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PubMed1998

Alpha 2 adrenergic agonists. Neurochemistry, efficacy, and clinical guidelines for use in children.

The alpha 2 adrenergic agonists are used to treat a variety of psychiatric disorders and their usage has been increasing. This article presents the rationale and neurochemical basis for treatment of psychiatric disorders with alpha 2 agents, reviews studies examining clinical efficacy, and develops guidelines for usage. Case vignettes are presented to illustrate how the alpha 2 agents can successfully be used in practice.

Adrenergic alpha-2 Receptor Agonists↗
PubMed2001

Measuring qualitative aspects of preschool boys' noncompliance: the Response Style Questionnaire (RSQ).

Child noncompliance is a core maladjustment factor in current clinical models of aggression and antisocial development. However, little is known about the relations among qualitative aspects of child noncompliance and aggressive maladjustment. The authors developed the Response Style Questionnaire, an instrument designed to measure the multidimensional qualities of child noncompliance, and tested its validity and reliability. Tests of internal validity provided a five-factor solution, featuring distinctions in noncompliance quality between and among skilled noncompliance (verbally skilled and emotionally regulated) and unskilled noncompliance (overt/confrontational, covert/sneaky, and emotionally labile). Theory-driven tests of external validity using peer-adjustment variables as criteria provided discriminant prediction (a) among qualitatively distinct aspects of noncompliance and (b) between noncompliance qualities and rate. Discussion focuses on a modified view of the nature and role of noncompliance in aggressive and antisocial development.

Aggression↗
PubMed2001

Relationship between specific adverse life events and psychiatric disorders.

This study examines whether certain psychiatric disorders are associated more closely with adverse life events than other disorders are, and whether some adverse life events are associated with a specific group of disorders (e.g., depressive disorders), but not with other disorders (e.g., anxiety disorders). A probability sample of youth aged 9-17 at 4 sites is used (N = 1,285). Univariate and multivariate logistic regressions identify specific relationships between 25 adverse life events and 9 common child and adolescent psychiatric disorders, measured by the Diagnostic Interview Schedule for Children. Conduct Disorder, Oppositional Defiant Disorder, Major Depressive Disorder, and Dysthymia are significantly associated with many of the adverse life events examined, whereas Attention Deficit/Hyperactivity Disorder, Agoraphobia, and Social Phobia are related to very few. This study suggests that certain psychiatric disorders may be more closely associated with adverse life events than other psychiatric disorders are, and that some adverse life events seem to be related to specific types of disorders.

Adolescent↗
PubMed1998

Early identification of the fledgling psychopath: locating the psychopathic child in the current nomenclature.

This research attempted to test D. R. Lynam's (1996) hypothesis regarding the developmental relation between adult psychopathy and children with symptoms of hyperactivity, impulsivity, and attention problems (HIA) and concurrent conduct problems (CP). In a large sample of adolescent boys, 4 groups (non-HIA-CP, HIA only, CP only, and HIA-CP) were compared on measures found to discriminate between psychopathic and nonpsychopathic offenders. In line with predictions, the HIA-CP boys most closely resembled psychopathic adults. HIA-CP boys scored higher than HIA-only and non-HIA-CP boys on a measure of psychopathic personality. As with their adult counterparts, HIA-CP boys were the most antisocial, were the most disinhibited, and tended to be the most neuropsychologically impaired of all the groups. Implications for treatment, research, and the study of comorbidity are discussed.

Adolescent↗
PubMed1998

Strategies to manipulate reliability: impact on statistical associations.

OBJECTIVE: To examine the effects of improving measurement reliability on associations between risk factors and childhood psychiatric disorder. METHOD: Data were from a general population sample of parents (N = 211) with children aged 6 to 16 years. Reliability of measurement was improved in three ways: by increasing the number of items in a scale (internal-consistency reliability), by averaging assessments of the same variables collected on two different occasions, and by constructing latent variable measures. To assess the effects of improving reliability, selected risk factors were regressed on parental assessments of childhood oppositional defiant disorder (ODD) and overanxious disorder (OAD). RESULTS: Improving reliability led to systematic increases in the magnitude of standardized regression coefficients between family dysfunction and ODD (beta = .30-.51) and between family dysfunction and OAD (beta = .24-.48). In multiple regression, improving reliability served to strengthen the specificity of associations between ODD, OAD, and family dysfunction and maternal depressed mood. Although latent variable methods produced the largest associations, the standard errors of these estimates were also larger, resulting in wider confidence intervals and slightly larger significance values. CONCLUSIONS: Improving reliability of measurement results in larger associations between risk factors and childhood disorder and may increase the opportunity of revealing differential associations between variables.

Adolescent↗
PubMed1999

When the earth stops shaking: earthquake sequelae among children diagnosed for pre-earthquake psychopathology.

OBJECTIVE: To examine risk and protective processes for posttraumatic stress reactions and negative sequelae following the Northridge earthquake (EQ) among youths diagnosed for pre-EQ psychopathology. METHOD: Symptoms of posttraumatic stress disorder (PTSD), depression, general anxiety, and social impairment were evaluated using telephone interviews among 66 children participating in a family-genetic study of childhood-onset depression at the time of the EQ. RESULTS: Significant predictors of PTSD symptoms 1 year after the EQ included perceived stress and resource loss associated with the EQ, a pre-EQ anxiety disorder, and more frequent use of cognitive and avoidance coping strategies. PTSD symptoms were associated with high rates of concurrent general anxiety symptoms, depressive symptoms, and social adjustment problems with friends. The only significant correlation between sibling scores was on measures of sibling reports of objective exposure. CONCLUSIONS: Preexisting anxiety disorders represent a risk factor for postdisaster PTSD reactions. Postdisaster services need to attend to the needs of these youths as well as those of youths experiencing high levels of subjective stress, resource loss, and/or high exposure. That children within families show significant variation in postdisaster reactions underscores the need for attention to individual child characteristics and unshared environmental attributes.

Adolescent↗
PubMed1999

Memory and anxiety in prepubertal boys at risk for delinquency.

OBJECTIVE: To examine the association between memory and anxiety symptoms in young urban-dwelling boys. METHOD: A series of 111 boys, aged 7 to 11 years, at risk for disruptive psychopathology received standardized assessments of psychopathology and neuropsychological abilities, including verbal and design memory ability. While neuropsychological ability was rated at an initial study wave, psychopathology was rated at both an initial and a follow-up study wave, separated by approximately 18 months. RESULTS: Anxiety symptoms were more strongly correlated with poor memory ability than with reduced intelligence. Disruptive symptoms, in contrast, were more strongly correlated with reduced intelligence than with poor memory ability. Finally, boys with an anxiety disorder exhibited reduced memory abilities relative to other boys in the sample. Relationships generally appeared strongest in longitudinal analyses, such that poorer memory ability at study intake predicted increased anxiety at follow-up. CONCLUSIONS: Anxiety is associated with reduced memory ability in young urban boys at risk for disruptive psychopathology.

Anxiety Disorders↗
PubMed2001

School refusal in children and adolescents: a review of the past 10 years.

OBJECTIVE: To critically review the past 10 years of research on school refusal in children and adolescents. METHOD: Literature on school refusal published from 1990 onward was reviewed following a systematic search of PsycINFO. The review focuses on definitional issues, epidemiology and school refusal identification, diagnostic considerations, family functioning, assessment, treatment, and follow-up studies. RESULTS: While definitional and conceptual issues are still evident, promising developments have occurred in relation to assessment and treatment practices and understanding of the family context of school refusal. CONCLUSIONS: From a clinical viewpoint, school refusal cases require comprehensive assessment and treatment. Advances have been made in the treatment of school refusal. However, additional controlled studies evaluating interventions for school refusal are needed.

Adolescent↗
PubMed2000

Informativeness of structured diagnostic interviews in the identification of Tourette's disorder in referred youth.

Although specialized programs have greatly advanced the treatment of youth with Tourette's disorder (TD), not all children with TD reach such programs, raising questions as to whether TD is adequately identified outside specialized settings. There is thus a need for evidence that cases identified in the nonspecialty setting are "true cases." Because structured diagnostic interview methodology can reduce errors of omission, this approach can facilitate the identification of TD in referred youth outside specialized programs. Similarities between cases ascertained in specialty and nonspecialty settings would suggest that those identified in the nonspecialty setting were indeed "true cases." Comparisons were made between youth with TD ascertained through a specialized TD program who had both a structured diagnostic interview-derived diagnosis of TD plus an expert evaluation of TD (N = 103), with youth ascertained through a non-TD specialized pediatric psychopharmacology program who had a structured diagnostic interview-derived diagnosis of TD (N = 92). Irrespective of ascertainment source, children with structured interview-derived diagnosis of TD shared similar correlates in terms of tic severity, mean age of onset and duration of tics, as well as patterns of comorbidity well known to be associated with TD in clinical samples. Children meeting diagnostic criteria for TD on structured diagnostic interviews share similarities and patterns of clinical correlates, irrespective of ascertainment through a specialized TD or non-TD specialized clinic. These findings support the usefulness of structured diagnostic interview methodology as a diagnostic aid for the identification of TD in non-TD specialized settings and facilitate delineation of patterns of comorbidity.

Adolescent↗
PubMed2004

Prevalence of child and adolescent psychiatric disorders in southeast Brazil.

OBJECTIVE: To describe the prevalence of DSM-IV disorders and the pattern of comorbidity in a population-based sample of 7- to 14-year-old Brazilian schoolchildren. METHOD: Random sampling of schools (stratified into private, public rural, and public urban) was followed by random sampling of pupils from school lists. In 2000-2001, a total of 1,251 children were assessed for DSM-IV diagnoses using the Development and Well-Being Assessment, a structured multiinformant assessment supplemented by verbatim reports reviewed by clinicians. RESULTS: The response rate was 83%. The overall prevalence of DSM-IV disorders was 12.7% (95% confidence interval = 9.8%-15.5%), with 3.5% of children being assigned as not otherwise specified rather than operationalized diagnoses. The overall prevalence of psychiatric disorder was significantly higher than in a British study with the same measures and diagnostic procedures (12.7% versus 9.7%, p =.02). CONCLUSIONS: Approximately one in eight schoolchildren in the study area in the southeast of Brazil have psychiatric disorders involving a level of distress or social impairment likely to warrant treatment. The gulf between need and provision is currently vast.

Adolescent↗
PubMed2001

The development of a screening questionnaire for childhood cruelty to animals.

Childhood cruelty to animals may be a marker of poor prognosis amongst conduct disordered children. However, other than semistructured interviews with parents or children, there are no screening instruments for this behavior. The aim of this study was to develop such an instrument. In the first phase of the study, a parent-report questionnaire, Children's Attitudes and Behaviors Towards Animals (CABTA) was designed and piloted on 360 elementary school children, enabling community norms and a factor structure for the instrument to be derived. In the second phase, the questionnaire was completed by the parents of a small sample of children (N = 17) to establish its test-retest reliability. In the third phase of the study, the CABTA was completed by the parents of 19 children who had been diagnosed with either a Disruptive Behavioral Disorder or Attention Deficit Hyperactivity Disorder, and the results were compared with the outcome of a semistructured interview with parents regarding their child's behavior toward animals. The results of the various phases of the study indicated that the CABTA consists of two factors. Typical and Malicious Cruelty to animals, and is a reliable and valid tool for detecting childhood cruelty to animals. Possible use and adaptations of the CABTA as a screening instrument in clinical and community samples are discussed.

Adolescent↗
PubMed2004

Evidence of fearlessness in behaviourally disordered children: a study on startle reflex modulation.

BACKGROUND: Patterns of low heart rate, skin conductance and cortisol seem to characterise children with disruptive behaviour disorder (DBD). Until now, the startle paradigm has not been used in DBD children. We investigated whether DBD children, like adult psychopaths, process emotional stimuli in an abnormal way. METHOD: Twenty-one DBD and 33 normal control children viewed a series of 27 positive, neutral and negative slides. Startle probes were presented unpredictably during slide presentations and eye blink reflexes were measured. RESULTS: DBD and control children showed a similar linear relationship between slide valence and startle magnitude, but the startle-elicited blinks of the DBD children were significantly lower for all categories of slides. Moreover, the more delinquent the DBD children were, the lower their startle responses during unpleasant states. CONCLUSIONS: The results suggest a deficit in neurophysiological fear modulation. The implications of the findings for the fearlessness theory of antisocial behaviour are discussed.

Antisocial Personality Disorder↗
PubMed2005

Test-retest reliability of the Chinese version of the Diagnostic Interview Schedule for Children-Version 4 (DISC-IV).

BACKGROUND: Despite the huge youth population, there is a lack of psychiatric diagnostic instruments with reported psychometric properties in Chinese. This study reports the development of the Chinese version of DISC-IV and examines its test-retest reliability. METHOD: Seventy-eight parents and 79 youths (mean age 13.1 years) attending child psychiatric clinics were interviewed twice using the Chinese DISC-IV (Diagnostic Interview Schedule for Children-IV) about 22 days apart. RESULTS: The kappa coefficients were good to excellent for obsessive compulsive disorder (OCD) (both youth (Y) and parent (P) versions), major depressive disorder (MDD) (P), attention deficit hyperactivity disorder (ADHD) (P); fair for anxiety disorder (P), oppositional defiant disorder (ODD) (P, Y), MDD (Y); but poor for anxiety disorder (Y) and ADHD (Y). Parent informants had better test-retest reliability than youth informants. CONCLUSIONS: The Chinese DISC-IV had comparable test-retest reliability with the original English version.

Adolescent↗
PubMed2006

Children's subjective emotional reactivity to affective pictures: gender differences and their antisocial correlates in an unselected sample of 7-11-year-olds.

BACKGROUND: Differential responses in terms of gender and antisocial behaviour in emotional reactivity to affective pictures using the International Affective Picture System (IAPS) have been demonstrated in adult and adolescent samples. Moreover, a quadratic relationship between the arousal (intensity) and valence (degree of unpleasantness) has been suggested. The picture perception methodology has rarely been applied to middle school-aged children. We examined the subjective ratings of emotional reactivity in children for: i) the relationship between arousal and valence, ii) gender differences, and iii) its association with measures of antisocial behaviour. METHOD: Twenty-seven IAPS pictures were selected to cover a wide range of affective content and were individually administered to a non-referred community sample of 659 7-11-year-old children using a paper-and-pencil version. Concurrent symptoms of conduct disorder, oppositional defiance and psychopathy were collected from multiple sources (teacher-, parent- and self-report). RESULTS: A quadratic relationship between arousal and valence, similar to that previously reported in adults, was demonstrated. A gender difference was found for valence ratings, with girls rating aversive pictures more unpleasant than boys. No gender differences for arousal ratings were found. A significant difference was found between groups scoring above and below cut-off scores on measures of antisocial behaviour. Children above cut-off reported lower arousal to unpleasant pictures, but higher arousal to pleasant pictures. CONCLUSIONS: We confirmed that a paper-and-pencil version of the IAPS for evaluating emotion response to affectively valent and arousing stimuli can be used in school settings and that comparable gender differences in emotional reactivity can be found in children. The differential emotional reactivity of children above cut-off on measures of antisocial behaviour suggested these symptoms to be associated with a combination of increased reward and decreased punishment sensitivity.

Affect↗
PubMed2006

A comparison of pure and comorbid CD/ODD and depression.

BACKGROUND: We studied the symptomatology of conduct/oppositional defiant disorder and major depression/dysthymic disorder in 'pure' and comorbid presentations. METHOD: The sample comprised 382 children of 8 to 17 years of age attending for psychiatric outpatient consultation. Ninety-two had depressive disorders without conduct disorders, 165 conduct disorder or oppositional defiant disorder without depressive disorders and 125 had both. RESULTS: In general, there were few differences in the distributions of the symptoms of shared disorders between the pure and the comorbid groups. Comorbidity accentuated depressive and emotional symptoms and functional impairment. After controlling for the presence of other disorders and severity of symptoms, comorbid children were more globally impaired than the pure conduct group and more impaired than the pure depressive group in school, the home, and in relationships with other people. CONCLUSIONS: The clinical presentations of 'pure' and comorbid depressive and conduct disorders are similar. Differences found in phenomenology and in functional impairment between the groups have implications for treatment planning and for nosology.

Adolescent↗
PubMed1989

Lack of seasonal variation in pediatric lumbar cerebrospinal fluid neurotransmitter metabolite concentrations.

Seasonal variation of cerebrospinal fluid (CSF) monoamines, particularly 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) has been reported for psychiatrically ill and normal adults. Circannual variability was examined for a group of 72 children (mean age = 159.4 +/- 40.3 (SD), range 77-238 months), with a primary diagnosis of obsessive-compulsive disorder (OCD) or disruptive behavior disorder (DBD) (attention deficit disorder, oppositional disorder and/or conduct disorder), from whom CSF had been obtained systematically. There were no seasonal differences in mean concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG), HVA, or 5-HIAA, either for the group as a whole, for the separate diagnostic (OCD vs DBD) categories or for the pre-pubertal subgroup. Log-corrected HVA concentrations for the Tanner IV and V subgroup differed by season with summer concentrations less than those of fall (P = 0.06) and winter (P = 0.005). The results suggest that pubertal changes may play a role in any expression of circannual variability.

Adolescent↗
PubMed2007

Comorbid personality disorder and treatment use in a community sample of youths: a 20-year follow-up.

OBJECTIVE: The impact of comorbid personality disorder (PD) on subsequent treatment and psychotropic drug use was examined in a representative sample of over 700 individuals. METHOD: Axis I disorders and PD were assessed by self- and mother-report at mean ages 13 and 22 years, and by self-report at mean age 33. Mothers reported treatment use by participants before mean age 33; participants reported treatment and psychotropic drug use at mean age 33. RESULTS: Individuals with multiple axis I disorders without PD, axis I disorder-PD comorbidity, and single disorders were compared simultaneously to individuals not diagnosed. Overall, odds of subsequent and past year treatment or psychotropic drug use or both were highest when PD co-occurred with a mood, an anxiety, a disruptive, or a substance use disorder. CONCLUSION: Co-occurring personality pathology may contribute to elevated mental health service use, including use of psychotropic drugs, among young adults in the community.

Adolescent↗