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PubMed2002

A DSM-IV-referenced screening instrument for preschool children: the Early Childhood Inventory-4.

OBJECTIVE: To examine the validity of the Early Childhood Inventory-4 (ECI-4), a parent and teacher rating scale designed to screen for DSM-IV emotional and behavioral disorders. METHOD: The convergent, divergent, and discriminant validity and clinical utility of the ECI-4 was studied in a sample of 224 consecutive referrals (3-6-year-old children) to a child psychiatric outpatient clinic. RESULTS: The ECI-4 demonstrated adequate criterion validity for the most common disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, pervasive developmental disorder) when compared with data-based psychiatric diagnoses and correlated well with relevant scales of the Child Behavior Checklist, Teacher's Report Form, and Inattention/Overactivity With Aggression (IOWA) Conners. CONCLUSION: The ECI-4 appears to be a useful screening measure for certain disorders in clinically referred children, but continued research is needed to determine its value in other settings (e.g., school and community), and its validity with other measurement methodologies.

Affective Symptoms↗

PubMed2004

The structure of child and adolescent psychopathology: generating new hypotheses.

To begin to resolve conflicts among current competing taxonomies of child and adolescent psychopathology, the authors developed an interview covering the symptoms of anxiety, depression, inattention, and disruptive behavior used in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), the International Statistical Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1992), and several implicit taxonomies. This interview will be used in the future to compare the internal and external validity of alternative taxonomies. To provide an informative framework for future hypothesis-testing studies, the authors used principal factor analysis to induce new testable hypotheses regarding the structure of this item pool in a representative sample of 1,358 children and adolescents ranging in age from 4 to 17 years. The resulting hypotheses differed from the DSM-IV, particularly in suggesting that some anxiety symptoms are part of the same syndrome as depression, whereas separation anxiety, fears, and compulsions constitute a separate anxiety dimension.

Adolescent↗

PubMed2006

Mothers' attributions for behavior in nonproblem boys, boys with attention deficit hyperactivity disorder, and boys with attention deficit hyperactivity disorder and oppositional defiant behavior.

This study compared attributions for child behavior among mothers of 38 nonproblem boys, 26 boys with attention deficit hyperactivity disorder (ADHD), and 25 boys with ADHD and oppositional defiant (OD) behavior. Boys ranged from 7 to 10 years of age. To capture different aspects of mothers' attributions, 2 assessment methods were employed: (a) ratings of the internality, controllability, globality, and stability of causes for written descriptions of child behavior and (b) coding of the types of causal attributions that mothers provided in vivo while watching their own child's behavior. In response to the written descriptions of child behavior, mothers of boys with ADHD/OD rated the causes of oppositional and inattentive-impulsive child behaviors as more stable and global than did mothers of nonproblem boys. In identifying causes of their own child's failure on lab tasks, mothers of boys with ADHD/OD provided more child-negative attributional causes than did mothers of either ADHD only or nonproblem boys. Implications for assessing and understanding attributions in families of children with ADHD and OD are discussed.

Adult↗

PubMed2003

Which treatment for whom for ADHD? Moderators of treatment response in the MTA.

Using receiver operating characteristics, the authors examined outcome predictors (variables associated with outcome regardless of treatment) and moderators (variables identifying subgroups with differential treatment effectiveness) in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD; MTA). Treatment response was determined using parent- and teacher-reported ADHD and oppositional defiant symptoms, with levels near or within the normal range indicating excellent response. Among 9 baseline child and family characteristics, none predicted but 3 moderated treatment response. In medication management and combined treatments, parental depressive symptoms and severity of child ADHD were associated with decreased rates of excellent response; when these 2 characteristics were present, below-average child IQ was an additional moderator. No predictors or moderators emerged for behavioral and community comparison treatments. The authors discuss conceptual and clinical implications of research on treatment moderators.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood.

This parameter reviews the current status of reactive attachment disorder with regard to assessment and treatment. Attachment is a central component of social and emotional development in early childhood, and disordered attachment is defined by specific patterns of abnormal social behavior in the context of "pathogenic care." Clinically relevant subtypes include an emotionally withdrawn/inhibited pattern and a socially indiscriminate/disinhibited pattern. Assessment requires direct observation of the child in the context of his/her relationships with primary caregivers. Treatment requires establishing an attachment relationship for the child when none exists and ameliorating disturbed attachment relationships with caregivers when they are evident. Coercive treatments with children with attachment disorders are potentially dangerous and not recommended.

Attention Deficit Disorder with Hyperactivity↗

PubMed2000

Cognitive and behavioral profile of fragile X boys: correlations to molecular data.

Fragile X syndrome (FXS) is the most common form of inherited mental retardation after Down syndrome. The expansion of a CGG repeat, located in the 5'-untranslated region (5'-UTR) of the FMR1 (fragile X mental retardation) gene, leads to the hypermethylation of the repeat and the upstream CpG island. Methylation is associated with transcriptional silencing of the FMR1 gene. The lack of FMR1 protein is believed to be responsible for the typical physical and mental characteristics of the syndrome. To analyze the specific phenotype of that syndrome as well as possible associations between the phenotype and the genotype, we examined a group of 49 fragile X boys and a control group of 16 patients with tuberous sclerosis. To determine the cognitive and behavioral phenotype, the Kaufman Assessment Battery for Children (K-ABC), the Child Behavior Checklist (4/18), and a structured psychiatric interview (Kinder DIPS) were used. The genotype was analyzed by the Southern blot method. The phenotype of boys with FXS is characterized by a specific cognitive profile with strengths in acquired knowledge and in simultaneous processing. The psychiatric comorbidity is high and ADHD (attention deficit hyperactivity disorder), oppositional defiant disorder, enuresis, and encopresis predominate. In a group of 24 fragile X boys, no significant correlations between the specific aspects of the phenotype and the genotype were found.

5' Untranslated Regions↗

PubMed2006

Child mania rating scale: development, reliability, and validity.

OBJECTIVE: To develop a reliable and valid parent-report screening instrument for mania, based on DSM-IVsymptoms. METHOD: A 21-item Child Mania Rating Scale-Parent version (CMRS-P) was completed by parents of 150 children (42.3% female) ages 10.3 +/- 2.9 years (healthy controls = 50; bipolar disorder = 50; attention-deficit/hyperactivity disorder [ADHD] = 50). The Washington University Schedule for Affective Disorders and Schizophrenia was used to determine DSM-IV diagnosis. The Young Mania Rating Scale, Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, Child Behavior Checklist, and Child Depression Inventory were completed to estimate the construct validity of the measure. RESULTS: Exploratory and confirmatory factor analysis of the CMRS-P indicated that the scale was unidimensional. The internal consistency and retest reliability were both 0.96. Convergence of the CMRS-P with the Washington University Schedule for Affective Disorders and Schizophrenia mania module, the Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, and the Young Mania Rating Scale was excellent (.78-.83). The scale did not correlate as strongly with the Conners parent-rated ADHD scale, the Child Behavior Checklist -Attention Problems and Aggressive Behavior subscales, or the child self-report Child Depression Inventory (.29-.51). Criterion validity was demonstrated in analysis of receiver operating characteristics curves, which showed excellent sensitivity and specificity in differentiating children with mania from either healthy controls or children with ADHD (areas under the curve of.91 to.96). CONCLUSION: The CMRS-P is a promising parent-report scale that can be used in screening for pediatric mania.

Adolescent↗

PubMed2005

Delinquency, hyperactivity, and phonological awareness: a comparison of adolescents with ODD and ADHD.

The incidence of reading disabilities in children with attention deficit hyperactivity disorder (ADHD) has been found at a higher proportion than would be expected by chance. This study explored the relationship between reading problems-comprehension and phonological awareness, and externalizing behaviors-hyperactivity (ADHD), and oppositional defiant disorder (ODD). One hundred boys from Central Texas area alternative education schools between the ages of 11 and 15 were grouped by categories: ADHD-Combined Type (ADHD:C), ODD only, a combination of ADHD:C and ODD, and children without either ADHD or ODD. Results indicated that there were no significant differences among the four groups in terms of reading skills. However, findings suggest a significant negative linear relationship between hyperactivity and reading skills. Application of these findings is discussed.

Adolescent↗

PubMed2004

Measuring informant discrepancies in clinical child research.

Discrepancies among informants' ratings of child psychopathology have important implications for diagnosis, assessment, and treatment. Typically, parents and children complete measures (e.g., self-report checklists, diagnostic instruments) to assess child dysfunction. Ratings gathered from these sources reveal relatively little agreement on the nature and extent of the child's social, emotional, and behavioral problems. This article reviews and illustrates the most frequently used methods of measuring informant discrepancies in the clinical child literature (i.e., raw difference, standardized difference, and residual difference scores) and outlines key considerations to influence their selection. The authors conclude that frequently used methods of measuring informant discrepancies are not interchangeable and recommend that future investigations examining informant discrepancies in clinical child research use the standardized difference score as their measure of informant discrepancies.

Adolescent↗

PubMed2005

Gender appropriateness of symptom criteria for attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and conduct disorder.

We examined the gender appropriateness of the DSM-IV symptoms of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). In Study 1, 100 mothers (35 of children with and 65 of children without ADHD) rated how gender-typical and problematic they saw DSM-IV symptoms of ADHD, ODD, and CD; feminine descriptions of ADHD, ODD, and CD behaviors that we created; and relationally and overtly aggressive behaviors. Mothers rated the DSM-IV symptoms and overt aggression as boy-descriptive, and the feminine items that we created and relational aggression as girl-descriptive. Mothers saw the feminine items as less problematic than the masculine items. In Study 2, for 80 girls (40 with and 40 without ADHD), mothers' ratings on the feminine items were related to the corresponding DSM-IV symptoms, and to general psychopathology and impairment. Most correlations were significant and support the construct validity of the feminine items.

Adolescent↗

PubMed2006

[Bibliotherapy as a self-help program for parents of children with externalizing problem behavior].

OBJECTIVES: Externalizing problem behaviour is one of the most frequent and most stable behavioural disorders of childhood and adolescence. The development of applicable alternatives to expensive and restrictedly available treatments becomes increasingly necessary. This pilot study tested bibliotherapy in the form of a manual-assisted self-help programme under minimum contact conditions for parents of children with externalizing problem behaviour. METHOD: A total of 21 children, aged 6 to 15 years and diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or an Oppositional Defiant Disorder, were recruited from an outpatient population. The bibliotherapy lasted 10 weeks and consisted of working through a self-help book for parents (Wackelpeter und Trotzkopf). Initial clinical interviews and pre- and post-treatment evaluations were included, as well as short weekly telephone contacts (approx. 20 min. per contact) with the parents. RESULTS: The children's externalizing behaviour was significantly reduced during the intervention. The parenting skills were strengthened. The satisfaction of the parents with the program was high. Fewer than 20% of the parents indicated a need for an additional intensive behavioural outpatient treatment at the end of the intervention. CONCLUSIONS: Bibliotherapy may be an applicable and effective treatment alternative for children with disruptive behaviour disorders, at least in families with the resources necessary for this kind of intervention. The results have to be replicated within randomized control group trials.

Adolescent↗

PubMed2004

ODD and ADHD symptoms in Ukrainian children: external validators and comorbidity.

OBJECTIVE: To examine potential external validators for oppositional defiant disorder (ODD) and attention-deficient/hyperactive disorder (ADHD) symptoms in a Ukrainian community-based sample of 600 children age 10 to 12 years old and evaluate the nature of co-occurring ODD and ADHD symptoms using mother- and teacher-defined groups. METHOD: In 1997, parents, children, and teachers participated in extensive clinical assessments using standard Western measures. Four areas of functioning were assessed: child mental health, parent-child interactions, parental well-being, and school/cognitive performance. RESULTS: Mother-defined ODD versus ADHD symptom groups were differentiated by a history of overactivity and tantrums, behavior in school, and maternal anxiety and hostility. Teacher-defined groups were differentiated by conduct problems, internalizing symptoms, mother-child interactions, and paternal alcohol use. The effects of co-occurring ODD and ADHD symptoms were greater than would be expected based on their separate effects for conduct problems, internalizing symptoms, social problems, academic performance, parent-child relations, and marital discord. CONCLUSIONS: Children with ODD versus ADHD symptoms were not significantly different from each other for the majority of variables examined, and group differences were dependent on the rater used to define symptom groups.

Analysis of Variance↗

PubMed1957

Emotional problems in children; the uses of drugs in therapeutic management.

Emotional disturbances in children may be due to an anxiety state, to obsessive-compulsive neurosis, to schizophrenia or to a brain injury causing a behavior disorder. Children in an anxiety state have difficulty in school because anxiety interferes with concentration, impairs memory and makes decisions difficult. Consequently, these children often fear school and express their anxiety by behavior disturbances which alienate them from parents and teachers. There are a number of chemotherapeutic agents physicians can use as a part of the treatment of emotionally disturbed children. Phenobarbital is valuable for short-term therapy for the anxious child. Meprobamate also may be prescribed for anxiety reactions. It is of limited value for the hyperkinetic and obsessive-compulsive child and of no value in the schizophrenic child. Atarax (hydroxyzine dihydrochloride) is beneficial for the neurotic and hyperkinetic brain-injured child. Children with severe anxiety reactions and schizophrenic disorders respond best to chlorpromazine or reserpine.It must be emphasized that drug therapy is a part of the total therapeutic attack on the emotional problems of children.

Anxiety↗

PubMed1999

[Social competence in children with social adjustment disorders].

Teachers and parents of a sample of 1774 students at three grade levels (4th, 6th and 8th grades) were asked to judge the social competence of the children by means of the social competence questionnaire by Buhrmester et al. (1988). These ratings were correlated with the social status of the pupils, with peer statements on aggressive behavior and victimization and with the teachers' ratings of behavior in class and towards fellow pupils. Teachers proved to be more critical than parents, crediting boys with less social competence than girls, though this difference diminished in the higher grades. Ratings of social competence differed significantly both with regard to respective social status, as well as to frequent involvement in aggressive disputes as reported by peers. Children rated by the teachers as hyperactive were no less socially competent than aggressive or aggressive-hyperactive children. Victims of peer aggression and particularly shy and withdrawn children were rated the least socially competent by parents and teachers. Implications for the training of the social skills of children with peer relationship problems are discussed.

Adolescent↗

PubMed2004

Gender differences in the effects of oppositional behavior on teacher ratings of ADHD symptoms.

H. Abikoff, M. Courtney, W. E. Pelham, and H. S. Koplewicz (1993) presented elementary school teachers with a videotape of a 4th-grade male child exhibiting behavior associated with either Attention Deficit Hyperactivity Disorder (ADHD) or Oppositional Defiant Disorder (ODD). Comparisons with ratings generated from a control tape (same child exhibiting unremarkable behavior) suggested that oppositional tendencies inflated teacher ratings of ADHD for boys. The term "halo effect" has been used in the literature to refer to the impact of one class of behavior on the perception of another. This study replicated this procedure using identical scripts with both male and female child models. Oppositional behavior was associated with higher teacher ratings of hyperactivity and inattentiveness. Portrayals of behavior associated with ADHD generated higher teacher ratings of oppositional conduct. This bidirectional effect differed in magnitude as a function of child gender. The boy actor exhibiting oppositional behavior received teacher ratings of hyperactivity and inattention that were roughly half of those elicited by his portrayal of ADHD itself. The girl actor portraying ADHD generated oppositional defiant ratings that were roughly two thirds of those elicited from her performance as a child with ODD. These teacher rating tendencies could contribute to higher diagnostic rates of ADHD among boys and ODD among girls. Available epidemiologic data indicate a much higher rate of ADHD among boys and prevalence differentials for ODD (girls initially lower) that disappear by adolescence. Future research will be required to determine the extent to which these teacher response sets generalize to other evaluators such as parents, physicians and mental health professionals.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

A randomized controlled trial of clonidine added to psychostimulant medication for hyperactive and aggressive children.

OBJECTIVE: To compare clonidine with placebo added to ongoing psychostimulant therapy for the treatment of attention-deficit/hyperactivity disorder with comorbid oppositional defiant disorder or conduct disorder. METHOD: Children 6 to 14 years of age recruited through 2000 to 2001 were randomized to receive clonidine syrup 0.10 to 0.20 mg/day (n = 38) or placebo (n = 29) for 6 weeks. Primary outcome measures were the Conduct and Hyperactive Index subscales of the parent-report Conners Behavior Checklist. Side effects were monitored using physiological measures and the Barkley Side Effect Rating Scale. RESULTS: Evaluable patient analysis showed that significantly more clonidine-treated children than controls were responders on the Conduct scale (21 of 37 versus 6 of 29; chi2(1) = 8.75, p <.01) but not the Hyperactive Index (13 of 37 versus 5 of 29). Compared with placebo, clonidine was associated with a greater reduction in systolic blood pressure measured standing and with transient sedation and dizziness. Clonidine-treated individuals had a greater reduction in a number of unwanted effects associated with psychostimulant treatment compared with placebo. CONCLUSIONS: The findings support the continued use of clonidine in combination with psychostimulant medication to reduce conduct symptoms associated with attention-deficit/hyperactivity disorder. Treatment is well tolerated and unwanted effects are transient.

Adolescent↗

PubMed1998

Bullying and psychiatric symptoms among elementary school-age children.

OBJECTIVE: The aim of this study was to assess bullying and psychological disturbance among 5,813 elementary school-aged children. METHOD: The data consisted of information given by the parents, teachers, and children themselves (Rutter A2 Scale, Rutter B2 Scale and Children's Depression Inventory). Children involved in bullying (as bullies, bully-victims, and victims) were compared to other children. RESULTS: More boys than girls were found to be involved in bullying. Bully-victims scored highest in externalizing behaviour and hyperactivity, and they themselves reported feelings of ineffectiveness and interpersonal problems. Victims scored highest in internalizing behavior and also psychosomatic symptoms, and they themselves reported anhedonia. Some gender differences in psychiatric symptomatology were also found. Children involved in bullying, especially children who both bullied and were bullied themselves, were psychologically disturbed. More children involved in bullying than others were referred for psychiatric consultation. The probability of being referred was highest among bully-victims (6.5 fold for males and 9.9 for females when compared to children not involved in bullying). CONCLUSIONS: The findings indicate that bullying is a common phenomenon among children who are psychologically disturbed. Bullying also elevates the probability of being referred for psychiatric consultation.

Aggression↗

PubMed2001

Oppositional defiant disorder with onset in preschool years: longitudinal stability and pathways to other disorders.

OBJECTIVE: To examine the stability and change in oppositional defiant disorder (ODD) with onset among preschool children in a pediatric sample. METHOD: A total of 510 children aged 2-5 years were enrolled initially in 1989-1990 (mean age 3.42 years); 280 participated in five waves of data collection over a period of 48 to 72 months (mean wave 5 age, 8.35 years). Test batteries varied by age, but they included the Child Behavior Checklist, developmental evaluation, Rochester Adaptive Behavior Inventory, and a play session (before age 7 years) and a structured interview (Diagnostic Interview for Children and Adolescents, parent and child versions) at ages 7+ years. Consensus diagnoses were assigned by using best-estimate procedures. RESULTS: Wave 1 single-diagnosis ODD showed a significant relationship with both single-diagnosis ODD and single-diagnosis attention-deficit hyperactivity disorder (ADHD) at subsequent waves, but not with single-diagnosis anxiety or mood disorders. Single-diagnosis ODD at wave 1 was associated with later comorbidity of ODD/ADHD, ODD/anxiety, and ODD/mood disorders. Stability across waves 2 through 5 was moderate to high for comorbid ODD/anxiety and ODD/ADHD; low to moderate stability for single-diagnosis ODD and single-diagnosis mood disorder; and low for mood disorder, single-diagnosis ADHD, and single-diagnosis anxiety disorder. CONCLUSIONS: Preschool children with ODD are likely to continue to exhibit disorder, with increasing comorbidity with ADHD, anxiety, or mood disorders.

Adaptation, Psychological↗