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PubMed2006

Ethnic differences in parental detection of externalizing disorders.

BACKGROUND: Previous research has reported lower treatment rates for externalizing disorders among non-Western children as compared to Western children. Ethnic differences in parental detection may be an explanation for this discrepancy. AIMS: In a cross-sectional study among the four largest ethnic groups in the Netherlands, namely Dutch, Moroccan, Turkish and Surinamese, we examined the influence of ethnicity on parental detection of behavioural disorders. METHOD: A total of 270 children (aged 6-10 years) and their parents were interviewed regarding psychiatric disorders and socio-demographic data. Sensitivity and specificity were calculated by using standard definitions, with adjustment for parental educational level. RESULTS: Sensitivity to detect any externalizing disorder and ADHD in particular was significantly lower among Moroccan and Surinamese parents when compared to Dutch parents. Sensitivity to detect ADHD tended to be lower among Turkish parents. Specificity to detect any externalizing disorder was higher among Moroccan and Turkish parents. Specificity to detect ADHD was higher among Moroccan parents and tended to be higher among Turkish parents. CONCLUSIONS: The detection rate of externalizing disorders is markedly lower among non-Dutch parents than among Dutch parents. This finding emphasizes the importance of taking parents' cultural context into account when appraising their report on possible externalizing disorders in their children.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

No hyperactive-impulsive subtype in teacher-rated attention-deficit/hyperactivity problems.

The aim of this study was to investigate which homogeneous groups, according to teacher reports of attention-deficit/hyperactivity (ADH) Problems on the Teacher's Report Form (TRF), can be identified in a referred sample (n = 4,422; age = 6-18 years; mean age = 9.9 years; 66% boys, 34% girls). Latent class analysis (LCA) was conducted on ADH Problems. In addition, co-morbidity levels in the different ADH Problems groups were compared. LCA yielded three different groups of children and adolescents with both Inattention and hyperactivity-impulsivity, and one group with high scores on Inattention but low scores on hyperactivity-impulsivity. A group of patients with predominantly hyperactivity and impulsivity was not found. Individuals in groups with higher levels of ADH Problems had significantly higher levels of oppositional defiant (OD) and conduct problems, and, although to a lesser extent, significantly higher levels of affective and anxiety problems than individuals in groups with lower levels of ADH Problems. It may not be useful to discern the hyperactive-impulsive type of ADHD.

Adolescent↗

PubMed2006

Autonomic reactivity in clinically referred children attention-deficit/hyperactivity disorder versus anxiety disorder.

This study examined whether children with attention-deficit/hyperactivity disorder (ADHD) have lower autonomic nervous system (ANS) activity and show less stress reactivity than children with an anxiety disorder. It also explored whether such a difference was accounted for by comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) in some of the ADHD children. Forty-three referred children performed a stress task, during which skin conductance (SCL) and heart rate (HR) levels were measured. Results showed that the ADHD group had similar SCL responses as the anxiety disorder group, but showed less HR reactivity immediately after the stress task. The ADHD with ODD/CD group had a slightly higher HR level than the pure ADHD group, but showed similar SCL and HR reactivity and recovery. It was concluded that ADHD children have less HR reactivity immediately after stress than children with an anxiety disorder, which was not accounted for by comorbid ODD/CD symptoms, and which may be related to a stronger parasympathetic than sympathetic activation.

Adolescent↗

PubMed2006

Which factors impact on clinician-rated impairment in children with ADHD?

OBJECTIVES: To describe the associations between a range of demographic, family and clinical factors and clinician-rated measures of global impairment in children with ADHD symptoms obtained at the baseline assessment in the ADHD Observational Research in Europe (ADORE) study. METHODS: Global impairment was measured by clinicians using the Clinical Global Impression-Severity (CGI-S) scale and the Children's Global Assessment Scale (CGAS). Associations with independent variables were investigated using forward-stepwise regression models. RESULTS: For the CGI-S and CGAS analyses, complete data sets were available for 1,265 and 985 children, respectively. The baseline mean CGI-S score in this population was 4.4 (SD 0.9) and the mean CGAS score was 55.0 (SD 10.6). Factors significantly associated with increased impairment on both outcome measures were: increased severity of ADHD symptoms, increased peer relationship problems and presence of oppositional defiant disorder and/or conduct disorder. Also, the presence of anxiety and/or depression and the presence of somatic symptoms were associated with increased impairment on CGI-S,while family health problems and premature birth were associated with increased impairment on CGAS. CONCLUSIONS: The severity of clinician-rated impairment in the ADORE sample is increased by the presence of disruptive behaviour problems and emotional problems, somatic symptoms, peer relationship difficulties, family health problems and premature birth.

Adolescent↗

PubMed2004

An ecological-transactional model of significant risk factors for child psychopathology in outer mongolia.

The present study examined significant risk factors, including child maltreatment, for child psychopathology in a cross-cultural setting. Ninety-nine Mongolian boys, ages 3-10 years, were assessed. Primary caregivers (PCG) completed structured interviews including the Emory Combined Rating Scale (ECRS) and the Mood and Feelings Questionnaire (MFQ). Structural equation modeling identifies eight risk factors affecting child psychopathology: Three with direct effects (severity of physical punishment, PCG's MFQ score, and PCG's education), three with indirect effects (cultural acceptance of violence as discipline, presence of community violence, and contact with extended family), and two with direct and indirect effects (quality of marriage/presence of spousal abuse, and household size). Results support the ecological-transactional theory of developmental psychopathology in a cross-cultural setting. Structural equation modeling provides a useful technique to isolate specific sites for intervention, while maintaining a comprehensive perspective of risk factor interaction.

Anxiety↗

PubMed2006

Social problem solving, conduct problems, and callous-unemotional traits in children.

This study examined the association between social problem solving, conduct problems (CP), and callous-unemotional (CU) traits in elementary age children. Participants were 53 children (40 boys and 13 girls) aged 7-12 years. Social problem solving was evaluated using the Social Problem Solving Test-Revised, which requires children to produce solutions to eight hypothetical social problems, including five problems involving acquiring a desired object and three problems gaining access to a peer. Regression analyses showed that greater frequency of CP symptoms was associated with producing less flexible, relevant, and prosocial solutions and more overtly aggressive solutions. However, this pattern was present only when CU traits were low. Results add to a growing body of literature demonstrating that CU traits are an important moderator of CP in children.

Affect↗

PubMed2005

Which executive functioning deficits are associated with AD/HD, ODD/CD and comorbid AD/HD+ODD/CD?

This study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3) whether a combination of AD/HD and ODD/CD is associated with EF deficits (and the possibility that there is no association between EF deficits and AD/HD or ODD/CD in isolation). Subjects were 99 children ages 6-12 years. Three putative domains of EF were investigated using well-validated tests: verbal fluency, working memory, and planning. Independent of ODD/CD, AD/HD was associated with deficits in planning and working memory, but not in verbal fluency. Only teacher rated AD/HD, but not parent rated AD/HD, significantly contributed to the prediction of EF task performance. No EF deficits were associated with ODD/CD. The presence of comorbid AD/HD accounts for the EF deficits in children with comorbid AD/HD+ODD/CD. These results suggest that EF deficits are unique to AD/HD and support the model proposed by R. A. Barkley (1997).

Adolescent↗

PubMed2005

A multitrait-multisource confirmatory factor analytic approach to the construct validity of ADHD and ODD rating scales with Malaysian children.

Confirmatory factor analysis (CFA) was used to model a multitrait by multisource matrix to determine the convergent and discriminant validity of measures of attention-deficit hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and oppositional defiant disorder (ODD) in 917 Malaysian elementary school children. The three trait factors were ADHD-IN, ADHDHI, and ODD. The two source factors were parents and teachers. Similar to earlier studies with Australian and Brazilian children, the parent and teacher measures failed to show convergent and discriminant validity with Malaysian children. The study outlines the implications of such strong source effects in ADHD-IN, ADHD-HI, and ODD measures for the use of such parent and teacher scales to study the symptom dimensions.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Family correlates of oppositional and conduct disorders in children with attention deficit/hyperactivity disorder.

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

An evaluation of the response modulation hypothesis in relation to attention-deficit/hyperactivity disorder.

Several hypotheses related to Newman's (e.g., Patterson & Newman, 1993) response modulation hypothesis were examined among adolescents with attention-deficit/hyperactivity disorder (ADHD; n=18) and normal controls (n=23). Consistent with predictions, youth with ADHD committed more passive avoidance errors (PAEs) than controls during the latter trials of a computerized go/no go task with mixed incentives, and this effect remained significant or marginally significant even after common variance associated with variables that covary with ADHD (i.e., IQ, oppositional-defiant/conduct disorder [ODD/CD] symptoms, anxious/depressed mood) was removed. While a moderate inverse association was observed between PAE frequency and the amount of time spent viewing response feedback following punishment, both categorical (diagnostic) and dimensional analyses of ADHD symptomatology indicated that ADHD and reflection on punishment feedback are uniquely associated with PAE commission. Findings from this study are discussed in relation to models of disinhibition applicable to youth with ADHD.

Adolescent↗

PubMed2006

What is the social impact of ADHD in girls? A multi-method assessment.

This study explores the social impact of ADHD, with and without opposition-defiant behaviour (ADHD+ODD (n= 22) and ADHD-only (n= 18)), in 9- to 12- year old girls compared to girls without ADHD (n= 40). Girls played a computer game involving simulated players, and mothers and teachers completed rating scales. In general, mothers and teachers saw girls with ADHD+ODD as more overtly and relationally aggressive and less prosocial than girls with ADHD-only, who were seen as more overtly and relationally aggressive and less prosocial than control girls. On the computer game, girls with ADHD+ODD were more overtly aggressive, more directly relationally aggressive, and showed less skilled behaviour than the other groups. Girls with ADHD-only showed less covert, indirect relational aggression and more socially awkward interactions than girls in the control group on the computer game. In all, the results indicate that girls with ADHD, with and without ODD behaviour, engage in socially detrimental behaviours.

Aggression↗

PubMed2006

Self-handicapping prior to academic-oriented tasks in children with attention deficit/hyperactivity disorder (ADHD): medication effects and comparisons with controls.

Examined self-handicapping prior to academic-oriented tasks in children with and without ADHD and examined whether stimulant medication influenced self-handicapping. Participants were 61 children ages 6 to 13, including 22 children with ADHD tested after taking a placebo, 21 children with ADHD tested after taking stimulant medication, and 18 non-ADHD controls. Participants completed three measures of self handicapping and also completed self-evaluations of their performance. Results showed greater self handicapping and more positive self-evaluations in children with ADHD than in controls regardless of medication condition. Findings suggest children with ADHD may use self handicapping to ameliorate the effects of experiencing high rates of academic failure.

Adolescent↗

PubMed2006

ADHD symptom subtypes in children with pervasive developmental disorder.

OBJECTIVE: Compares DSM-IV ADHD subtypes in large samples of 3-to-5 and 6-to-12 year old children with pervasive developmental disorder (PDD) vs. nonPDD clinic referrals. METHOD: Parents and teachers completed a DSM-IV-referenced rating scale. RESULTS: ADHD subtypes were clearly differentiated from the nonADHD group and showed a differential pattern of co-occurring psychiatric symptoms (more pronounced for teacher- than parent-defined subtypes and older than younger children) that was similar in both PDD and nonPDD samples. The Combined type had more severe oppositional, aggressive, and PDD symptoms than Inattentive type and were from less advantaged homes than other subtypes. Hyperactive-Impulsive type was least impaired. CONCLUSION: Findings support the notion that ADHD may be a clinically meaningful syndrome in children with PDD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

How to differentiate bipolar disorder from attention deficit hyperactivity disorder and other common psychiatric disorders: a guide for clinicians.

Bipolar disorder in children often is confused with attention deficit disorder, substance-induced mood disorder, oppositional defiant disorder, and conduct disorder. It is not uncommon for some of these disorders to be comorbid with pediatric bipolar disorder. This article provides the reader with a review of the existing literature on differentiating these illnesses and recognizing the phenomenology of each disorder as it pertains to a psychiatric diagnostic work-up of a child. Clinically helpful overlapping and unique characteristics of each disorder are discussed and a practical approach to differentiate these disorders is provided.

Adolescent↗

PubMed2005

Heterogeneity of irritability in attention-deficit/hyperactivity disorder subjects with and without mood disorders.

BACKGROUND: We hypothesized that irritability is a heterogeneous symptom distinguished by severity and that attending to this heterogeneity would impact the relationship between irritability and bipolar disorder. METHODS: A total of 274 ADHD children were administered the Kiddie Schedule for Affective Disorders and Schizophrenia (Epidemiologic Version) structured diagnostic interview. Three measures of irritability were identified: oppositional defiant disorder (ODD)-type irritability, mad/cranky irritability, and super-angry/grouchy/cranky irritability. Subjects were stratified as having bipolar disorder (n = 30), unipolar depression (n = 100), and no history of depression or bipolar disorder (non-mood-disordered, n = 144). RESULTS: Oppositional defiant disorder-type irritability was very common in all ADHD subjects, was the least impairing, and did not increase the risk of mood disorder. Mad/cranky irritability was common in only ADHD children with a mood disorder, was more impairing than the ODD-type irritability, and was predictive of unipolar depression. Super-angry/grouchy/cranky irritability was common only in ADHD children with bipolar disorder, was the most impairing, and was predictive of both unipolar depression and bipolar disorder. Two percent of the subjects with ODD-type irritability only, 6% of subjects with mad/cranky irritability, and 46% of subjects with super-angry/grouchy/cranky irritability were diagnosed with bipolar disorder. CONCLUSIONS: These results challenge the conclusion that irritability is necessarily a poor diagnostic indicator of bipolar disorder in children.

Adolescent↗

PubMed2005

How cardinal are cardinal symptoms in pediatric bipolar disorder? An examination of clinical correlates.

BACKGROUND: The main goal of this study was to test whether the hypothesized cardinal symptom of euphoria results in differences in clinical correlates in bipolar youth ascertained with no a priori assumptions about cardinal symptoms. METHODS: Subjects (n = 86) satisfying DSM-IV criteria for bipolar disorder with and without the proposed cardinal symptom of euphoria were compared in their bipolar symptom pattern, functioning and patterns of comorbidity. RESULTS: Among Criterion A (abnormal mood), we found that severe irritability was the predominant abnormal mood rather than euphoria (94% vs. 51%). We also found that among Criterion B items, grandiosity was not uniquely overrepresented in youth with mania, nor did the rate of grandiosity differ whether irritability or irritability and euphoria were the Criterion A mood symptom. Neither symptom profile, patterns of comorbidity nor measures of functioning differed related to the presence or absence of euphoria. CONCLUSIONS: These findings challenge the notion that euphoria represents a cardinal symptom of mania in children. Instead they support the clinical relevance of severe irritability as the most common presentation of mania in the young. They also support the use of unmodified DSM-IV criteria in establishing the diagnosis of mania in pediatric populations.

Adolescent↗

PubMed2006

EEG coherence in children with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder.

OBJECTIVES: This study is the first to investigate EEG coherence differences between two groups of children with attention-deficit/hyperactivity disorder combined type (AD/HD), with or without comorbid oppositional defiant disorder (ODD), and normal control subjects. METHODS: Each group consisted of 20 males. All subjects were between the ages of 8 and 12 years, and groups were matched on age. EEG was recorded during an eyes-closed resting condition from 21 monopolar derivations. Wave-shape coherence was calculated for 8 intrahemispheric electrode pairs (4 in each hemisphere), and 8 interhemispheric electrode pairs, within each of the delta, theta, alpha, and beta bands. RESULTS: Children with comorbid AD/HD and ODD had intrahemispheric coherences at shorter inter-electrode distances significantly reduced from those apparent in children with AD/HD without comorbid ODD. Such reduced coherences in the comorbid group appeared to wash out coherence elevations previously noted in AD/HD studies. CONCLUSIONS: The present results suggest that, rather than suffering an additional deficit, children with AD/HD and comorbid ODD show significantly less CNS impairment than AD/HD patients without comorbid ODD. SIGNIFICANCE: These results have treatment implications, suggesting that behavioural training, perhaps using family-based cognitive behavioural therapy, could be useful for those children with AD/HD and comorbid ODD. This should focus on the ODD symptoms, in association with a medication regime focussed on the AD/HD symptoms.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Teacher reports of ADHD symptoms in Italian children at the end of first grade.

OBJECTIVE: To determine the prevalence of teacher-rated ADHD symptoms in Italian first-graders. METHOD: 1891 first-graders aged 6.6-7.4 years were evaluated using a 34-item DSM-IV-referenced ADHD teacher rating questionnaire which included all the 18 DSM-IV ADHD diagnostic criteria, some Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), depression and anxiety symptoms, and questions about the child's social and scholastic impairment. RESULTS: Criteria for ADHD were met in 7.1% (n=135) of the subjects (10.4% males and 3.8% females), 3.5% with the Inattentive subtype, 2.3% with the Hyperactive/Impulsive subtype and 1.3% with a Combined subtype. Internalizing (depression and/or anxiety) symptoms were reported in 25.9% of the subjects with ADHD symptoms, 17% showed externalizing symptoms (ODD or CD), and 12.6% showed both. Comorbid symptoms were 10 times more frequent than in subjects without ADHD symptoms. Inattentive subtype and scholastic impairment were more frequent in females, Hyperactive/Impulsive subtype and social impairment were more frequent in males. CONCLUSIONS: Even though the real prevalence of ADHD in first graders is presumably lower than that found in the present study, this screening procedure might allow detecting those children who could benefit from referral for more comprehensive assessments.

Anxiety↗