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PubMed2006

Psychopathology in the young offspring of parents with bipolar disorder: a controlled pilot study.

Studies have suggested that the offspring of parents with bipolar disorder are at risk for a spectrum of psychopathology, but few have focused on children in the youngest age ranges or examined the impact of comorbid parental disorders. We utilized a pre-existing sample of young (mean age: 6.8 years) offspring of parents with bipolar disorder (n=34), of parents with panic or major depression (n=179), and of parents with neither mood or anxiety disorder (n=95). Children were assessed blindly to parental diagnoses using the Schedule for Affective Disorders and Schizophrenia-Epidemiologic version (K-SADS-E). Offspring of bipolar parents had significantly higher rates of disruptive behavior and anxiety disorders than offspring from both of the comparison groups, accounted for by elevated rates of ADHD and overanxious disorder. These comparisons were significant even when lifetime histories of the corresponding categories of comorbid disorders in the parents (disruptive behavior disorders and anxiety disorders) were covaried. In addition, offspring of bipolar parents had increased rates of bipolar I disorder, compared with psychiatric controls. Results support the hypotheses of elevated behavior, anxiety, and mood disorders among offspring at risk for bipolar disorder, and suggest that this psychopathology is already evident in early childhood.

Adult↗

PubMed2006

Biases in ratings of disruptive behavior in children: effects of sex and negative halos.

OBJECTIVE: Behavior disorders are more prevalent among boys than girls, but the etiology of this difference is unclear. Studies have not tested for sex bias in ratings as a contributing factor to the differential sex prevalence rates. However, there are several studies showing "negative halo effects" in ratings of boys (i.e., the presence of one type of behavior artificially inflating ratings of another behavior). These findings have only been extended to girls in one recent study. The current study is designed to test for sex difference in (a) ratings of boys and girls who exhibit the same degree of disruptive behavior and (b) negative halo effects. METHOD: Two hundred and thirty-nine college students participated. Sex differences in ratings are not found. Nonetheless, bidirectional negative halo effects are found for boys and girls (i.e., the presence of oppositionality artificially increased ratings of inattention and hyperactivity; the presence of inattention and hyperactivity artificially increased oppositionality).

Adolescent↗

PubMed2004

Stress responsivity in children with externalizing behavior disorders.

Patterns of lower autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis activity have been found in children with oppositional defiant disorder (ODD). The aim of the present study was to investigate whether children with attention-deficit/hyperactivity disorder (ADHD) differ from ODD children with (OD/AD) or without comorbid ADHD in ANS and HPA axis activity under baseline and stressful conditions. The effects of stress on cortisol, heart rate (HR), and skin conductance level (SCL) were studied in 95 children (26 normal control [NC] children and 69 child psychiatric patients referred for externalizing behavior problems [15 ODD, 31 OD/AD, and 23 ADHD]). No baseline differences were found in cortisol between the four groups. However, the ODD and OD/AD groups showed a significantly weaker cortisol response to stress compared to the ADHD and NC groups; the ADHD group had a similar cortisol response as the NC group. Within the ODD group this pattern of low cortisol responsivity was most clearly present in the more severely affected inpatients. With respect to HR, the ODD group had a significantly lower HR during baseline and stressful conditions. The higher HR levels in the OD/AD and ADHD groups were likely to be caused by methylphenidate. The externalizing groups had significantly lower SCL levels, and no differences were found between these groups. It was concluded that differences in cortisol responsivity during stress exposure are important in distinguishing within a group of children with externalizing behavior between those with ODD and ADHD.

Arousal↗

PubMed2006

Bruxism in children: effect on sleep architecture and daytime cognitive performance and behavior.

STUDY OBJECTIVES: Sleep bruxism is an involuntary mandibular movement with tooth grinding during sleep. The prevalence of sleep bruxism in children is high and may lead to frequent arousals with altered daytime functioning. We investigated the sleep architecture, the incidence of gastroesophageal reflux, and the daytime cognitive behavioral functioning in a group of children with sleep bruxism. DESIGN-PATIENTS: This prospective pilot study included 10 children. Polysomnographic data with pH-probe analysis was compared with 10 age- and sex-matched controls. Each patient completed a dental evaluation, a nighttime polysomnogram, and cognitive behavioral tests (Kaufman Brief Intelligence Test and Achenbach Child Behavior Checklist). RESULTS: Eight of 10 children had clinically significant bruxism and the 2 remaining patients had recent teeth exfoliation. There was no difference on sleep architecture between patients and controls, except for a higher arousal index for the bruxism group (36.7 vs 20.7, p < .007). Sleep bruxism occurred more frequently in stage 2 and rapid eye movement sleep, with arousals in 66% of the cases. There was no relationship of bruxism to gastroesophageal reflux or intelligence. However, 40% of the patients had elevated scores on the Achenbach Child Behavior Checklist, indicating significant attention and behavior problems, and there were moderate correlations between the arousal index and several of the behavior-problem scales from the Achenbach Child Behavior Checklist (0.5 to 0.6). CONCLUSIONS: The data suggest that children with bruxism have a higher arousal index, which may be associated with an increased incidence of attention-behavior problems. Future studies investigating pediatric sleep bruxism will need to focus on behavior issues that may be prevalent in this population.

Adolescent↗

PubMed2003

Presenting problems and assigned diagnoses among young Latino children with disruptive behaviors.

It is unclear whether the behaviors that alert families to the need for services are those that classify children for the diagnoses they receive. This study describes the behaviors that Latina mothers from Cuba, Puerto Rico, and the Dominican Republic report to have induced them to seek services for their young children. Both qualitative and quantitative analyses were used. Results indicated that mothers most frequently cited behaviors that fell in the categories of Hyperactivity, Aggression/Temper Tantrums, and School Complaints as reasons for help seeking. Whereas aggression and self-injurious acts were most alarming to mothers, School Complaints appeared to be a strong motivator for help seeking. Children whose mothers cited school behavior as a reason for help seeking had significantly poorer global functioning and presented significantly higher care giving demands than peers. In addition, their mothers reported significantly more disciplinary laxity than the mothers of peers without School Complaints. Maternal narratives of children's behaviors moderately concurred with assigned diagnoses. Mothers overlooked inattentive behaviors in children with ADHD and reported much more aggression and oppositionality than might be expected from the number of diagnoses of ODD that were assigned.

Attention Deficit Disorder with Hyperactivity↗

PubMed2007

High rates of psychiatric co-morbidity in PDD-NOS.

Rates of co-morbid psychiatric conditions in children with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) are hardly available, although these conditions are often considered as more responsive to treatment than the core symptoms of PDD-NOS. Ninety-four children with PDD-NOS, aged 6-12 years were included. The DISC-IV-P was administered. At least one co-morbid psychiatric disorder was present in 80.9% of the children; 61.7% had a co-morbid disruptive behavior disorder, and 55.3% fulfilled criteria of an anxiety disorder. Compared to those without co-morbid psychiatric disorders, children with a co-morbid disorder had more deficits in social communication. Co-morbid disorders occur very frequently in children with PDD-NOS, and therefore clinical assessment in those children should include assessment of co-morbid DSM-IV disorders.

Adolescent↗

PubMed2006

How mothers parent their children with behavior disorders: implications for unintentional injury risk.

INTRODUCTION: This study was designed to test the role of parental supervision in explaining why children with behavior disorders have increased risk of unintentional injury. METHOD: Children referred to a pediatric behavior disorders clinic and their mothers were unknowingly observed in a "hazard room" environment that housed several items that appeared dangerous but actually were altered to be safe. RESULTS: Mother and child behavior in the hazard room was correlated to parent-, teacher-, and observational-reports of children's externalizing behavior patterns, children's injury history, and mother's parenting styles. Maternal ignoring of children's dangerous behavior in the hazard room was the strongest correlate to children's injury history. CONCLUSIONS: Poor parental supervision might serve as a mechanism to explain why children with behavior disorders, and those with oppositional behavior patterns in particular, have increased risk of unintentional injury.

Accident Prevention↗

PubMed2006

Parenting in mothers with and without attention-deficit/hyperactivity disorder.

The authors examined the impact of maternal attention-deficit/hyperactivity disorder (ADHD) on parenting behaviors. Sixty mothers between the ages of 31 and 50 with (n = 30) and without (n = 30) ADHD and their 8- to 14-year-old children with ADHD completed self-report and laboratory measures of monitoring of child behavior, consistency in parenting, and parenting problem-solving abilities. These parenting behaviors were selected because of their established links to the development of child behavior problems. As predicted, mothers with ADHD were found to be poorer at monitoring child behavior and less consistent disciplinarians compared with mothers without ADHD. There was some evidence to support the prediction that mothers with ADHD were less effective at problem solving about childrearing issues than control mothers. The differences between the 2 groups of mothers persisted after child oppositional and conduct-disordered behavior were controlled. These results indicate that parenting is an area of functioning that requires more attention in adult ADHD research.

Adolescent↗

PubMed2002

Social problems associated with ADHD vs. ODD in children referred for friendship problems.

Four groups were composed of children referred for friendship problems (age range: 6 to 12 years old). One group was diagnosed with both Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional-Defiant Disorder (ODD), one group with ADHD only, one group with ODD only and one group with neither disorder. Parents and teachers were given questionnaires to rate the social behavior of each child. The groups differed significantly on one parent scale (Self-control) and one teacher scale (Aggression). Inspection of the items composing these scales suggested that some items measured social relationships with adults while other items measured peer relationships. Subsequent factor analysis separated peer and adult components. Analysis of subscales derived from factor analysis revealed the diagnosis of ADHD was associated with increases in classroom disruption and decreased resistance to provocation by peers, while the diagnosis of ODD was associated with increased in hostility towards peers, decreased resistance to provocation by peers and decreased respect for adults. Limitations of the study were: domains of social functioning assessed, sample size and diversity, and the absence of a comparison group with adequate peer relationships. Social skills programs should target social deficits associated with ODD and ADHD. The scales refined in the present study offer a convenient means of assessing peer dysfunction from the points of view of parents and teachers.

Analysis of Variance↗

PubMed1999

An evaluation of the properties of attention as reinforcement for destructive and appropriate behavior.

The analogue functional analysis described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994) identifies broad classes of variables (e.g., positive reinforcement) that maintain destructive behavior (Fisher, Ninness, Piazza, & Owen-DeSchryver, 1996). However, it is likely that some types of stimuli may be more effective reinforcers than others. In the current investigation, we identified 2 participants whose destructive behavior was maintained by attention. We used concurrent schedules of reinforcement to evaluate how different types of attention affected both destructive and appropriate behavior. We showed that for 1 participant praise was not an effective reinforcer when verbal reprimands were available; however, praise was an effective reinforcer when verbal reprimands were unavailable. For the 2nd participant, we identified a type of attention that effectively competed with verbal reprimands as reinforcement. We then used the information obtained from the assessments to develop effective treatments to reduce destructive behavior and increase an alternative communicative response.

Aggression↗

PubMed1998

Racial differences on the Conners Teacher Rating Scale.

Factor congruence and mean differences on the Conners Teacher Rating Scale were assessed across African-American and Caucasian school children. Factor analyses conducted separately by gender revealed similar factors across races for males and females. The main differences in factor structure within gender were the presence of an Antisocial factor in black males and an Inattention factor in white females. Across both males and females, teachers tended to rate black children higher than white children on factors relating to externalizing behaviors. Whether mean differences are a result of teacher bias or actual behavioral differences in the classroom needs further research.

Adolescent↗

PubMed2006

Should sex-specific norms be used to assess attention-deficit/hyperactivity disorder or oppositional defiant disorder?

The authors investigated whether sex-specific norms should be used to assess symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in girls. It was hypothesized that (a) there would be a group of girls who exhibit ADHD or ODD symptoms using sex-specific norms but not using Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria; (b) these girls would be significantly impaired relative to typically developing girls. These hypotheses were examined using behavior ratings completed by mothers and teachers of 1,491 elementary school students. Results showed that there was a small group of girls who did not meet DSM-IV criteria for ADHD or ODD but who had elevated ADHD and ODD scores when sex-specific norms were used. The same was not true for boys. The girls identified with sex-specific norms were more impaired than other girls. These results suggest that there may be a small number of girls who have behaviors and impairment that are consistent with ADHD and ODD, but they are not currently being identified by DSM-IV criteria.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

A model for school psychology practice: addressing the needs of students with emotional and behavioral challenges through the use of an in-school support room and reality therapy.

This article describes a treatment approach for students with emotional and behavioral challenges. The approach involves conducting reality therapy in an in-school support room. Data from this pilot study indicate that the treatment assists in developing more effective choices and in turn promotes cognitive and behavioral change in most students, while reducing the number of disciplinary actions for these students.

Adolescent↗

PubMed1997

A prospective study of hyperactive boys with conduct problems and normal boys: adolescent and adult criminality.

OBJECTIVE: To examine the relationship between attention deficit disorder with hyperactivity in childhood and criminality in adolescence and adulthood in 89 hyperactive and 87 normal control subjects. METHOD: In this prospective study, adolescent follow-up intervals ranged from 13 to 21 years and adult follow-up ranged from 18 to 23 years. The official arrest records for all subjects were obtained. RESULTS: Hyperactive subjects had significantly higher juvenile (46% versus 11%) and adult (21% versus 1%) arrest rates. Juvenile and adult incarceration rates were also significantly higher. Childhood conduct problems predicted later criminality, and serious antisocial behavior in adolescence predicted adult criminality. CONCLUSIONS: Hyperactive children are at risk for both juvenile and adult criminality. The risk for becoming an adult offender is associated with conduct problems in childhood and serious antisocial behavior (repeat offending) in adolescence. Hyperactive children who do not have conduct problems are not at increased risk for later criminality.

Adolescent↗

PubMed1998

Obtaining systematic teacher reports of disruptive behavior disorders utilizing DSM-IV.

This study examines the psychometric properties of the Vanderbilt AD/HD Diagnostic Teacher Rating Scale (VADTRS) and provides preliminary normative data from a large, geographically defined population. The VADTRS consists of the complete list of DSM-IV AD/HD symptoms, a screen for other disruptive behavior disorders, anxiety and depression, and ratings of academic and classroom behavior performance. Teachers in one suburban county completed the scale for their students during 2 consecutive years. Statistical methods included (a) exploratory and confirmatory latent variable analyses of item data, (b) evaluation of the internal consistency of the latent dimensions, (c) evaluation of latent structure concordance between school year samples, and (d) preliminary evaluation of criterion-related validity. The instrument comprises four behavioral dimensions and two performance dimensions. The behavioral dimensions were concordant between school years and were consistent with a priori DSM-IV diagnostic criteria. Correlations between latent dimensions and relevant, known disorders or problems varied from .25 to .66.

Achievement↗

PubMed2004

The reliability and validity of the Oppositional Defiant Behavior Inventory.

OBJECTIVE: The aim of this study was to develop an evaluation scale for use as a supplementary tool for the diagnosis of oppositional defiant disorder (ODD). METHOD: The subjects were 98 Japanese children (91 males and 7 females), aged 6-15 years, diagnosed with attention deficit/hyperactivity disorder (ADHD) or ODD. Internal consistency, test-retest reliability, concurrent validity and divergent validity of the oppositional defiant behavior inventory (ODBI), an evaluation scale of oppositional defiant tendency, were examined. RESULTS: Cronbach's alpha coefficient of the ODBI was 0.925. The correlation coefficient between the test and the retest was 0.820 (p < 0.0001). Both the ODBI scores (test and retest) were correlated with the number of items that matched the ODD diagnostic criteria of DSM-IV (r = 0.660, 0.659, p < 0.001), and with the ODD-scale of Disruptive Behavior Disorders Rating Scale (r = 0.725, 0.654, p < 0.001). Compared with the ADHD group or controls, the ADHD and ODD group showed a significantly higher ODBI score at p < 0.0001. CONCLUSION: The concurrent use of this scale with clinical examination is expected to increase the accuracy of the diagnosis of ODD.

Adolescent↗

PubMed2002

Reduction in children's symptoms of attention deficit hyperactivity disorder and oppositional defiant disorder during individual tutoring as compared with classroom instruction.

Children who display symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in classrooms are reputed to display fewer symptoms in one-on-one interaction. We tested this hypothesis with children who received tutoring for reading and behavior problems. We selected 30 children whose teacher-rated ADHD symptoms fit a pattern consistent with DSM criteria for the diagnosis. Teachers rated the frequency of symptoms in classrooms before and after tutoring. Tutors rated the frequency of the same behaviors during individual tutoring sessions. Children's ADHD symptoms, as well as oppositional symptoms, were significantly lower in the tutoring sessions than in the classrooms. The effect sizes for the difference between behavior in classrooms and in individual tutoring ranged from 0.7 to 2.5 standard deviations. These effect sizes appear as large as those reported for the effect of stimulant medication on ADHD symptoms. All 30 children at preintervention fit the pattern for ADHD using teachers' ratings of classroom behavior; 87% of them did not meet those DSM criteria using tutors' ratings of behavior in individual sessions. The confound of different raters for the two different settings must be resolved by another study with a new design.

Attention Deficit Disorder with Hyperactivity↗

PubMed1998

Classroom-based functional and adjunctive assessments: proactive approaches to intervention selection for adolescents with attention deficit hyperactivity disorder.

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systematically manipulated by teachers, were related to the occurrence and nonoccurrence of problem behaviors. Classroom interventions derived from information that was obtained during functional and adjunctive assessments and from subsequent analyses resulted in substantial reductions in problem behaviors. Teacher and student consumer satisfaction ratings indicated that the interventions were effective and feasible in the classroom setting.

Adolescent↗