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Biomedical subjects

J H Newcorn

Publications and source records attributed to J H Newcorn.

At least 37 records · Page 2Linked to original sources
PubMed1999

Identification of AD/HD subtypes using laboratory-based measures: a cluster analysis.

The current investigation used laboratory-based measures of inattention, impulsivity, and activity level to identify subgroups of children with attention-deficit/hyperactivity disorder (AD/HD). Data derived from solid state actigraphs and a continuous performance test (CPT) were obtained from a clinically referred sample and submitted to a cluster analysis. These empirically derived groups were then evaluated for clinical relevance and subsequently validated by parent and teacher ratings and tests of intellectual functioning and academic achievement. Four distinct subgroups emerged: Hyperactive-inattentive (HYP-IN), impulsive-inattentive (IMP-IN), inattentive only, and hyperactive only. The HYP-IN group was impaired on measures of intellectual functioning and academic achievement relative to the other three groups. In contrast, the IMP-IN group was generally rated as more aggressive, although this difference was not statistically significant for all measures. The data suggest that the augmentation of clinical descriptors with laboratory-based data may be an effective strategy by which to categorize diagnostic subgroups of AD/HD.

Achievement↗
PubMed1999

Thermal response to serotonergic challenge and aggression in attention deficit hyperactivity disorder children.

Body temperature change in response to the serotonergic (5-HT) enhancer, d,l-fenfluramine (FEN), was examined in 27 prepubescent boys diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) to determine (1) the utility of this measure as an index of central serotonergic function; and (2) if the magnitude of temperature change is associated with aggression. FEN, 1 mg/kg, produced a significant increase in body temperature, the magnitude of which was correlated with plasma levels of the FEN metabolite, norfenfluramine (NORFEN). Furthermore, a significant inverse relationship was found between temperature response to FEN and teacher ratings of aggression. Parent ratings of aggression were not significantly correlated with the hyperthermic response to FEN. Interestingly, the magnitude of the hyperthermic response was unrelated to changes in plasma levels of prolactin and cortisol, suggesting that thermal and neuroendocrine responses are mediated by distinct 5-HT mechanisms. The agreement of these finding with those of studies using other procedures to assess the relationship between 5-HT and aggression suggests that decreased central 5-HT is associated with increased aggression.

Aggression↗
PubMed1998

Alpha 2 adrenergic agonists. Neurochemistry, efficacy, and clinical guidelines for use in children.

The alpha 2 adrenergic agonists are used to treat a variety of psychiatric disorders and their usage has been increasing. This article presents the rationale and neurochemical basis for treatment of psychiatric disorders with alpha 2 agents, reviews studies examining clinical efficacy, and develops guidelines for usage. Case vignettes are presented to illustrate how the alpha 2 agents can successfully be used in practice.

Adrenergic alpha-2 Receptor Agonists↗
PubMed1998

Serotonin function and risk for alcoholism in boys with attention-deficit hyperactivity disorder.

Data in animals and adults indicate that central serotonergic (5-HT) function may be involved in the development of alcohol abuse. Despite this, studies exploring this mechanism in individuals at risk for alcoholism are scant. This study used a fenfluramine (FEN) challenge procedure to investigate the relationship between risk for alcoholism and 5-HT function in 7- to 11-year-old boys with attention-deficit hyperactivity disorder (ADHD). The prolactin (PRL) and cortisol (CORT) responses to FEN were examined in 10 sons of alcoholic fathers (FA+) and 30 sons of nonalcoholic fathers (FA-). The FA+ group had a significantly greater CORT, but not PRL, response to FEN relative to the FA- group. The discrepancy between the CORT and PRL responses may be due to the different mechanisms that underlie their 5-HT stimulated release. This suggests that, among ADHD boys, those at familial risk for alcohol abuse may differ from those who are not at risk in 5-HT function.

Alcoholism↗
PubMed1997

Age-related changes in the association between serotonergic function and aggression in boys with ADHD.

The results of several studies have indicated an inverse relationship between central serotonergic (5-HT) mechanisms and aggression in animals and adults, but studies in children have yielded conflicting results. This study assessed 5-HT function, using a fenfluramine (FEN) challenge procedure, in an attempt to replicate a previously reported enhancement of the prolactin (PRL) response to FEN in aggressive relative to nonaggressive ADHD boys. The study failed to replicate the previous finding. Samples from both studies were then examined to reconcile the discrepant findings. The samples differed significantly in age. The entire group (n = 50) was then divided into older and younger subgroups and reanalyzed using a two-way (age-group x aggression) analysis of covariance (ANCOVA) controlling for plasma medication level. The ANCOVA generated a significant age-group x aggression interaction. Young aggressive boys had a significantly greater PRL response to FEN than young nonaggressive boys, but no such difference existed in the older age-group. These findings raise the possibility of different developmental trajectories in 5-HT function between aggressive and nonaggressive boys.

Aggression↗
PubMed1997

Changes in plasma prolactin and catecholamine metabolite levels following acute needle stick in children.

Changes in plasma levels of prolactin (PRL), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) following insertion of an indwelling catheter into a forearm vein were assessed in 11 boys with attention-deficit hyperactivity disorder. Results indicated decreases in plasma PRL and HVA, but not MHPG, from the time of needle stick until 105 min post-insertion. These data indicate a significant increase in plasma PRL and HVA in children following needle stick which gradually decreases over a 1.5-2-h period. These stress-induced changes indicate that values obtained immediately after needle insertion cannot be assumed to accurately reflect baseline levels.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices.

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first child multisite cooperative agreement treatment study of children conducted by the National Institute of Mental Health, Rockville, Md. It examines the long-term effectiveness of medication vs behavioral treatment vs both for treatment of ADHD and compares state-of-the-art treatment with routine community care. In a parallel-groups design, 576 children (age, 7-9 years) with ADHD (96 at each site) are thoroughly assessed and randomized to 4 conditions: (1) medication alone, (2) psychosocial treatment alone, (3) the combination of both, (4) or community comparison. The first 3 groups are treated for 14 months and all are reassessed periodically for 24 months. Designers met the following challenges: framing clinically relevant primary questions; defining the target population; choice, intensity, and integration and combination of treatments for fair comparisons; combining scientific controls and standardization with clinical flexibility; and implementing a controlled clinical trial in a nonclinical setting (school) controlled by others. Innovative solutions included extensive decision algorithms and manualized adaptations of treatments to specific needs.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Plasma cortisol and aggression in boys with ADHD.

OBJECTIVE: The results of several studies suggest an inverse relationship between cortisol secretion and aggressive behavior. This study examined basal plasma cortisol levels in aggressive and nonaggressive boys with attention-deficit hyperactivity disorder (ADHD). METHOD: The subjects were 23 aggressive and 27 nonaggressive boys with ADHD, aged 7 to 11 years. After 3 days of a low monoamine diet and an overnight fast, an indwelling catheter was inserted into a forearm vein. Samples for plasma cortisol levels were obtained 105 and 115 minutes after insertion of the catheter. RESULTS: A one-way analysis of covariance (ANCOVA) controlling for body mass revealed no significant difference in plasma cortisol between the aggressive and nonaggressive boys. Furthermore, when the children were alternatively divided on the basis of the presence or absence of a DSM-III-R diagnosis of conduct disorder, a one-way ANCOVA again revealed no significant difference in cortisol levels. CONCLUSIONS: The hypothesized inverse relationship between cortisol secretion and aggressive behavior in boys with ADHD was not found. These findings are consistent with a large body of literature indicating that the biological substrate of aggression is complex and that the identification of biological laboratory markers of aggressive behavior is not a clinically useful strategy at this time.

Aggression↗
PubMed1997

Serotonin, aggression, and parental psychopathology in children with attention-deficit hyperactivity disorder.

OBJECTIVE: To explore the relationship between central serotonergic (5-HT) function and history of parental aggression in aggressive and nonaggressive boys with attention-deficit hyperactivity disorder (ADHD). METHOD: History of psychiatric symptoms was assessed in the biological parents of 41 boys with ADHD. The relationship between 5-HT function in aggressive and nonaggressive probands, as assessed via the prolactin response to fenfluramine (FEN) challenge, and parental history of aggression was examined. RESULTS: Aggressive boys with a parental history of aggressive behavior had a significantly lower prolactin response to FEN challenge than aggressive boys without a parental history of aggression. Nonaggressive boys had a prolactin response midway between those of the two aggressive subgroups, and their prolactin response did not vary as a function of parental aggression. Children subdivided on the basis of parental history of other psychiatric symptoms did not differ in their response to the FEN challenge. CONCLUSIONS: These data indicate an association between parent aggressive behavior and lower 5-HT function in aggressive boys with ADHD but do not indicate the extent to which this association is environmentally and/or genetically transmitted. There may be different neurochemical mechanisms in familial and nonfamilial aggressive children, which have clinical implications for pharmacological interventions.

Adult↗
PubMed1997

Noradrenergic mechanisms in ADHD children with and without reading disabilities: a replication and extension.

OBJECTIVE: To examine noradrenergic (NA) function in children with attention-deficit hyperactivity disorder (ADHD) by replicating and expanding upon a previous finding that ADHD children with and without reading disabilities (RD) differ in plasma levels of the NA metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG). METHOD: Plasma levels of MHPG were compared in ADHD children who were subdivided on the basis of the presence or absence of RD. Subsequently, this replication sample was combined with a previously studied sample to further explore the relationship between plasma MHPG levels and measures of cognitive function in children with ADHD. RESULTS: Plasma levels of MHPG were significantly lower in ADHD children without RD, compared with those with RD, replicating a published finding. Analyses in the combined sample indicated that, among children with ADHD, plasma MHPG levels were inversely associated with measures of academic achievement and verbal processing, but not parent or teacher ratings of behavior or continuous performance test measures of attention and impulsivity. CONCLUSIONS: These data indicate that children with ADHD are not homogeneous with regard to NA function and that neurochemical variation is closely associated with differences in clinical characteristics of the children.

Achievement↗
PubMed1997

Validity of the age-of-onset criterion for ADHD: a report from the DSM-IV field trials.

OBJECTIVE: To examine the validity of the DSM-IV requirement of an age of onset of impairment due to symptoms before 7 years of age for the diagnosis of attention-deficit/hyperactivity disorder (ADHD). METHOD: The validity of this criterion was examined in a clinic sample of 380 youths aged 4 through 17 years by comparing youths who met symptom criteria for ADHD and either did or did not display impairment before age 7 years. RESULTS: Nearly all youths who met symptom criteria for the predominantly hyperactive-impulsive subtype also met the age of onset of impairment criterion, but 18% of youths who met symptom criteria for the combined type, and 43% of youths who met symptom criteria for the predominantly inattentive type, did not manifest impairment before 7 years. For the latter two subtypes, requiring impairment before age 7 years reduced the accuracy of identification of currently impaired cases of ADHD and reduced agreement with clinicians' judgments. CONCLUSIONS: These findings raise questions about the validity of the DSM-IV definition of age of onset of ADHD. Marked differences in the ages of onset of both symptoms and impairment for the three subtypes of ADHD support the validity of distinguishing among these subtypes in DSM-IV.

Adolescent↗
PubMed1995

Impulsivity and the initiation of fights in children with disruptive behavior disorders.

This study examined whether children who initiate physical fights are impulsive as measured by a continuous performance test. A series of 111 7-13-year-old psychiatric patients were diagnosed using DSM-III-R criteria and divided according to whether they showed a persistent pattern of initiating physical fights. Children who initiated fights were impulsive irrespective of whether ADHD was present or not, although ADHD was also associated with increased impulsivity. Oppositional-defiant disorder and conduct disorder diagnoses were not associated with impulsivity. These findings are discussed in terms of an underlying impulsive personality trait and its possible relationship to outcome in children with disruptive behavior disorders.

Adult↗
PubMed1994

Serotonergic function in aggressive and nonaggressive boys with attention deficit hyperactivity disorder.

OBJECTIVE: This study was designed to assess central serotonergic (5-HT) function in aggressive and nonaggressive boys with attention deficit hyperactivity disorder. METHOD: Prolactin response to a challenge dose of the 5-HT agonist d,l-fenfluramine was assessed in 25 7-11-year-old boys with attention deficit hyperactivity disorder who were divided into aggressive and nonaggressive subgroups. In addition, the subgroups were compared on plasma catecholamine metabolites and platelet 5-HT. RESULTS: The aggressive group had a significantly greater prolactin response to the fenfluramine challenge than the nonaggressive subgroup. The groups did not differ on peripheral measures of neurotransmitter function. CONCLUSIONS: These data suggest that aggressive and nonaggressive children with attention deficit hyperactivity disorder differ in central 5-HT functioning.

Aggression↗
PubMed1994

Parent and teacher ratings of attention-deficit hyperactivity disorder symptoms: implications for case identification.

This study was designed to evaluate the relationship between the DSM-III criteria for attention-deficit deficit disorder with hyperactivity (ADDH) and the DSM-III-R criteria for attention-deficit hyperactivity disorder (ADHD). Seventy-two children from an inner-city elementary school were evaluated using parent and teacher ratings on a scale consisting of the symptoms of DSM-III-R ADHD and oppositional-defiant disorder and DSM-III ADDH. Each child was also assessed using a psychometric test battery designed to examine cognitive function, attention, and activity level. Teacher ratings identified more children as DSM-III-R ADHD than DSM-III ADDH. Among these ADHD children, those who also met the ADDH criteria missed more targets on a continuous performance test (CPT) and were rated more overactive than controls. They also had a greater likelihood of being rated ADHD by parents. Children rated as meeting criteria for DSM-III-R ADHD, but not DSM-III ADDH, were not substantially different from controls on teacher ratings of overactivity, CPT performance, or parent ratings of ADHD, which raises questions regarding the nature and severity of the pathology in this group.

Attention↗
PubMed1993

The factor structure of ADHD items in DSM-III-R: internal consistency and external validation.

Previous research employing factor-analytic procedures to study the underlying dimensions of DSM-III attention deficit disorder with hyperactivity (ADDH) symptoms have consistently supported a two-factor model. Revision of the structure of the ADHD diagnosis in DSM-III-R, as well as inclusion of new items, has raised the question of comparability of the two diagnoses. To explore the significance of these changes, teacher ratings of DSM-III ADDH items and DSM-III-R ADHD items of 85 nonreferred school children were factor-analyzed to determine their underlying factor structures. A similar two-factor solution was obtained for each diagnostic scale. The factors consisted of items believed to reflect inattention and hyperactivity-impulsivity constructs. These factors were further evaluated against results of a cognitive test battery to ascertain whether objective, external validation could be demonstrated. The hyperactivity-impulsivity factor scores were related to continuous performance test measures of response inhibition, while inattention-disorganization factor scores were related to measures of attention and visual search. Implications for assessment and diagnosis of ADHD are discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed1993

Discriminant validity of attention-deficit hyperactivity disorder.

OBJECTIVE: The primary purpose of this study was to assess the discriminant validity of attention-deficit hyperactivity disorder (ADHD) relative to well-defined groups of children with other psychiatric disorders. METHOD: Clinic-referred patients diagnosed as having ADHD without any other comorbid diagnosis (N = 13), were compared with patients with only anxiety disorders (N = 20), disruptive disorders other than ADHD (N = 15), and nonreferred controls (N = 18) on measures of cognitive and academic functioning, as well as on objective measures of attention, impulse control, and activity level. RESULTS: All three patient groups were found to have cognitive and academic achievement difficulties relative to controls. However, the ADHD group was found to be inattentive and impulsive relative to the other patient groups and the nonreferred controls. Objective measurement of activity level distinguished the ADHD group from controls but not from the other two patient groups. CONCLUSIONS: These data support the diagnostic validity of a small subgroup of ADHD children (i.e., those without comorbid diagnoses) and demonstrates, that as a group, these children can be distinguished from patients with anxiety as well as other disruptive disorders on objective test measures.

Adolescent↗
PubMed1992

Specificity of inattention, impulsivity, and hyperactivity to the diagnosis of attention-deficit hyperactivity disorder.

Children with attention-deficit hyperactivity disorder (ADHD) were compared with non-ADHD psychiatric patients and normal controls on objective measures of inattention, impulsivity, and hyperactivity to determine the specificity of these symptoms to ADHD. Inattention and impulsivity were assessed using a continuous performance test, and activity was measured using solid state actigraphs. Both patient groups were inattentive relative to normals, but were indistinguishable from each other. However, the ADHD group was more active than both non-ADHD patients and normals, who did not differ from each other. These data suggest that inattention may be a nonspecific symptom of child psychiatric disorder. However, ADHD may be uniquely characterized by overactivity.

Adolescent↗