[Medication for ADHD and the risk of cardiovascular mortality].
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Amphetamine↗
Biomedical subjects
R J van der Gaag
Publications and source records attributed to R J van der Gaag.
A randomized controlled trial of risperidone in the treatment of aggression in hospitalized adolescents with subaverage cognitive abilities.
BACKGROUND: Risperidone is an atypical antipsychotic drug that blocks dopamine as well as serotonin receptor systems. The present study was designed to examine the efficacy and safety of risperidone in a 6-week double-blind, randomized, parallel-group design in the treatment of aggression in adolescents with a primary diagnosis of DSM-IV disruptive behavior disorders and with subaverage intelligence. METHOD: We randomly assigned 38 adolescents (33 boys; 10 subjects with slightly subaverage IQ, 14 with borderline IQ, and 14 with mild mental retardation), who were hospitalized for treatment of psychiatric disorders associated with severe aggression, to receive risperidone or placebo. The main efficacy measures were the Clinical Global Impressions-Severity of Illness scale (CGI-S), the modified Overt Aggression Scale (OAS-M), and the Aberrant Behavior Checklist (ABC). Side effects were measured using the Extrapyramidal Symptom Rating Scale (ESRS). RESULTS: The mean daily dose of risperidone at the end of treatment was 2.9 mg (range, 1.5-4 mg). Risperidone, compared with placebo, was associated with significant improvements on the CGI-S (p < .001) and the at-school ABC overall and hyperactivity scales (p < .05). During a 2-week washout following the 6-week trial, a statistically significant worsening was found in the risperidone group on the CGI-S scale, the OAS-M. and the ABC. Extrapyramidal symptoms were absent or very mild during risperidone treatment. Transient tiredness was present in 11 (58%) of 19 drug-treated subjects. Other untoward effects included sialorrhea, nausea, and slight weight gain (mean = 3.5% of body weight in the risperidone group). No clinically relevant changes were found in laboratory parameters, electrocardiogram, heart rate, or blood pressure. CONCLUSION: These results suggest that risperidone may be effective for severe aggression in adolescents with disruptive behavior disorders and subaverage intelligence, and these results are consistent with reports suggesting its effectiveness for treating severe aggression in adolescents in general.
Adolescent↗
ERP differences among subtypes of pervasive developmental disorders.
BACKGROUND: Children with multiple complex developmental disorder (MCDD) have been distinguished from autistic children on the basis of chart reviews. It was questioned whether it is possible to find other, e.g., event-related potential (ERP), evidence for this assertion. METHODS: ERPs were measured in response to stimuli in a visual oddball task in autistic, MCDD, attention deficit disorder, dyslexic, and normal control children, to study whether ERP peaks can be used to distinguish autistic and MCDD children, and to classify the aforementioned groups. RESULTS: It was found that the P3 at four different leads and the frontal Nc showed differences among the groups, and that the autistic and MCDD groups differed from each other as well as from the other groups. Also, it was found that, using discriminant analyses in which these parameters were included, children were classified above chance level. Especially in the MCDD group, a high percentage of correct classification was seen. CONCLUSIONS: ERP parameters indicate that autistic and MCDD children might differ in underlying pathology and might therefore, better be regarded as two separate diagnostic entities.
Adolescent↗
Pituitary-adrenal reactivity in a child psychiatric population: salivary cortisol response to stressors.
The aim of this explorative study was to investigate whether physical and psychological challenges are effective in inducing a cortisol response in psychiatric and control children, and if so whether the cortisol response can discriminate between diagnostic groups and is related to psychiatric symptoms. Fifty-two patients, including children with dysthymia, oppositional defiant disorder/conduct disorder, pervasive developmental disorder, not otherwise specified (PDDNOS) and attention deficit hyperactivity disorder, were compared to 15 healthy control children. Symptomatology was scored using the Child Behaviour Checklist. The response to both psychological and physical challenges was assessed by measuring salivary cortisol and heart rate. Physical challenge, but not psychological challenge, resulted in an overall increase in heart rate and saliva cortisol. Dysthymic and PDDNOS patients showed a diminished cortisol response, in spite of a significant increase in heart rate. These groups scored highest on the symptom factor withdrawal. Withdrawal was negatively correlated with the cortisol response. Thus, physical exercise is effective in inducing a salivary cortisol response in children. Dysthymic and PDDNOS patients have a disturbed pituitary-adrenal function in relation to physical stress, that may be associated with withdrawal.
Adolescent↗
Theory of mind and emotion-recognition functioning in autistic spectrum disorders and in psychiatric control and normal children.
The hypothesis was tested that weak theory of mind (ToM) and/or emotion recognition (ER) abilities are specific to subjects with autism. Differences in ToM and ER performance were examined between autistic (n = 20), pervasive developmental disorder-not otherwise specified (PDD-NOS) (n = 20), psychiatric control (n = 20), and normal children (n = 20). The clinical groups were matched person-to-person on age and verbal IQ. We used tasks for the matching and the context recognition of emotional expressions, and a set of first- and second-order ToM tasks. Autistic and PDD-NOS children could not be significantly differentiated from each other, nor could they be differentiated from the psychiatric controls with a diagnosis of ADHD (n = 9). The psychiatric controls with conduct disorder or dysthymia performed about as well as normal children. The variance in second-order ToM performance contributed most to differences between diagnostic groups.
Adolescent↗
Verbal memory and Performance IQ predict theory of mind and emotion recognition ability in children with autistic spectrum disorders and in psychiatric control children.
This study was designed to examine the developmental and cognitive correlates of theory of mind (ToM) and emotion recognition ability in children with autism (N = 20), with pervasive developmental disorder-not otherwise specified (PDD-NOS) (N = 20), and in psychiatric control children (N = 20). The diagnostic groups were person-to-person matched on age and verbal IQ. The age of the children was between 8 and 18 years; their Full Scale IQ was at least 65. The test battery included tasks for the matching and the context recognition of emotional expressions, and a set of first- and second-order ToM tasks. The relationships between composite domain scores and the subjects' age, Verbal IQ, Performance IQ, verbal memory, visual memory, and gender were examined in bivariate and multivariate analyses. Further, the subjects who reliably and consistently passed the tasks of a domain and those who could not were compared on developmental and cognitive characteristics. Overall, the results of the various analyses converged and indicated that verbal memory, Performance IQ, age and gender were the best predictors of social cognitive ability.
Adolescent↗
Differential effects of hydrocortisone and dexamethasone on cortisol suppression in a child psychiatric population.
The suppressive effect of hydrocortisone and dexamethasone on salivary cortisol was investigated in a 2-year study of pituitary-adrenal function in a variety of child psychiatric patients and healthy controls. Symptomatology was assessed using the Child Behavioral Checklist (CBCL). Cortisol day profiles were assessed at 2-h intervals from 0800 to 2000 h on three occasions. Dexamethasone and hydrocortisone were administered orally twice at 2000 h, the doses being adjusted for bodyweight according to the standard dexamethasone suppression test. Fifty-one patients, including patients with dysthymia, oppositional defiant disorder, pervasive developmental disorder, and attention deficit hyperactivity disorder, and ten age and sex matched controls participated. Basal cortisol levels in patients were generally lower than in controls. Both dexamethasone and hydrocortisone were effective in suppressing salivary cortisol, although dexamethasone was somewhat more potent and its effect lasted longer. Hyporesponsiveness to hydrocortisone, but not to dexamethasone, distinguished patients with dysthymia and oppositional defiant disorder from controls. Responsiveness to hydrocortisone was correlated with the symptom clusters social problems and anxious/depressed. The data support the idea that there exist syndrome aspecific disturbances in feedback activity beyond the level of the pituitary, i.e. at the hypothalamic level, at an early age. From this perspective, hydrocortisone suppression is a useful tool for studying pituitary-adrenal function in children. Behavioral correlates of these disturbances of pituitary-adrenal function should be determined.
Arousal↗
Buspirone in the management of anxiety and irritability in children with pervasive developmental disorders: results of an open-label study.
BACKGROUND: We evaluated the efficacy and safety of buspirone in the management of anxiety and irritability in children with pervasive developmental disorders (PDD). METHOD: Twenty-two subjects, 6 to 17 years old, with DSM-III-R diagnosed PDD-NOS (N = 20) or autistic disorder (N = 2), were included. They were treated with buspirone in dosages ranging from 15 to 45 mg/day in an open-label trial lasting 6 to 8 weeks. Responders continued buspirone treatment and were followed up for up to 12 months. RESULTS: Nine subjects had a marked therapeutic response and 7 subjects a moderate response on the Clinical Global Impressions (CGI) scale after 6 to 8 weeks of treatment. Side effects were minimal, except for 1 patient who developed abnormal involuntary movements. CONCLUSION: These results suggest that buspirone may be useful for treating symptoms of anxiety and irritability in children with PDD.
Adolescent↗
Diagnostic rules for children with PDD-NOS and multiple complex developmental disorder.
This study was designed to examine the classification performance of diagnostic rules for pervasive developmental disorder not otherwise specified (PDD-NOS) and multiple complex developmental disorder (McDD), with clinical diagnosis as the gold standard. McDD is an heuristic concept of a developmental disorder characterised by social impairments, affective dysregulation, and thought disturbance. Detailed information on the symptoms, reliably extracted from the charts of 103 children with PDD-NOS and McDD, 32 with autistic disorder, and 96 with non-PDD disorders, was used to determine the presence of the DSM-IV criteria of autistic disorder and the criteria of McDD. A scoring rule for PDD-NOS based on a short set of seven DSM-IV criteria with a cut-off point of three items and one social interaction item set as mandatory had the best balance between high sensitivity and high specificity. The most effective and simple rule based on McDD criteria had a cut-off of three items, out of six items of anxieties and thought disturbance.
Child↗
Event-related brain potentials in children with attention-deficit and hyperactivity disorder: effects of stimulus deviancy and task relevance in the visual and auditory modality.
It has frequently been reported that in so-called oddball tasks, children with attention-deficit and hyperactivity disorder (ADDH) show small P3 peaks of the event-related potential (ERP) in response to "targets" (task-relevant deviant stimuli) than normal children. It is not clear, however, whether this smaller P3 is due to abnormal processing of infrequent stimuli per se and/or of task-relevant stimuli and whether it is preceded by abnormalities in earlier peaks, especially those thought to be related to automatic deviancy detection [mismatch negativity (MMN) in the auditory modality and P2N2 in the visual modality]. ERPs of ADDH and normal children in response to visual and auditory stimuli were studied in a condition without task relevance as well as in a task-relevant condition. ADDH children showed smaller P3 amplitudes and (marginally) smaller MMN to auditory deviant stimuli, irrespective of task relevance, so smaller P3s in ADDH children are due to stimulus deviancy per se. In the visual modality the P3 effect failed to reach significance. Because the smaller P3s were also found in a condition not requiring task-related motivation, recent motivational interpretations of differences with normal children are not supported. ADDH children also showed smaller P1 amplitudes than normal children to all stimuli except visual novels. The ERP differences were unrelated to performance, since both groups performed equally well.
Acoustic Stimulation↗
Neuropsychological impairments and deficits in theory of mind and emotion recognition in a non-autistic boy.
A 9-year-old non-autistic boy revealed marked deficits in visuo-spatial and visuo-motor skills, in planning and organizational capacities and in impulse inhibition. Particular strengths were his verbal comprehension and reasoning abilities. This neuropsychological pattern of assets and deficits fitted the nonverbal learning disability syndrome as described by Rourke (1989). On a battery of Theory of Mind (TOM) and emotion recognition tests he performed rather poor on several first-order TOM tasks and on all second-order TOM and emotion-matching tasks, compared to samples of autistic and normal subjects. It is suggested that his visuo-spatial and cognitive shifting deficits account for his social cognitive failures, while his superior verbal skills protect him from severe social handicaps.
Affect↗
Pindolol and methylphenidate in children with attention-deficit hyperactivity disorder. Clinical efficacy and side-effects.
The purpose of this study was to examine the efficacy and side-effects of pindolol, a beta-blocker, in children with attention-deficit hyperactivity disorder (ADHD). Fifty-two ADHD children, 7-13 years old, participated in a prospective double-blind placebo-controlled comparison of pindolol and methylphenidate (MPH). Active treatment was pindolol and MPH: pindolol 20 mg b.i.d. or MPH 10 mg b.i.d. for 4 weeks. The outcome was assessed on the basis of the Abbreviated Conners Rating Scales (ACRS) completed by parents, teachers, and by a psychologist during psychological testing. Pindolol treatment was associated with a higher incidence of paraesthesias and with more intense nightmares and hallucinations than MPH or placebo treatment. These side-effects led to an interim change in design by ending pindolol treatment after 32 participants. Pindolol proved to be just as effective as MPH in decreasing hyperactivity and conduct problems at home, and hyperactivity problems at school. Pindolol, however, had less therapeutic effects than MPH during psychological testing, and failed to affect conduct problems in school. In sum, pindolol was modestly effective in the treatment of ADHD. Safety concerns on troubling side-effects clearly limit the use of it.
Adolescent↗
Methylphenidate influences on both early and late ERP waves of ADHD children in a continuous performance test.
Although it has frequently been reported that hyperactive children have abnormally small P3 amplitudes of the event-related potential (ERP), which are normalized by the stimulant drug methylphenidate (MPH), the literature is inconsistent concerning earlier ERP waves. The aim of the present study was to investigate whether the normalizing effect of a 10-mg dose of MPH was also apparent on earlier waves, such as the N1, the P2, and the N2, besides the P3. Twelve attention deficit with hyperactivity disorder (ADHD) children performed a Continuous Performance Test involving a button-press response to the letter X (CPT-X) under the influence of MPH in a double-blind placebo controlled acute dosage design. ERPs were recorded at Oz, Pz, Cz, and Fz. The expected increase of the parietal P3, both to targets and nontargets, was apparent, as well as a significant increase in percentage of hits. There also was a significant increase of an earlier, negative going, wave, the N2, with a frontal maximum, under the influence of MPH. This wave was probably a manifestation of an increase in processing negativity for target stimuli only, after the intake of the stimulant drug. No effect of MPH was found on the N1 or the P2.
Adolescent↗
An ethological study on behavioural differences between hyperactive, aggressive, combined hyperactive/aggressive and control children.
Frequencies and sequential patterns of behaviour elements in pure hyperactive (N = 12), pure aggressive (N = 13), combined hyperactive/aggressive (N = 15) and control children (N = 10) were recorded in a semistructured playroom session and subsequently compared. The samples were age- and IQ-matched. In an overall MANOVA a significant main effect for hyperactivity but not for aggression was found. The hyperactive children were characterized particularly by differences in squirming and changes in sitting. The sequential patterning of their behaviour revealed weaker temporal contingencies between their behaviour and the conversational speech of the experimenter than in the case of the nonhyperactive (aggressive and control) children. This may be explained by deficits in social attention in the hyperactive groups.
Aggression↗
[Children with attention deficit disorders with hyperactivity; the role of drugs in treatment].
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Antidepressive Agents, Tricyclic↗