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Biomedical subjects

B B Lahey

Publications and source records attributed to B B Lahey.

At least 19 recordsLinked to original sources
PubMed1995

Developmental change in attention-deficit hyperactivity disorder in boys: a four-year longitudinal study.

One hundred six clinic-referred boys meeting criteria for DSM-III-R attention-deficit hyperactivity disorder (ADHD) (mean age 9.4 years) were assessed annually for 4 years using structured interviews of multiple informants. Hyperactivity-impulsivity symptoms declined with increasing age, but inattention symptoms did not. Rather, inattention declined only from the first to the second assessment and remained stable thereafter in boys of all ages. The rate of decline in hyperactivity-impulsivity symptoms was independent of the amount and type of treatment received. Boys who still met criteria for ADHD in Years 3 and 4 were significantly younger, more hyperactive-impulsive, and more likely to exhibit conduct disorder in Year 1 than boys who no longer met criteria in Years 3 and 4.

Age Factors↗
PubMed1995

Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study.

OBJECTIVE: This article addresses the following questions: What are the best demographic and psychiatric predictors of the onset of conduct disorder (CD)? Does physical fighting play a role in the transition from oppositional defiant disorder (ODD) to CD? And what are the predictors of an earlier compared with a later onset of CD? METHOD: Data are presented on the follow-up of a clinic-referred sample of 177 preadolescent boys who were studied for a period of 6 years. Psychiatric assessments were based on information from the boys, their parent, and their teacher. RESULTS: Of all CD symptoms, physical fighting best predicted the onset of CD in bivariate analyses. Logistic regression showed that low socioeconomic status of the parent, ODD, and parental substance abuse best predicted the onset of CD. In addition, attention-deficit hyperactivity disorder (ADHD) predicted an early onset of CD. CONCLUSIONS: Parental substance abuse, low socioeconomic status, and oppositional behavior are key factors in boys' progression to CD. Physical fighting, although not a symptom of ODD, should be targeted in preventive interventions along with ODD symptoms. ADHD is implicated in the early onset of CD, but not in later-onset CD.

Adolescent↗
PubMed1994

DSM-IV field trials for the disruptive behavior disorders: symptom utility estimates.

OBJECTIVE: We tested the predictive utility of symptoms for proposed DSM-IV definitions of the disruptive behavior disorders using indices corrected for symptom and diagnosis base rates. METHOD: The field trials sample consisted of 440 clinic-referred youths who were consecutive referrals to a heterogeneous group of mental health clinics. Multiple informants were interviewed to determine the presence of symptoms and diagnoses. RESULTS: Some symptoms which were either not in DSM-III or DSM-III-R, or were modifications of DSM-III-R symptoms, had greater diagnostic efficiency than did several existing symptoms. Symptom utility estimates were generally similar for different ages and genders, although some interesting age and sex trends emerged for a few symptoms. CONCLUSIONS: The results supported the inclusion of more restricted definitions of "lying" and "truancy" to increase their association with a conduct disorder diagnosis and they supported the elimination of "swearing" in the oppositional defiant disorder criteria. In addition to their relevance for developing optimal criteria for DSM-IV, these results can aid DSM-IV users by providing a useful guide to the relative efficiency of individual symptoms based on data from a large heterogeneous clinic population.

Adolescent↗
PubMed1994

DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents.

OBJECTIVE: Optimal diagnostic thresholds were determined for DSM-IV attention deficit hyperactivity disorder, and the psychometric properties were compared to alternative definitions. METHOD: Structured diagnostic interviews of multiple informants for 380 clinic-referred youths aged 4-17 years were conducted. In addition, standardized clinicians' validation diagnoses of attention deficit disorder were obtained to assess agreement with clinical judgment. Measures of impairment were obtained to assess the accuracy of identifying youth with an impairing condition. RESULTS: Three subtypes of attention deficit hyperactivity disorder (predominantly inattentive, predominantly hyperactive-impulsive, and combined types) were distinguished on the basis of the degree of deviance on separate dimensions of inattention and hyperactivity-impulsivity. These three subtypes were found to differ in terms of types of impairment, age, and sex ratio, but not ethnicity. In terms of case identification of attention deficit hyperactivity disorder, DSM-IV was found to be very similar to DSM-III-R, except that DSM-IV identified more impaired girls and preschool children. CONCLUSIONS: These results support the decision to subdivide the heterogeneous category of DSM-III-R attention deficit hyperactivity disorder into three subtypes. The resulting DSM-IV definition appears to be somewhat less biased toward the symptom pattern typical of elementary school boys.

Adolescent↗
PubMed1994

DSM-IV field trials for oppositional defiant disorder and conduct disorder in children and adolescents.

OBJECTIVE: The purpose of the field trials for oppositional defiant disorder and conduct disorder was to select valid diagnostic thresholds for these disorders and to compare the psychometric properties of DSM-IV criteria for oppositional defiant disorder and conduct disorder with previous DSM diagnostic formulations. METHOD: Structured diagnostic interviews, standardized clinician's validation diagnoses, and multiple measures of impairment were obtained for 440 clinic-referred children and adolescents aged 4-17 years. RESULTS: A diagnostic threshold of four symptoms of oppositional defiant disorder optimized identification of impaired children, improved agreement somewhat with the clinician's validation diagnosis, and had somewhat better test-retest agreement than DSM-III-R. In the case of conduct disorder, the optimal time window for ascertainment of symptoms was clarified. A diagnostic threshold of three symptoms of conduct disorder maximized accurate identification of impaired children and agreement with the clinician's validation diagnosis and resulted in slightly better test-retest agreement than DSM-III-R. Compared with the DSM-III-R definition, the DSM-IV definition of oppositional defiant disorder was somewhat more prevalent, but the prevalence of conduct disorder was essentially unchanged. CONCLUSIONS: DSM-IV definitions of oppositional defiant disorder and conduct disorder are somewhat better than DSM-III-R definitions in terms of internal consistency and test-retest agreement, and the validity of the DSM-IV definition of oppositional defiant disorder is slightly better than that of DSM-III-R.

Adolescent↗
PubMed1993

Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder.

This paper compares the validity of DSM-III-R diagnoses of oppositional defiant disorder (ODD) and conduct disorder (CD) and an alternative option which is subdivided into three levels according to developmental sequence and severity: modified oppositional disorder (MODD), intermediate CD (ICD), and advanced CD (ACD). Using a sample of 177 boys followed over 3 years, both the DSM-III-R and the alternative diagnostic constructs are evaluated on three criteria: symptom discriminative validity, and diagnostic external and predictive validity. Most DSM-III-R ODD and CD symptoms discriminated between ODD and CD, but exceptions are noted. Additional analyses demonstrated considerable overlap among DSM-III-R oppositional symptoms. The majority of the symptoms proposed for the alternative option could be assigned to a specific level based on acceptable symptom discrimination. External validity lent support to the distinctions between DSM-III-R ODD and CD, and between MODD, ICD, and ACD. MODD was a better predictor than ODD of which MODD, ICD, and ACD. MODD was a better predictor than ODD of which boys received a later diagnosis of CD. Suggestions are made for the inclusion and exclusion of symptoms for developmentally based diagnoses of oppositional and conduct disorders.

Antisocial Personality Disorder↗
PubMed1993

Young boys who commit serious sexual offenses: demographics, psychometrics, and phenomenology.

This study reports on a population of early adolescent male sexual offenders 9 to 14 years of age compared with a clinic control group matched for age, sex, ethnic status, and the presence of a DSM-III-R conduct disorder. The sex offenders were found to exhibit a significant history of nonsexual antisocial behavior, physical and sexual abuse, and psychiatric comorbidity. The two groups did not differ in number and category of comorbid psychiatric diagnoses, the number of nonsexual aggressive and nonaggressive symptoms of conduct disorder, symptoms of major depressive disorder or dysthymia, and symptoms of anxiety disorders. The EGTC group demonstrated significantly lower mathematic achievement. There is evidence that sexual offending behavior in this population is one aspect of a pattern of antisocial behavior. Sixty-five percent of the index group had a history of early sexual victimization.

Adolescent↗
PubMed1992

Familial risk factors to oppositional defiant disorder and conduct disorder: parental psychopathology and maternal parenting.

In a sample of 177 clinic-referred children aged 7-13, an association was found between a diagnosis of conduct disorder (CD) and several aspects of family functioning: maternal parenting (supervision and persistence in discipline) and parental adjustment (paternal antisocial personality disorder and paternal substance abuse). Children with oppositional defiant disorder (ODD) were intermediate to families of children with CD and clinic control children on all variables, but differed from control children only in having a higher rate of paternal substance abuse and paternal antisocial personality disorder (APD). When both parental APD and deviant maternal parenting were entered into 2 x 2 logit-model analyses predicting CD, only parental APD was significantly associated with CD, and no interactions between parental adjustment and maternal parenting were found. The importance of these findings for understanding the etiology of CD and for disentangling correlated risk factors in future studies is discussed.

Antisocial Personality Disorder↗
PubMed1992

Oppositional defiant and conduct disorders: issues to be resolved for DSM-IV.

Oppositional defiant disorder (ODD) and conduct disorder (CD) are reasonably distinct both in terms of statistical covariation among symptoms and ages of onset. The two disorders are related in similar ways to impairment and family history of antisocial behavior, but the association is stronger for CD than ODD. Virtually all clinic-referred youths with prepubertal onset of CD have retained the symptoms of ODD that emerged at earlier ages. Furthermore, a set of serious antisocial behaviors characteristically emerges at later ages in some youths with CD, suggesting further developmental progression within CD. These findings are consistent with a conceptualization of ODD and CD as developmentally staged, hierarchically organized levels of severity of the same disorder, but two findings argue for distinguishing separate disorders in DSM-IV: (1) many youths with ODD never develop CD, and (2) CD that emerges for the first time in adolescence appears to be independent of ODD.

Acting Out↗
PubMed1991

Differences and similarities between children, mothers, and teachers as informants on disruptive child behavior.

Prevalence rates of disruptive child behaviors, based on structured psychiatric interviews, are presented for samples of clinic-referred prepubertal boys at two sites to investigate differences and similarities among reports of the behaviors from children, parents, and teachers. Children reported significantly less hyperactive/inattentive and oppositional behaviors than either parents or teachers. In contrast, children did not differ from parents or teachers in their report on the prevalence of more serious conduct problems. These results were well replicated across two sites, despite the fact that there were significant differences between the sites in the level of hyperactive/inattentive child behaviors and conduct problems. The ranking of parents' and teachers' reported prevalence of specific child behavior problems in each of the three domains of disruptive behavior was strikingly similar. With one exception, the concordance between the prevalence ranking based on the children's reports was lower than that based on adults' reports, Children's reports on their own behavior did not predict various child handicaps 1 year later as well as did adults' reports. The results are discussed in relation to the usefulness of certain child behaviors in symptom lists for diagnostic purposes; the reliability of children's reports on their own behavior; and the possible reasons why prevalence rankings, as perceived by adults, are so similar.

Attention Deficit Disorder with Hyperactivity↗
PubMed1991

Diagnostic conundrum of oppositional defiant disorder and conduct disorder.

Evidence for a diagnostic distinction of oppositional defiant disorder (ODD) and conduct disorder (CD) is reviewed, and alternative conceptualizations and definitions for the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders are considered. Studies suggest that CD and ODD are strongly and developmentally related but clearly different. Factor analyses indicate that distinct covarying groups of ODD and CD symptoms can be identified, but certain symptoms relate to both (particularly mild aggression and lying). Age of onset for ODD is earlier than for most CD symptoms. Nearly all youths with CD have a history of ODD, but not all ODD cases progress to CD. The disorders demonstrate the same forms of parental psychopathology and family adversity but to a greater degree for CD than for ODD. Alternative conceptualizations for the disorders are presented for further study before the introduction of the DSM-IV.

Aggression↗
PubMed1991

Stability of mothers' recall of the age of onset of their child's attention and hyperactivity problems.

The stability of mothers' recall of age of onset of attention deficit and hyperactive behaviors was assessed over a 1-year interval. The paper reports on which behaviors have the highest stability and the stability of a psychiatric diagnosis of attention deficit hyperactive disorder using different age cut-offs. The data showed a moderate degree of stability over a 1-year period, with school-related symptoms showing the least amount of change. An argument is made for keeping the current DSM-III-R diagnostic cut-off at age 6.

Attention↗
PubMed1991

Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment.

Jeffrey A. Gray has proposed a model in which conduct disorder (CD) is viewed as the result of both excessive activity of a behavioral activation system that mediates appetitive and aggressive behavior and deficient activity of a behavioral inhibition system that mediates both anxiety and the inhibition of behavior in the presence of cues signalling impending punishment or frustration. The relation of anxiety to antisocial behavior was examined in 177 clinic-referred boys, aged 7 to 12 years, 68 of whom met DSM-III-R criteria for CD. As predicted by Gray's model, boys with CD and comorbid anxiety disorder were markedly less impaired than boys with CD alone.

Aggression↗
PubMed1991

Anxiety, inhibition, and conduct disorder in children: II. Relation to salivary cortisol.

The relation of symptoms of conduct disorder (CD) and anxiety to salivary cortisol was explored in 67 clinic-referred boys aged 8 to 13 years. Children with anxiety disorder had higher levels of cortisol, but this main effect was qualified by a significant CD x anxiety disorder interaction. Consistent with Gray's biological model of the behavioral inhibition system (BIS), children with both CD and anxiety disorder had higher levels of salivary cortisol than children with CD without comorbid anxiety disorder. In the absence of CD, however, anxiety disorder was not clearly associated with higher cortisol. This result suggests that cortisol may be a useful biological marker of arousal associated with BIS activity in children with CD.

Adolescent↗
PubMed1991

Validity of the diagnostic category of attention deficit disorder without hyperactivity: a review of the literature.

The validity of the diagnostic category of Attention Deficit Disorder Without Hyperactivity (ADD/WO) has been the subject of debate since it was first introduced in DSM-III. The differentiation of two syndromes of ADD is supported by factor analytic studies that indicate two dimensions of maladjustment: (1) inattention and disorganization, and (2) motor hyperactivity and impulsive responding. Cluster analyses of these two dimensions have yielded two profiles of deviance that correspond to the DSM-III subtypes. Furthermore, clinic-referred children who meet DSM-III criteria for ADD/WO have been shown to exhibit less serious conduct problems, are less impulsive, are more likely to be characterized as sluggish and drowsy, are less rejected by peers but more socially withdrawn, and are more likely to exhibit depressed mood and symptoms of anxiety disorder than children with Attention Deficit Disorder with Hyperactivity (ADD/H).

Attention↗
PubMed1991

Methodological issues and learning disabilities diagnosis in clinical populations.

Previous research suggests that the diagnosis of a comorbid learning disability is dependent on the method used for making the LD diagnosis. This study investigated that proposition by studying the effects of using three approaches to the assessment of learning disabilities in a sample of 177 six- to thirteen-year-old boys referred to outpatient mental health clinics for behavior problems. The use of these three procedures to diagnose comorbid learning problems produced significantly different results. All methods identified significant numbers of children in the clinical population as learning disabled; however, each method identified children with differing characteristics. Consistent with predictions from measurement theory, the commonly used simple standard score discrepancy method was more likely to identify children with above-average IQs as learning disabled, whereas a regression approach identified learning disabilities more consistently across the ability range. These results were interpreted as supporting the use of regression approaches to diagnose co-occurring learning disabilities, as that method is less likely to be biased by the child's intelligence test score. The implications of the use of each method in research investigations is also discussed.

Adolescent↗
PubMed1991

Attention deficit disorder without hyperactivity: a distinct behavioral and neurocognitive syndrome.

This study examined the issue as to whether or not children carefully diagnosed as having either attention deficit disorder with hyperactivity (ADDH) or without hyperactivity (ADDnoH) could be distinguished on selected cognitive, academic, rapid naming, and behavioral measures. Employing a previously validated multimodal, multi-informant diagnostic process that results in reliable clinical diagnoses, 10 ADDH and 10 ADDnoH children were examined. While no significant differences in cognitive ability were noted between groups, significant underachievement was found in the children diagnosed as ADDnoH, particularly in mathematics achievement. The ADDnoH children were also significantly slower on rapid naming tasks than the ADDH children. Further, 60% of the ADDnoH children had a codiagnosis of a developmental reading or arithmetic disorder while none of the ADDH children received such a codiagnosis. Conversely, 40% of the ADDH children had a codiagnosis of conduct disorder and were rated by their parent as significantly more motorically active, impulsive, and deviant in the demonstration of age-appropriate social skills. These findings are discussed as they relate to the notion that children with attention deficit disorder may suffer from a right hemispheric syndrome.

Attention Deficit Disorder with Hyperactivity↗