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PubMed2006

Psychopharmacologic treatment of aggressive preschoolers: a chart review.

Very young children with severe aggression are a growing focus of care in child psychiatry. Notwithstanding diagnostic uncertainties in this age group, medication, not usually considered a first-line intervention, is becoming a treatment option for a growing number of clinicians in spite of a dearth of research in this area. This chart review assessed the patient characteristics, diagnoses and treatment responses of aggressive preschoolers who were treated in a university child psychiatry outpatient clinic from 2001-2004. The most common diagnoses were Attention Deficit Hyperactivity Disorder (ADHD), Disruptive Behavior Disorder and Posttraumatic Stress Disorder (PTSD). Medication was prescribed for a majority of the children with prominent aggression; atypical antipsychotics were prescribed with the greatest frequency, followed by stimulants and then alpha agonists--treatment response ratings indicated moderate to marked improved in a majority of the preschoolers who received one or a combination of these medications. Findings support the need for controlled trials of medication in preschoolers with severe aggression.

Adrenergic alpha-Agonists↗

PubMed2000

Findings on disruptive behavior disorders from the first decade of the Developmental Trends Study.

The paper summarizes the first decade of the Developmental Trends Study, a prospective longitudinal study of 177 boys. Initially, they were referred to mental health clinics in Pennsylvania (Pittsburgh), and Georgia (Athens and Atlanta). Since 1987, the boys, their parents, and their teachers have been followed up almost annually. The study is unique because the cooperation rate of participants has remained very high over the years, psychiatric diagnoses were derived from structured interviews (especially disruptive behavior disorders), and many risk factors were measured over the years. The present paper summarizes key findings on the development of disruptive behavior, especially Oppositional Defiant Disorder, Conduct Disorder, and Attention Deficit-Hyperactivity Disorder. The paper also highlights results on risk factors and comorbid conditions of disruptive behaviors.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Reliability, validity, and preliminary normative data for the Children's Aggression Scale-Teacher Version.

OBJECTIVE: To provide preliminary psychometric data on the Children's Aggression Scale-Teacher Version (CAS-T), which was designed to assess severity and frequency of aggressive, as distinct from nonaggressive, disruptive behaviors. METHOD: The CAS-T has 23 items representing five domains: Verbal aggression, Aggression against objects and animals, Provoked physical aggression, Unprovoked physical aggression, and Use of weapons. The CAS-T was completed for 273 nonreferred boys and 67 clinically referred children (60 boys; 7 girls). Coefficient alpha was assessed separately in clinical and nonreferred groups. Validity was evaluated by comparing CAS-T scores of children with different disruptive behavior disorder diagnoses and by examining the relationship of CAS-T scores to other parent and teacher ratings. RESULTS: The scale as a whole had excellent reliability as measured by coefficient alpha. Children with conduct disorder were rated significantly higher than those with oppositional defiant disorder, attention-deficit/hyperactivity disorder, and no disruptive behavior disorder diagnosis. Further, patterns of correlations with other rating scales provide strong support for the convergent and discriminant validity of the CAS-T. CONCLUSIONS: The CAS-T may fill a gap in that it distinguishes among various types and severity of aggression, as distinct from oppositional-defiant behaviors.

Aggression↗

PubMed2004

Quality of life in children with psychiatric disorders: self-, parent, and clinician report.

OBJECTIVE: To study the relationship between child psychiatric disorders and quality of life (QoL). METHOD: In a sample of 310 children (ages 6-18 years) referred for psychiatric problems, children, parents, and clinicians reported on psychopathology and subjective and objective QoL indicators. RESULTS: Six diagnostic categories were distinguished: attention-deficit and disruptive behavior disorders, anxiety disorders, pervasive developmental disorders, mood disorders, other disorders, and no diagnosis. In overall QoL, no differences were found between the diagnostic categories, except in clinician's ratings, who rated children with pervasive developmental disorder as having a poorer QoL than children with other diagnoses. In each diagnostic category specific QoL subdomains were affected: for children with attention-deficit and disruptive behavior disorder, school functioning and social functioning; for children with anxiety disorder, emotional functioning; for children with pervasive developmental disorder, social functioning; and for children with mood disorder, emotional functioning. CONCLUSIONS: Across multiple raters, the distinguished child psychiatric disorders had a different impact on QoL. Knowledge about domains of QoL that are affected in specific child psychiatric disorders can help clinicians to focus on particular QoL domains during the diagnostic process and to define adequate treatment goals.

Adolescent↗

PubMedDate not supplied

Relationship of childhood behavior disorders to weight gain from childhood into adulthood.

OBJECTIVE: Obesity and behavior disorders are important conditions that affect the health of children and adolescents; some evidence suggests that they are associated. However, these relationships have not been studied longitudinally from childhood to adulthood. We investigated childhood to adulthood weight change associated with attention-deficit and disruptive behavior disorders. METHODS: We analyzed data from a prospective cohort study in which 655 individuals observed before age 16.6 years, and assessed in 1983 (when aged 9.1 to 16.6 years), 1985-1986 (when 11.1 to 20.8 years), 1991-1994 (when 16.6 to 26.9 years), and 2001-2003 (when 27.7 to 38.3 years). Attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder (collectively, "disruptive disorders") were assessed by trained interviewers who used the Diagnostic Interview Schedule for Children. We evaluated the association of disruptive disorders (assessed when youth were <16.6 years) with longitudinal body mass index (BMI) z scores from childhood to adulthood using linear mixed-effects models. RESULTS: Female subjects with disruptive disorders were estimated, at all ages, to have mean BMI z scores 0.23 (95% confidence interval, 0.03-0.44) units higher than female subjects without disruptive disorders. Male subjects with disruptive disorders were estimated, at all ages, to have mean BMI z scores 0.20 (95% confidence interval, 0.00-0.39) units higher than male subjects without disruptive disorders. For male and female subjects, annual BMI z-score change was statistically unrelated to disruptive disorder history. CONCLUSIONS: Disruptive disorders were associated with elevated weight status that was maintained from childhood into adulthood. These findings suggest that associations between behavior disorders and increased weight begin early in childhood and may have lifelong health effects.

Adolescent↗

PubMed2003

Sequential evaluation of behavioral treatments and methylphenidate dosage for children with attention deficit hyperactivity disorder.

We used a sequential approach to evaluate the relative and combined effects of different types of behavioral treatments, as well as dosage of methylphenidate (MPH), on the disruptive behavior of 3 students who had been diagnosed with attention deficit hyperactivity disorder. Results showed that individualized behavioral treatments produced decreases in disruptive behavior equivalent to MPH for all 3 participants and demonstrated the need to evaluate behavioral treatments and medication dosage on an individual basis.

Attention Deficit Disorder with Hyperactivity↗

PubMed1998

Anxiety and cognitive performance in adolescent women with disruptive behavior disorders.

Comparing 36 disruptive behavior-disordered and 40 normal female adolescents, we found higher levels of anxiety and poorer performance on a measure of verbal fluency in the clinical sample. No group differences were found on a nonverbal measure of reflectivity nor on a measure of interpersonal cognitive problem solving. Nor was evidence found for an hypothesized anxiety-related performance decrement among disruptive behavior-disordered youth. However, anxiety induction facilitated performance across groups on interpersonal cognitive problem solving.

Adolescent↗

PubMed2000

Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders.

Consecutive child psychiatric outpatient admissions with disruptive behavior or adjustment disorders were assessed by validated instruments for trauma exposure and posttraumatic stress disorder (PTSD) symptoms and other psychopathology. Four reliably diagnosed groups were defined in a retrospective case-control design: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), comorbid ADHD-ODD, and adjustment disorder controls. ODD and (although to a lesser extent) ADHD were associated with a history of physical or sexual maltreatment. PTSD symptoms were most severe if (a) ADHD and maltreatment co-occurred or (b) ODD and accident/illness trauma co-occurred. The association between ODD and PTSD Criterion D (hyperarousal/hypervigilance) symptoms remained after controlling for overlapping symptoms, but the association of ADHD with PTSD symptoms was largely due to an overlapping symptom. These findings suggest that screening for maltreatment, other trauma, and PTSD symptoms may enhance prevention, treatment, and research concerning childhood disruptive behavior disorders.

Adjustment Disorders↗

PubMed1998

Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: explainable by comorbid disruptive behavior or reading problems?

Questions remain as to whether neuropsychological processing deficits associated with child attention-deficit/hyperactivity disorder (ADHD) are accounted for by co-occurring disorders, especially in clinical samples. The authors examined ADHD and comorbid oppositional defiant, conduct, and reading disorders. Boys with ADHD displayed hypothesized deficits on effortful neuropsychological tasks regardless of categorical or dimensional control of comorbid antisocial behavior problems. The same result held when reading problems were controlled, although boys with ADHD plus reading disorder (n = 16) exhibited specific impairment on linguistic output tasks. Simultaneous control of reading and behavior problems yielded the same result. Overall, results suggest that in a clinical sample, difficulties on effortful neuropsychological tasks that require planning or controlled motor output pertain at least in part to ADHD and are not fully accounted for by comorbid conditions.

Analysis of Variance↗

PubMed1991

Reaction time indices of attention deficits in boys with disruptive behavior disorders.

Boys with diagnoses in the disruptive behavior disorder (DBD) spectrum and normal controls were tested in two reaction time (RT) experiments. In Experiment I simple warned RT was measured and the length and regularity of the preparatory intervals were varied in order to study sustained attention in the sense of preparation. With age and IQ controlled, DBD boys had slower and more variable RT overall than controls and showed generally more pronounced effects of variations in the length and sequence of the preparatory intervals. The results suggest that DBD boys are subject to lapses of attention which are increased by a relatively long preparatory interval, and that they have a particular problem with temporal uncertainty. In Experiment II some aspects of selective attention were studied in a paradigm in which stimulus modality uncertainty and response selection were varied. DBD boys showed greater effects of modality uncertainty but not response selection than controls. No differences between subdiagnoses within the DBD spectrum could be demonstrated.

Attention↗

PubMed2003

Comparing DISC-IV and clinician diagnoses among youths receiving public mental health services.

OBJECTIVES: To compare the prevalence and agreement of diagnoses based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) and clinician assignment for youths receiving public mental health services between 1996 and 1997 and to examine potential predictors of diagnostic agreement. METHOD: Participants included 240 youths aged 6-18 years. Past-year prevalence rates and kappa statistics were calculated for four diagnostic categories: anxiety, mood, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBD). Potential predictors of diagnostic agreement were examined with logistic regression analysis. RESULTS: The prevalence of ADHD, DBD, and anxiety disorders was significantly higher based on the DISC-IV, while the prevalence of mood disorders was significantly higher based on clinician assignment. Diagnostic agreement was poor overall. The kappa values ranged from -0.04 for anxiety disorders to 0.22 for ADHD. Significant predictors of agreement varied by diagnosis and included symptom severity, comorbidity, youth age and gender, and school-based problem identification. CONCLUSIONS: Consistent with previous findings of poor diagnostic agreement between structured interviews and clinicians, these results call for a better understanding of factors affecting diagnostic assignment across different methods. This is especially important if researchers continue to use structured interviews to determine prevalence, establish diagnosis-based treatment guidelines, and disseminate evidence-based treatments to community mental health settings.

Adolescent↗

PubMed1999

Effective treatment for mental disorders in children and adolescents.

As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.

Adolescent↗

PubMed1998

The outcome of parent training using the behavior management flow chart with mothers and their children with oppositional defiant disorder and attention-deficit hyperactivity disorder.

The effects of parent training, using parameters established in the Behavior Management Flow Chart, on mother behavior and on the disruptive behavior of eight children who emitted behavior consistent with the diagnoses of both Oppositional Defiant Disorder and Attention-Deficit Hyperactivity Disorder were evaluated. There are important differences between the Behavior Management Flow Chart and well-known parent-training programs that are based on the Hanf model. Parent training was conducted within a multiple baseline design across children. Direct observation of mother and child behavior, phone interviews, and standardized rating scales showed that training improved parenting behavior, reduced maternal stress, and reduced oppositional child behavior. A 6-month follow-up revealed that parenting and child behavior remained stable. The results are comparable with prior research on behavioral parent training for families that have children with oppositional/hyperactive behavior.

Adult↗

PubMed2004

Associations between temperament and DSM-IV externalizing disorders in children and adolescents.

This study investigated associations between child temperament and DSM-IV disorders in children. A total of 156 probands (97 boys, 59 girls; mean age = 10.78 years) and 154 randomly selected siblings were assessed using the Junior Temperament and Character Inventory (JTCI) and a structured DSM-IV interview. Subjects were placed in nonoverlapping groups of (1) attention-deficit hyperactivity disorder (ADHD) only, (2) disruptive behavior disorders (DBD) only, (3) DBD plus an affective and/or anxiety disorder (DBD+Int), and (4) controls with no diagnosis. Many JTCI scales were found to differ between diagnostic groups and controls. Regression analyses showed independent associations between low persistence and ADHD-only group membership, high novelty seeking (NS), and the DBD-only group and between high harm avoidance (HA) and DBD+Int group membership. The interaction NS x HA was related to the ADHD-only group. Future research is needed to determine the mechanism of these association.

Anxiety Disorders↗

PubMed2002

Review of the evidence base for treatment of childhood psychopathology: externalizing disorders.

This article reviews controlled research on treatments for childhood externalizing behavior disorders. The review is organized around 2 subsets of such disorders: disruptive behavior disorders (i.e., conduct disorder, oppositional defiant disorder) and attention-deficit/hyperactivity disorder (ADHD). The review was based on a literature review of nonresidential treatments for youths ages 6-12. The pool of studies for this age group was limited, but results suggest positive outcomes for a variety of interventions (particularly parent training and community-based interventions for disruptive behavior disorders and medication for ADHD). The review also highlights the need for additional research examining effectiveness of treatments for this age range and strategies to enhance the implementation of effective practices.

Adolescent↗

PubMed1998

Attention-deficit hyperactivity disorder subtypes and comorbid disruptive behaviour disorders in a child and adolescent mental health clinic.

OBJECTIVE: To assess demographic characteristics and patterns of comorbid disruptive behavior disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]) in subtypes of attention-deficit hyperactivity disorder (ADHD). METHOD: One hundred youths consecutively referred to a community child and adolescent mental health clinic and subsequently diagnosed with ADHD by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria were evaluated. The diagnosis was made by a child psychiatrist and was based on information from physicians, parents, teachers, and diagnostic interviews with the youth and their parents. RESULTS: The major findings were: 1) ADHD combined (C) type was diagnosed in 78% of the subjects, while 15% had inattentive (1) type and 7% had hyperactive-impulsive (HI) type; and 2) patterns of comorbid disruptive behavioural disorders significantly differed among subtypes. Specifically, subjects with the I type showed lower rates of comorbid ODD than those with the C type (33% and 85%; P < 0.001) and HI type (33% and 100%; P = 0.005); subjects with the HI type displayed a higher prevalence of CD than those with the I type (57% and 0%; P = 0.005) and C type (57% and 8%; P = 0.003). These results should be considered tentative because the reliability of the diagnostic procedures was not formally assessed and the number of subjects in the I and HI groups was small. CONCLUSION: ADHD subtypes showed significant differences in the distribution of comorbid disruptive behaviour disorders. These results support the utility of ADHD subtypes but should be replicated with a larger sample of I and HI type subjects using more rigorous diagnostic methods.

Adolescent↗

PubMed2001

The influence of a token economy and methylphenidate on attentive and disruptive behavior during sports with ADHD-diagnosed children.

Three children diagnosed with attention deficit hyperactivity disorder (ADHD) participated in a summer program designed to evaluate the influence of stimulant medication and a token economy on attentive and disruptive behavior during kickball games. Attentive and disruptive behavior were assessed using an interval coding system, and daily ratings on the ADHD Index of the Conners Teacher Rating Scale-Revised were also obtained. A multielement reversal design was used, and the results indicated that both interventions independently improved attentive behavior and decreased disruptive behavior for the participants. Contrary to other research, when the token economy and medication were compared in isolation, the token system appeared more effective in reducing disruptive behavior for 2 of the 3 participants. In addition, the token system generally enhanced the effects of stimulant medication.

Attention Deficit Disorder with Hyperactivity↗

PubMed2001

Gene-environment interplay in oppositional defiant and conduct disorder.

Oppositional defiant and conduct disorder is a disturbance in behavior that is characterized by aggressive and antisocial acts. At present, genetic research on conduct disorder has raised more questions than it has answered, and basic questions such as the heritability of childhood antisocial behavior cannot yet be answered with certainty. Current research, however, has consistently highlighted the importance of gene-environment interplay in antisocial behavior.

Adolescent↗