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Results for “Attention Deficit and Disruptive Behavior Disorders”

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PubMed1997

Decreasing disruptive behavior by adolescent boys in residential care by increasing their positive to negative interactional ratios.

An intervention for disruptive boys in residential care involving increases in positive to negative interactional ratios is described. The target of the intervention was daily problem behavior. Results from a pooled time series analysis of the data revealed a significant decrease in behavior problems (one problem per boy per day) during the intervention for the boys as a group. Results from comparisons of mean behavior problems during baseline and intervention revealed decreases for five of the six boys. Results from a multiple baseline across boys revealed experimental control for three of the six. The results are discussed in terms of response contingent reinforcement and systemic behavior analyses. The benefits of combined group and single subject data analyses are also discussed.

Adolescent↗

PubMed2005

Clinical differences between suicidal and nonsuicidal depressed children and adolescents.

OBJECTIVE: To examine the clinical symptoms and comorbid psychiatric disorders of depressed children and adolescents with and without clinically significant suicidal ideation. METHOD: Children and adolescents aged 7 to 17 years with current DSM-III-R major depressive disorder (MDD) (N = 135) were recruited between January 1987 and April 2002. Current MDD symptoms and lifetime comorbid psychiatric disorders were assessed using either a combination of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic and -Present Episode versions or the -Present Lifetime version. Thirty-two percent (N = 43) of the depressed subjects were classified as suicidal (at least suicidal ideation with a plan). RESULTS: Depressed suicidal youth presented with a more severe episode (p = .001) and a poorer functional status (p = .019), were more hopeless (p = .001), and presented more frequently with insomnia (p = .011). There was an interaction between suicide x sex x pubertal status for severity of MDD (p = .013), the presence of hopelessness (p < .001), poor functional status (p = .023), and comorbidity with a lifetime history of any disruptive behavior (p = .019). Among pre-pubertal depressed males, suicidal boys had significantly increased severity of MDD (p = .025) and poorer functional status (p = .044) than non-suicidal boys. Among postpubertal depressed females, suicidal girls were more frequently hopeless (p = .008) and presented an increased severity of MDD (p = .022) and more frequent lifetime history of any disruptive behavior (p = .03) when compared with nonsuicidal girls. CONCLUSION: There appears to be a sex difference for some clinical features, particularly hopelessness, among depressed suicidal children and adolescents. Whether hopelessness is a sex-specific characteristic of depressed suicidal children and adolescents requires further study.

Adolescent↗

PubMed2006

Predictors of rebellious behavior in childhood parental drug use, peers, school environment, and child personality.

This study assesses the interrelationships among several sets of variables and rebellious behavior in a sample of Puerto Rican and African American elementary school-aged children. The independent sets of variables (domains) were child personality attributes, parental attributes, including parental marijuana use, peer factors, school environment, and ethnic identification and discrimination. The dependent or outcome variable was children's rebellious behavior. Children and their mothers were interviewed in their homes. Pearson correlations and hierarchical multiple regression analyses were used to assess the extent to which the independent variables were related to the children's rebellious behavior. Each of the domains was associated with children's rebellious behavior without control on the remaining domains. With control on the remaining domains, child personality accounted for the most variance in childhood rebellious behavior. With control on child personality, only the school environment remained significant. Children with personality traits that are associated with rebellious behavior may have parents who exhibit antisocial behavior and use marijuana. Furthermore, these children may be at risk for other problem behaviors, including legal drug use, and would benefit from interventions which address primarily their personality characteristics, but also their school environments.

Adult↗

PubMed2006

Children of currently depressed mothers: a STAR*D ancillary study.

OBJECTIVE: To assess the current and lifetime prevalence of psychiatric disorders among children of currently depressed mothers and to assess the association of clinical features of maternal depression (i.e., severity, chronicity, and clinical features) with child psychopathology. Mothers were participants in the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) multisite trial, designed to compare effectiveness and acceptability of different treatment options for outpatients with non-psychotic major depressive disorder (MDD). METHOD: Treatment-seeking mothers with a current DSM-IV diagnosis of MDD and with at least 1 child 7 to 17 years old were assessed during a major depressive episode (MDE). For each mother, 1 child was assessed (if a mother had more than 1 child, 1 was randomly selected). Maternal features assessed for this study were history of MDEs, severity of current MDE, comorbid conditions, depressive symptom features, and social functioning. Children were assessed for selected psychiatric diagnoses (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]), psychopathologic symptoms and social functioning (Child Behavior Checklist), and global functioning (Children's Global Assessment Scale). Data were gathered from December 2001 to April 2004. RESULTS: A large proportion (72%) of mothers were severely depressed (17-item Hamilton Rating Scale for Depression score >/= 22). About a third (34%) of children had a current psychiatric disorder, including disruptive behavior (22%), anxiety (16%), and depressive (10%) disorders. Nearly half (45%) had a lifetime psychiatric disorder, including disruptive behavior (29%), anxiety (20%), and depressive (19%) disorders. Atypical depressive features in the mother were associated with a 3-fold increase in the odds of having a child with depressive (OR = 3.3 [95% CI = 1.2 to 9.5]; p = .02) or anxiety (OR = 2.6 [95% CI = 1.1 to 6.9]; p = .03) disorders. A history of maternal suicide attempts and the presence of comorbid panic disorder with agoraphobia were associated with a 3-fold increase and an 8-fold increase in the odds of depressive disorders in the offspring, respectively. The final model showed significant associations (p </= .05) between the following characteristics of maternal depression and offspring disorders: maternal comorbid panic disorder with agoraphobia and offspring depressive and anxiety disorders, maternal irritable depression and offspring disruptive behavior disorders and any disorder, and maternal substance use disorders and any disorder. CONCLUSIONS: Children of mothers in the midst of a current MDE are at high risk for disruptive behavior and anxiety disorders. The elevated risk of psychopathology among children of depressed mothers may recommend assessment of these children when clinically suggested. Children of depressed mothers with comorbid panic disorder with agoraphobia are at high risk for depressive and anxiety disorders and deserve special attention from clinicians.

Adult↗

PubMed2003

A preliminary meta-analysis of the child behavior checklist in pediatric bipolar disorder.

BACKGROUND: A possible explanation for the ongoing controversy surrounding pediatric bipolar disorder is that differences in assessment methodologies lead to conflicting results. One way to address methodological differences in assessment across studies is to use a single standardized assessment of psychopathology to calibrate the findings reported in different studies. To this end, we conducted a meta-analysis of several studies that have employed the Child Behavior Checklist in the assessment of children with a diagnosis of bipolar disorder. METHODS: MEDLINE was searched for all publications that utilized the Child Behavior Checklist in addition to structured diagnostic interviews to assess pediatric bipolar disorder. Random effects models were used to calculate combined estimates of Child Behavior Checklist clinical subscales. RESULTS: Children with bipolar disorder had scaled scores of >70 in the Aggression, Attention Problems, and Anxious/Depressed subscales of the Child Behavior Checklist. The Child Behavior Checklist was useful in distinguishing bipolar from attention-deficit/hyperactivity disorder subjects. CONCLUSIONS: While there was a significant heterogeneity in estimates between studies, a consistent pattern of elevations in inattention/hyperactivity, depression/anxiety, and aggression was identified.

Adolescent↗

PubMed1997

Axis II psychopathology as a function of Axis I disorders in childhood and adolescence.

OBJECTIVE: To examine the occurrence of elevated personality disorder (PD) dimensional scores in a community sample of young adults as a function of the occurrence of Axis I disorders through age 18 years. METHOD: 299 individuals who had been interviewed regarding Axis I disorders twice while in adolescence (first when 14 through 18 years of age) were carefully assessed regarding Axis I and II psychopathology at age 24. RESULTS: The prevalence of PD diagnoses was relatively low (3.8% in participants with a history of Axis I versus 1.7% in participants with no Axis I history). The occurrence of all four Axis I diagnostic categories (major depression, anxiety disorders, disruptive behavior disorders, substance use disorders) in childhood and adolescence was associated with elevated PD dimensional scores. The likelihood of elevated PD dimensional scores increased as a function of the number of Axis I disorders. Elevated PD scores were significantly associated with a negative course of major depression. CONCLUSIONS: Although the rates of PDs were low, the findings suggest a substantial degree of association between early-onset Axis I disorders and Axis II psychopathology in young adulthood. More research is needed to develop assessment and treatment recommendations addressing the early manifestations of PDs.

Adolescent↗

PubMed2004

The relationship between automatic thoughts and negative emotions in children and adolescents: a test of the cognitive content-specificity hypothesis.

The aim of this study was to test the cognitive content-specificity hypothesis in children and adolescents aged 7-16 years. Participants consisted of a community sample of 200 youth and a clinical sample of 160 youth with anxiety, depressive, or disruptive behavior disorders. Participants completed several self-report measures assessing a wide range of negative beliefs and symptoms of internalizing and externalizing problems. Multivariate analyses examining the interrelationships between beliefs and noncognitive symptoms revealed that thoughts on loss or personal failure were the strongest predictors of depressive symptoms, thoughts on social threat were the strongest predictors of anxiety symptoms, and thoughts on hostility or revenge were the strongest predictors of aggression. Results showed clear evidence of cognitive-affective specificity across both internalizing and externalizing problems in youth.

Adolescent↗

PubMed2006

Tourette's syndrome and the law.

Diminished legal responsibility and mental capacity have been used in defense of individuals with neurological disorders charged with legal misdemeanors, including criminal behavior. The purpose of this report is to 1) critically examine the mechanisms that may predispose patients with Tourette's syndrome (TS) to potentially, legally liable behaviors; 2) report the results of a nation-wide review of state, federal, and appellate cases involving TS; and 3) instigate awareness within the professional legal community regarding unrecognized organically-based behaviors that may predispose TS patients to unwanted legal disciplinary action. TS is a common neurological movement disorder of childhood onset associated with behavioral comorbidities, including impulse control problems, exhibition of obscene language or gestures, rage attacks, inappropriate obsessions, and other behaviors. To our knowledge, there are no studies (to date) addressing the potential impact of TS on the legal system. A comprehensive review of the neurobehavioral mechanisms underlying comorbid issues in TS is outlined. A comprehensive review of all cases tried in state and federal courts between 1985 and 2003, in which TS was somehow implicated, was conducted using the Westlaw database. As of October, 2003, TS was implicated in more than 150 cases found in the federal and state databases, 21 of which were criminal. Other cases are categorized as civil rights, criminal, education, family, labor, and social security cases. The authors conclude that TS rarely leads to criminal behavior, but patients with TS who have behavioral comorbidities are at risk of being involved with the legal system. The medical-legal community must learn to recognize the vulnerability of this patient population to potential mistreatment by the courts of justice.

Adolescent↗

PubMed2004

[Case series with childhood bipolar disorder phenotype features].

Although outcomes of bipolar disorder with onset in late adolescence and adulthood have been reported, little is known about childhood and prepubertal onset mania. There is a considerable overlap between the diagnostic criteria for mania and disruptive behavioral disorders, particularly attention deficit hyperactivity disorder (ADHD). The overlapping diagnostic boundaries need to be described. We aimed to determine the frequency and severity of symptoms and cycling features in our patients. We reported 7 cases (between 7 and 15 years old) with bipolar phenotype features who were being followed in our unit. The Washington University at St. Louis-Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia-Present state and lifetime-B. Geller et al.1996 (WASH-U-KSADS) was used for the assessment of psychiatric diagnoses and symptomatology. The Turgay DSM-IV Disruptive Behaviour Disorders Scale was used to determine the frequency of comorbidity between ADHD symptoms and bipolar disorder phenotype features. The most frequent severe symptoms observed at the end of the assessment by WASH-U-KSADS were grandiosity, distractibility, and unusual energy. Four of the cases had mixed cycling features. Five of the cases had ultradian cycling features. All these findings suggest that more research should be carried out on psychosocial and psychopharmacological strategies and pathogenetic mechanisms for mania during the prepubertal and early adolescent years.

Adolescent↗

PubMed2006

Pharmacotherapy and postdischarge outcomes of child inpatients admitted for aggressive behavior.

OBJECTIVES: : (1) To ascertain the use rates of specific pharmacotherapy strategies for child psychiatric inpatients with aggressive behavior from preadmission care through 12 months after discharge, and (2) To examine the associations between these strategies and postdischarge outcomes. METHOD: : Prospective follow-up of eighty-three 5- to 13-year-old children admitted to acute inpatient care for aggressive behavior in the context of a disruptive behavior disorder. Treatment and symptom severity data were obtained at admission, discharge, and 3, 6, and 12 months after discharge between 1998 and 2001. RESULTS: : Utilization. The number of concurrent medications increased over assessment times. Changes in children's pharmacotherapy occurred most frequently during hospitalization and from discharge to 3 months after discharge. Treatment with antipsychotics and mood stabilizers increased over assessment times, whereas selective serotonin reuptake inhibitor (SSRI) treatment decreased. Outcomes. Children treated with stimulants and risperidone 3 months after discharge had significantly improved behavioral ratings, adjusted for admission scores and concurrent medications. Children treated with SSRIs at 6 months after discharge had higher problem severity ratings. Those who maintained lithium and SSRI treatment between 6 and 12 months showed improvements. CONCLUSIONS: : The complexity of pharmacotherapy for child inpatients ratchets upwards from admission through 1 year after discharge. Hospital-initiated treatment is commonly altered soon after discharge. Within the limitations of observational methodology, the postdischarge outcomes seem related to specific pharmacotherapy regimens.

Adolescent↗

PubMed2006

Teenage mothers' anger over twelve years: partner conflict, partner transitions and children's anger.

BACKGROUND: This study examined the effects of maternal anger, partner transitions and partner conflict on later oppositional and angry behavior of the children of teenage mothers. METHODS: One hundred and twenty-one teenage women were interviewed prior to the birth of the baby and at 3 points subsequently, when children were newborn, 7 years old and 12 years old. Child and teacher reports of children's oppositional behavior were obtained. RESULTS: Women who showed higher levels of anger at Time 1 experienced more conflict with partners and more partner transitions over the next 12 years than women with lower levels of anger. Partner conflict was a stronger predictor of children's oppositional and angry behavior than partner transitions. Maternal anger at Time 1 was associated with maternal anger at Time 4 but neither predicted children's oppositional behavior at Time 4. CONCLUSION: There was support for the theoretical model that suggested that the personality characteristics of teenaged mothers confer some of their risk to children through children's exposure to the mothers' problematic partner relationships.

Adolescent↗

PubMed1998

Distinct contributions of conduct and oppositional defiant symptoms to adult antisocial behavior: evidence from an adoption study.

BACKGROUND: We conducted an exploratory multivariate analysis of juvenile behavior symptoms in an adoption data set. One goal was to see if a few DSM-interpretable symptom dimensions economically captured information within the data. A second goal was to study the relationships between any such dimensions, biological and environmental background, and eventual adult antisocial behavior. METHODS: The data originated from a retrospective adoption study. Probands with a biological background for parental antisocial personality or alcoholism were heavily oversampled. Symptoms were ascertained by proband and adoptive parent interview. We performed, by gender, orthogonal rotated principal component analyses of juvenile behavior disturbance symptoms (females, n = 87; males, n = 88). We used structural equation modeling to examine the relationships hypothesized above. RESULTS: For both genders, an oppositional defiant disorder (ODD) component and at least 1 conduct component emerged. Regardless of the conduct component scores, the ODD components were significant predictors of adult antisocial behavior. For males, the ODD component was predicted by an antisocial biological background, but not by scores on the Adverse Adoptive Environment Scale. The conduct components were predicted by adoptive environment alone. For females, biological background or biological-environmental interactions predicted each of the components. CONCLUSIONS: There has been little previous distinction between conduct disorder and ODD in studies of genetic and environmental influences on juvenile behavior. The study suggests that adolescent ODD symptoms may be a distinct antecedent of adult antisocial personality. In males, adolescent ODD symptoms may represent early expression of genetic sociopathic personality traits.

Adolescent↗

PubMed2005

The effects of cognitive-behavioral treatment for forensic inpatients.

The effects of an intramural cognitive-behavioral treatment for forensic inpatients with personality disorders in a high-security hospital were examined. Treatment was aimed at modifying maladaptive coping and social skills, at enhancing social awareness, at reducing egoistic and oppositional behaviors, and at reducing psychological complaints. The patients, who all had committed serious crimes (violence, arson, sexual offences), participated voluntarily in the study. A total of 39 patients started the study, but during the course of the study, several patients dropped out because of several reasons. Patients as a group showed significant improvements over time on psychopathological symptoms, personality traits, and coping. A significant decrease of oppositional behaviors was reported by the staff. Though the patients improved well at the group level, only a minority of patients showed reliable change over time at the individual level. The meaning of the results in relation to treatment are discussed.

Adaptation, Psychological↗

PubMed2004

Psychopathy and comorbidity in a young offender sample: taking a closer look at psychopathy's potential importance over disruptive behavior disorders.

The authors examined the construct of psychopathy as applied to 130 adolescent offenders using 3 psychopathy measures and a broad range of DSM-TV Axis I diagnoses and psychosocial problems. Measures used in the study included the following: (a) Psychopathy Checklist-Youth Version, (b) Antisocial Process Screening Device, (c) a modified version of the Self-Report Psychopathy-II scale, and (d) the Adolescent Psychopathology Scale. Results from this study offer incremental support for the construct validity of psychopathy in youth. Psychopathy evidenced better convergent and discriminant validity results than did the disruptive behavior disorders (DBDs) such as oppositional-defiant disorder (ODD) and conduct disorder (CD). Despite this finding, psychopathy scales nonetheless correlated with other forms of psychopathology at a higher rate than was expected, suggesting that comorbidity is high even when psychopathy is used as a classification scheme. Also, hierarchical multiple regression was used to determine whether psychopathy offered an improvement in the prediction of previous violent and nonviolent offenses. The results for the current study were mixed, with only the PCL-YV significantly predicting previous violent and nonviolent offenses beyond the DBDs. The findings indicate that psychopathy may offer incremental improvement over DBDs with regard to level of comorbidity and perhaps even prediction. However, simply extending the adult construct of psychopathy to youth without considering the array of psychopathology that may accompany adolescent psychopathy could be misleading.

Adolescent↗

PubMed2001

Antisocial personality, substance abuse, and exposure to parental violence in males referred for domestic violence.

This study investigated whether childhood disruptive behavior (hyperactivity, oppositional-defiance, conduct problems) plus adult psychopathic adjustment are associated with domestic violence. Adult males (n = 66) in diversion programs completed the Wender Utah Rating Scale (WURS), MMPI Psychopathic Deviate scale (PD), Conflict Tactics Scales representing themselves and their parents, and substance use measures. Substance use and lifespan antisocial personality (measured by high WURS and PD scores) were robust predictors of verbal and moderate physical domestic abuse. Violence in the family of origin was associated with abuse when tested alone, but failed to exhibit unique association with abuse when other predictors were taken into account. The possibility that antisocial batterers respond to contingencies by moderating physical harm, while persisting at psychological harm, is discussed.

Adolescent↗

PubMed2006

Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior.

Comorbidity and complexity of cases seen in clinical work form a basis for discounting the applicability and generality of evidence-based treatments (EBTs). The authors evaluated treatment outcomes in 2 samples of clinically referred children who met criteria for oppositional defiant disorder (n = 183; 42 girls, 141 boys; ages 3-14) or conduct disorder (n = 132; 35 girls, 97 boys; ages 7-14) but varied in comorbidity (up to 5 additional disorders). In addition to comorbidity, 4 domains of case complexity were evaluated: scope and severity of child dysfunction, socioeconomic disadvantage, parent and family functioning, and barriers that emerged during treatment. Comorbidity was associated with greater therapeutic change. Children who varied in comorbidity did not differ on outcome measures at the end of treatment. Complexity was either unrelated or positively related to therapeutic change. As an exception, perceived barriers were associated with less child improvement, but, even with high barriers, effect sizes for these children were large. The findings suggest that comorbidity or complexity of cases does not necessarily influence outcome or limit the applicability of EBTs.

Adolescent↗

PubMed2001

Prevalence and correlates of antisocial behaviors among three ethnic groups.

Using data from the MECA Study, this report examines the prevalence of Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), and various levels of antisocial behavior and their correlates among three ethnic groups: Hispanics, subdivided into Island Puerto Ricans and Mainland Hispanics; African Americans; and Mainland Non-Hispanic, Non-African Americans. Correlates considered include stressful life events, birth defects, low birth weight, learning difficulties, teen mothers, family environment, marital adjustment, social competence, parental monitoring, and family relationships. Logistic regression was used to determine the association of outcomes with individual correlates and of interaction terms with ethnicity. Differences between adjusted rates and observed rates of disorders and levels of antisocial behaviors are compared to estimate the extent to which each correlate explains the group differences in rates. Island Puerto Ricans had a lower prevalence of CD, ODD, and various levels of antisocial behavior than mainland Hispanics, African Americans, and non-Hispanic Whites. The lower prevalence appears to be associated with differences in the extent to which a number of these correlates are found on the island, the most salient being better family relations between the target children and their parents and siblings.

Adolescent↗

PubMed2005

Depression and anxiety disorders in pediatric epilepsy.

PURPOSE: This study examined affective disorders, anxiety disorders, and suicidality in children with epilepsy and their association with seizure-related, cognitive, linguistic, family history, social competence, and demographic variables. METHODS: A structured psychiatric interview, mood self-report scales, as well as cognitive and language testing were administered to 100 children with complex partial seizures (CPSs), 71 children with childhood absence epilepsy (CAE), and 93 normal children, aged 5 to 16 years. Parents provided behavioral information on each child through a structured psychiatric interview and behavior checklist. RESULTS: Significantly more patients had affective and anxiety disorder diagnoses (33%) as well as suicidal ideation (20%) than did the normal group, but none had made a suicide attempt. Anxiety disorder was the most frequent diagnosis among the patients with a diagnosis of affective or anxiety disorders, and combined affective/anxiety and disruptive disorder diagnoses, in those with suicidal ideation. Only 33% received some form of mental health service. Age, verbal IQ, school problems, and seizure type were related to the presence of a diagnosis of affective or anxiety disorder, and duration of illness, to suicidal ideation. CONCLUSIONS: These findings together with the high rate of unmet mental health underscore the importance of early detection and treatment of anxiety disorders and suicidal ideation children with CPSs and CAE.

Adolescent↗