaviors affect a substantial proportion of the global population, but more methodologically rigorous and geographically representative epidemiological research is needed to generate more precise and comparable prevalence estimates across clinical and population samples.

The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) presents significant challenges, underscoring the need for improved transitional care procedures. Few European countries have implemented national transition-related guidance, despite the potential of clinical guidance to support appropriate care decisions and practices. We conducted a literature review to inform the development of the European Society of Child and Adolescent Psychiatry (ESCAP) transition guidance for clinicians. Following systematic principles, four databases (Medline, Embase, PsychInfo, Web of Science) were searched to identify relevant international research published from January 1, 2019 to April 10, 2025, to build on existing evidence. Titles and abstracts were reviewed by two independent reviewers. We screened 12,595 records and included 149 reports published since 2019. Illness severity was the primary predictor of AMHS transition, with only 20–25% transitioning directly, challenging assumptions that only specific diagnostic groups warrant continuity. Among those reaching the upper age boundary, the majority (40–60%) discontinue specialist services rather than transitioning to AMHS. Longitudinal data from the MILESTONE study – though limited by recruitment bias towards less severe cases – show that most maintain stable mental health without ongoing specialist input, yet 25% experience deterioration and 13% require readmission within two years. Many studies reported shortcomings regarding transition experiences for young people and parents/caregivers. However, structured preparation and stakeholder involvement can improve outcomes regardless of service destination. Findings challenge deficit-focused perspectives by showing that discontinuation represents the appropriate pathway for about half of young people. Substantial cross-country variation, often resource driven, underscores the importance of individualised, developmentally appropriate approaches that respect young people’s autonomy while providing necessary support.

Background: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is poorly managed, with discontinuity of care commonplace, leading to poorer outcomes, while evidence-based interventions to improve transition are scarce. This study is a secondary analysis of the MILESTONE trial, aiming to determine whether managed transition increases the proportion of young people who appropriately transition from CAMHS to AMHS. Methods: The MILESTONE trial was a multicenter, two-arm, cluster-randomized controlled trial across eight countries at 40 CAMHS sites to compare usual care (UC) to managed transition (MT). MT consisted of training, identification, and assessment of transition readiness and appropriateness. Eligible participants were receiving CAMHS care, IQ ⩾ 70 and within 1 year of their service transition boundary. CAMHS sites were randomized 2:1 between UC and MT. The main outcome was whether participants were receiving care from AMHS at 15 months follow up. Results: The MILESTONE study included 793 participants, 552 receiving UC and 241 receiving MT. In the MT group, 24.9% transitioned to AMHS at 15 months compared to 14.2% in the UC group ( p = 0.002), and appropriate transitions (in those with a need for transition at baseline or ongoing clinical need at 15 months) were 32.3% in the MT group compared to 16.4% in the UC group ( p < 0.001). Conclusions: A higher proportion of the MT group transitioned to AMHS at 15 months, and there was a higher proportion of appropriate transitions compared to UC. Clinicians and services should consider the incorporation of MT into routine clinical care.

The European Society for Child and Adolescent Psychiatry (ESCAP) clinical guidance on transition supports care across the child and adolescent mental health service (CAMHS) and adult mental health service (AMHS) boundary throughout Europe. It outlines practices, procedures, and service environments to promote appropriate, safe and timely transition of young people from child and adolescent to adult mental health services or alternative care settings. The guidance addresses planning, decision-making and discharge management at CAMHS and, where needed, continuity in AMHS. The development of the guidance followed established methodological standards for clinical guidance production, combining evidence review, patient and public involvement (PPI), and expert consensus through a structured four-stage process. The guidance is presented in two parts: Part 1 covers six key domains of transition practice, while Part 2 targets service improvement. Intended primarily for clinicians and service managers and providers, the guidance also offers useful information for young people and their families. To enhance local relevance, countries should adapt recommendations to national service and policy contexts.

Paediatric randomised controlled trials (RCTs) generate critical evidence on the effects of interventions aimed at improving health outcomes in children and adolescents (aged 0-19 years). Evidence from appropriately designed, conducted, and reported RCTs is key to the evaluation and implementation of safe and effective interventions. Clear and comprehensive reporting of paediatric specific trial methods implemented in the trial and of its results facilitates a proper evaluation, including generalisability and applicability considerations and critical appraisal of trial methods and findings. The Consolidated Standards of Reporting Trials (CONSORT) 2025 statement provides general guidance for authors when reporting RCTs but contains no detail specific to paediatric trials. To overcome existing deficiencies in the reporting of paediatric clinical trials, we developed CONSORT-Children and Adolescents (CONSORT-C) 2026 as an extension of CONSORT 2025. A group writing approach was implemented and involved key partners with lived experience relevant to paediatric clinical trials, including family caregivers, trialists, child health researchers, clinicians, journal editors, and methodologists to contribute to this explanation and elaboration paper. This paper was prepared to provide explanations and good reporting examples for the 13 new CONSORT-C 2026 reporting items, paediatric considerations with good reporting examples for eight CONSORT 2025 items, and a glossary. It is recommended to use this explanation and elaboration paper as a resource together with the CONSORT-C 2026 checklist. Widespread implementation of CONSORT-C 2026 should improve reporting quality, enhance critical appraisal of key methodological aspects of paediatric RCTs, facilitate the peer review processes, and foster better understanding and interpretation of study findings by end users. Consequently, effective interventions may be translated to paediatric practice and policy decisions more efficiently, and ultimately improve patient outcomes.