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Adrian Angold

Publications and source records attributed to Adrian Angold.

34 records · Page 2Linked to original sources
PubMed2003

Prevalence and development of psychiatric disorders in childhood and adolescence.

BACKGROUND: This longitudinal community study assessed the prevalence and development of psychiatric disorders from age 9 through 16 years and examined homotypic and heterotypic continuity. METHODS: A representative population sample of 1420 children aged 9 to 13 years at intake were assessed annually for DSM-IV disorders until age 16 years. RESULTS: Although 3-month prevalence of any disorder averaged 13.3% (95% confidence interval [CI], 11.7%-15.0%), during the study period 36.7% of participants (31% of girls and 42% of boys) had at least 1 psychiatric disorder. Some disorders (social anxiety, panic, depression, and substance abuse) increased in prevalence, whereas others, including separation anxiety disorder and attention-deficit/hyperactivity disorder (ADHD), decreased. Lagged analyses showed that children with a history of psychiatric disorder were 3 times more likely than those with no previous disorder to have a diagnosis at any subsequent wave (odds ratio, 3.7; 95% CI, 2.9-4.9; P<.001). Risk from a previous diagnosis was high among both girls and boys, but it was significantly higher among girls. Continuity of the same disorder (homotypic) was significant for all disorders except specific phobias. Continuity from one diagnosis to another (heterotypic) was significant from depression to anxiety and anxiety to depression, from ADHD to oppositional defiant disorder, and from anxiety and conduct disorder to substance abuse. Almost all the heterotypic continuity was seen in girls. CONCLUSIONS: The risk of having at least 1 psychiatric disorder by age 16 years is much higher than point estimates would suggest. Concurrent comorbidity and homotypic and heterotypic continuity are more marked in girls than in boys.

Adolescent↗
PubMed2003

Natural categories or fundamental dimensions: on carving nature at the joints and the rearticulation of psychopathology.

The question of whether to view psychopathology as categorical or dimensional continues to provoke debate. We review the many facets of this argument. These include the pragmatics of measurement; the needs of clinical practice; our ability to distinguish categories from dimensions empirically; methods of analysis appropriate to each and how they relate; and the potential theoretical biases associated with each approach. We conclude that much of the debate is misconceived in that we do not observe pathology directly; rather, we observe its properties. The same pathology can have some properties that are most easily understood using a dimensional conceptualization while at the same time having other properties that are best understood categorically. We suggest replacing Meehl's analogy involving qualitatively distinct species with an alternative analogy with the "duality" of light, a phenomenon with both wave- and particle-like properties.

Child↗
PubMed2003

Relations between Continuous Performance Test performance measures and ADHD behaviors.

The Conners' Continuous Performance Test (CPT) is a neuropsychological task that has repeatedly been shown to differentiate ADHD from normal groups. Several variables may be derived from the Conners' CPT including errors of omission and commission, mean hit reaction time(RT), mean hit RT standard error, d', and beta. What each CPT parameter actually assesses has largely been based upon clinical assumptions and the face validity of each measure (e.g., omission errors measure inattention, commission errors measure impulsivity). This study attempts to examine relations between various CPT variables and phenotypic behaviors so as to better understand the various CPT variables. An epidemiological sample of 817 children was administered the Conners' CPT. Diagnostic interviews were conducted with parents to determine ADHD symptom profiles for all children. Children diagnosed with ADHD had more variable RTs, made more errors of commission and omission, and demonstrated poorer perceptual sensitivity than nondiagnosed children. Regarding specific symptoms, generalized estimating equations (GEE) and ANCOVAs were conducted to determine specific relationships between the 18 DSM-IV ADHD symptoms and 6 CPT parameters. CPT performance measures demonstrated significant relationships to ADHD symptoms but did not demonstrate symptom domain specificity according to a priori assumptions. Overall performance on the two signal detection measures, d' and beta, was highly related to all ADHD symptoms across symptom domains. Further, increased variability in RTs over time was related to most ADHD symptoms. Finally, it appears that at least 1 CPT variable, mean hit RT, is minimally related to ADHD symptoms as a whole, but does demonstrate some specificity in its link with symptoms of hyperactivity.

Algorithms↗
PubMed2003

Continuous performance test performance in a normative epidemiological sample.

A 14-min continuous performance test (CPT) requiring a high rate of responding was administered to a probability-weighted random sample of 816 9-17-year-old children drawn from a population of 17,117 children in an ongoing epidemiological and longitudinal study in Western North Carolina. Systematic main effects of improved performance with older age were found in this age range for all variables, including reaction time (RT), RT standard error, errors of omission, errors of commission, and signal detection parameters (d' and beta). Significant gender main effects included more impulsive errors, less variability, and faster RT by males, with no interactions between age and gender. There were no main effects of ethnicity or interactions of ethnicity with age and/or gender. Large main effects of interstimulus interval (ISI; 1, 2, or 4-s intervals) and time block were present for most CPT performance measures. The normative data from the CPT should provide a useful framework for interpreting similar data in future studies of child and adolescent psychopathology.

Adolescent↗
PubMed2003

Pathways to violence in the children of mothers who were depressed postpartum.

The impact of postnatal depression on a child's risk for violent behavior was evaluated in an urban British community sample (N=122 families). Mothers were interviewed during pregnancy, at 3 months postpartum, and when the child was 1, 4, and 11 years of age. Mothers, teachers, and children reported on violent symptoms at age 11. Structural equation modeling revealed that the child's violence was predicted by the mother's postnatal depression even when her depression during pregnancy, her later history of depression, and family characteristics were taken into account. Violence was associated with symptoms of attention-deficit/hyperactivity disorder and problems with anger management. Children were most violent if mothers had been depressed at 3 months and at least once thereafter.

Adolescent↗
PubMed2003

School refusal and psychiatric disorders: a community study.

OBJECTIVE: To examine the association between anxious school refusal and truancy and psychiatric disorders in a community sample of children and adolescents using a descriptive rather than etiological definition of school refusal. METHOD: Data from eight annual waves of structured psychiatric interviews with 9- to 16-year-olds and their parents from the Great Smoky Mountains Study were analyzed. RESULTS: Pure anxious school refusal was associated with depression (odds ratio [OR] = 13, 95% confidence interval [CI] 3.4, 42) and separation anxiety disorder (OR = 8.7, 95% CI 4.1, 19). Pure truancy was associated with oppositional defiant disorder (OR = 2.2, 95% CI 1.2, 4.2), conduct disorder (OR = 7.4, 95% CI 3.9, 14), and depression (OR = 2.6, 95% CI 1.2, 56). Of mixed school refusers (children with both anxious school refusal and truancy), 88.2% had a psychiatric disorder. They had increased rates of both emotional and behavior disorders. Specific fears, sleep difficulties, somatic complaints, difficulties in peer relationships, and adverse psychosocial variables had different associations with the three types of school refusal. CONCLUSIONS: Anxious school refusal and truancy are distinct but not mutually exclusive and are significantly associated with psychopathology, as well as adverse experiences at home and school. Implications of these findings for assessment, identification, and intervention for school refusal are discussed.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed2003

Mental health assessments in juvenile justice: report on the consensus conference.

OBJECTIVE: At national, state, and local levels, there is increasing recognition of the importance of identifying and responding to the mental health needs of youths in the juvenile justice system, as policymakers and practitioners struggle to find ways to address causes and correlates of juvenile crime and delinquency. The proposed guidelines for mental health assessment provide explicit information about how, why, and when to obtain mental health information on justice youths at each important juncture in processing. METHOD: A national group of expert researchers and practitioners convened in April 2002. Experts derived six recommendations, following the expert consensus method, for conducting mental health assessments in juvenile justice settings. Experts had broad experience creating collaborations between juvenile justice, mental health, and child welfare systems and understood the policy and health implications of conducting such assessments in juvenile justice settings. RESULTS: Consensus Conference recommendations regarding screening for emergent risk, screening and assessment of mental health service needs, comprehensive mental health assessment components, assessment before community re-entry, need for periodic reassessment, and staff training are presented. CONCLUSION: Deriving specific recommendations that can be implemented systematically is a necessary first step toward policy changes that will optimize the standard of care for this vulnerable population.

Adolescent↗
PubMed2003

Pathways into and through mental health services for children and adolescents.

OBJECTIVE: This study examined points of entry into the mental health service system for children and adolescents as well as patterns of movement through five service sectors: specialty mental health services, education, general medicine, juvenile justice, and child welfare. METHODS: The data were from the Great Smoky Mountains Study, a longitudinal epidemiologic study of mental health problems and service use among youths. The sample consisted of 1,420 youths who were nine, 11, or 13 years old at study entry. Each youth and a parent were interviewed at baseline and every year thereafter about the use of services for mental health problems over the three-year study period. RESULTS: Population estimates indicated that 54 percent of youths have used mental health services at some time during their lives. The education sector was the most common point of entry and provider of services across all age groups. The specialty mental health sector was the second most common point of entry for youths up to age 13 years, and juvenile justice was the second most common point of entry for youths between the ages of 14 and 16. Youths who entered the mental health system through the specialty mental health sector were the most likely to subsequently receive services from other sectors, and those who entered through the education sector were the least likely to do so. CONCLUSIONS: The education sector plays a central role as a point of entry into the mental health system. Interagency collaboration among three primary sectors-education, specialty mental health services, and general medicine-is critical to ensuring that youths who are in need of mental health care receive appropriate services.

Adolescent↗
PubMed2003

Obesity and psychiatric disorder: developmental trajectories.

OBJECTIVES: To identify age-related trajectories of obesity from childhood into adolescence, and to test the association of these trajectories with the development of psychiatric disorders (conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, substance abuse, depression, and anxiety). METHODS: White children (N = 991) 9 to 16 years old from the Great Smoky Mountains Study, a representative sample of rural youth, were evaluated annually over an 8-year period for height, weight, psychiatric disorder, and vulnerabilities for psychiatric disorder. Longitudinal analyses on the repeated measures data were conducted using developmental trajectory models and generalized estimating equation models. RESULTS: Obesity was 3 to 4 times more common than expected from national rates using Centers for Disease Control and Prevention 2000 criteria. Four developmental trajectories of obesity were found: no obesity (73%), chronic obesity (15%), childhood obesity (5%), and adolescent obesity (7%). Only chronic obesity was associated with psychiatric disorder: oppositional defiant disorder in boys and girls and depressive disorders in boys. CONCLUSIONS: In a general population sample studied longitudinally, chronic obesity was associated with psychopathology.

Adolescent↗
PubMed2002

Psychiatric disorder, impairment, and service use in rural African American and white youth.

BACKGROUND: The Caring for Children in the Community Study examined the prevalence of DSM-IV psychiatric disorders and correlates of mental health service use in rural African American and white youth. METHODS: Four thousand five hundred youth aged 9 to 17 years from 4 North Carolina counties were randomly selected from school databases. Parents completed telephone questionnaires about their children's behavior problems. A second-stage sample of 1302 was identified for recruitment into the interview phase of the study, and 920 (70.7%) of these were successfully interviewed at home using the Child and Adolescent Psychiatric Assessment and related measures of service use. RESULTS: Weighted back to general population estimates, 21.1% of youth had 1 or more DSM-IV psychiatric disorders in the past 3 months. Prevalence was similar in African American (20.5%) and white (21.9%) youth. The only ethnic difference was an excess of depressive disorders in white youth (4.6% vs 1.4%). Thirteen percent of participants (36.0% of those with a diagnosis) received mental health care in the past 3 months. White youth were more likely than African American youth to use specialty mental health services (6.1% vs 3.2%), but services provided by schools showed very little ethnic disparity (8.6% vs 9.2%). The effect of children's symptoms on their parents was the strongest correlate of specialty mental health care. CONCLUSIONS: In this rural sample, African American and white youth were equally likely to have psychiatric disorders, but African Americans were less likely to use specialty mental health services. School services provided care to the largest number of youths of both ethnic groups.

Adolescent↗
PubMed2002

The prevalence of potentially traumatic events in childhood and adolescence.

This paper examines exposure to potentially traumatic events from middle childhood through adolescence, and vulnerability to such exposure. Analyses are based on the first 4 annual waves of data from a longitudinal general population study of youth in western North Carolina, involving 4,965 interviews with 1,420 children and adolescents and their parents or guardians. Participants reported on DSM extreme stressors ("high magnitude events"), other potentially traumatic events ("low magnitude events"), and background vulnerability factors. In this general population sample, one-quarter experienced at least one high magnitude event by age 16, 6% within the past 3 months. One third experienced a low magnitude event in the past 3 months. The likelihood of such exposure increased with the number of vulnerability factors.

Adolescent↗
PubMed2002

The relationship between DSM-IV oppositional defiant disorder and conduct disorder: findings from the Great Smoky Mountains Study.

BACKGROUND: We examine models of the relationship between oppositional defiant disorder (ODD) and conduct disorder (CD) in a community sample. Particular attention is paid to the generalisability of findings based on clinic-referred boys. METHODS: The analyses were based on four waves of data from the Great Smoky Mountains Study covering children in the community aged 9-16 years. Child and parent reports of DSM-IV symptoms, diagnoses, and a range of family and environmental adversities were collected using the Child and Adolescent Psychiatric Assessment. RESULTS: Cross-sectional analyses indicated that CD and ODD largely shared similar correlates, although some aspects of parenting appeared more related to CD than ODD. This pattern was broadly similar in boys and girls. Longitudinal analyses confirmed that ODD was a strong risk factor for CD in boys and there was a suggestion that ODD was a stronger risk factor for CD than for other common disorders. Atypical family structure was an important factor in the transition between ODD and CD in boys. In girls ODD provided no increased risk for later CD but was associated with increased risk for continued ODD, depression, and anxiety. CONCLUSIONS: These results are more consistent with a developmental relationship between ODD and CD in boys than girls.

Adolescent↗
PubMed2002

Depression scale scores in 8-17-year-olds: effects of age and gender.

BACKGROUND: The excess of unipolar depression in females emerges in adolescence. However, studies of age effects on depression scale scores have produced divergent estimates of changes from childhood to adolescence. METHOD: We explored possible reasons for this discrepancy in two large, longitudinal samples of twins and singletons aged 8-17. RESULTS: There were no differences between twins and singletons in their scores on the Short Mood and Feelings Questionnaire (SMFQ), a 13-item self-report depression scale. SMFQ scores for boys fell over this age-range, while those for girls fell from age 9 to age 11 and then increased from age 12 to age 17. The mean scores of girls under 12 and those 12 and over differed by only around one-fifth of a standard deviation. However, given the non-normal distribution of the scores, a cut point that selected the upper 6% of scores created the expected female:male ratio of 2:1. CONCLUSIONS: Implications for future research on adolescent depression are discussed.

Adolescent↗
PubMed2001

Exposure to violence against a family member and internalizing symptoms in Colombian adolescents: the protective effects of family support.

Associations between exposure to serious violence against a family member and internalizing symptoms, and the protective effects of support from family versus friends, were examined in 5,775 adolescents (50% female; mean age = 15.2 years, SD = 2.0) with data from a national, random household survey of residents in Colombia, South America. After accounting for the effects of age, gender, and family life events other than violence, support from family buffered the relations between exposure to violence and adjustment; this relation was strongest for girls and younger adolescents. Disclosure to friends appeared to be protective for younger adolescents but harmful for older adolescents, and this relation was only observed for hopelessness. Results are discussed in terms of cognitive processing models of adjustment to violence.

Adaptation, Psychological↗
PubMedDate not supplied

Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology.

We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children.

Anxiety Disorders↗