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PubMed2006

Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality.

BACKGROUND: Models of attention-deficit/hyperactivity disorder (ADHD) suggest developmental influences may feed into components of the disorder separately from associated disruptive behavior problems. We investigated this in terms of key personality/temperament traits of Reactive and Effortful Control, Resiliency, and Emotionality. METHODS: A sample of 179 children (age 6-12, 63% boys), of whom 92 had ADHD, 52 were Controls, and 35 were borderline or not otherwise specified cases of ADHD, were examined. Dispositional trait scores were derived from parent-completed California Q-sort and the Early Adolescent Temperament Questionnaire. Child ADHD symptoms were evaluated using maternal structured diagnostic interview and teacher-completed symptom ratings. RESULTS: Traits were differentially associated with symptoms. Reactive Control was related to hyperactivity-impulsivity as rated by both parents and teachers. Negative Emotionality was related to oppositional-defiance. Resiliency was primarily related to inattention-disorganization as rated by both parents and teachers; Effortful Control was related uniquely to inattention in parent but not teacher data. A moderation effect emerged; the relationship between parent-rated Negative Emotionality and teacher-rated ADHD symptoms was stronger for children with high levels of both Reactive and Effortful Control. CONCLUSIONS: Results are interpreted in relation to a two-pathway model of ADHD; regulation problems contribute to the emergence of symptoms of inattention-disorganization, reactive or motivational control problems to the emergence of hyperactivity-impulsivity, and these are distinct from negative affectivity. Children with regulation deficits and a reactive motivational style are especially at risk for the development of ADHD.

Adaptation, Psychological↗

PubMed2001

Comorbid disruptive behavior disorder symptoms and their relationship to adolescent alcohol use disorders.

This investigation evaluated the relationship between comorbid Disruptive Behavior Disorder (DBD) and Alcohol Use Disorder (AUD) symptoms in adolescents. The factor structure of both DBD and AUD symptoms was evaluated and a structural model then examined the relationships between comorbid DBD symptoms and AUD symptoms. A full model and a sex differentiated model were evaluated. For the full model, only Conduct Disorder (CD) symptoms were associated with AUD symptoms. In the sex differentiated model, male adolescents demonstrated direct effects of CD and Attention Deficit Hyperactivity Disorder (ADHD) on AUD. For female adolescents we found only a robust direct effect of CD on AUD. We concluded that CD symptoms have the strongest concurrent association with AUD symptoms in adolescents. However, there is preliminary evidence of sex heterogeneity.

Adolescent↗

PubMedDate not supplied

The effect of academic self-concept on ADHD and antisocial behaviors in early adolescence.

Using structural equation modeling techniques, we evaluated the effect of academic self-concept (ASC) on the development of attention-deficit/hyperactivity disorder (ADHD) and antisocial behaviors in early adolescence. Participants (n = 445) were recruited from the Dunedin Multidisciplinary Health and Development Research study. Eligibility was determined by the presence of complete data for the following variables at the specified time periods: reading at age 7, teacher reports of ADHD and antisocial behaviors at age 7, self-ratings of ASC at ages 9 and 11, and teacher reports of ADHD and antisocial behaviors at age 13. The results indicated that ASC is an important construct that directly contributes to the development of antisocial behaviors rather than to symptoms of ADHD. The results also indicated that children's early history of behavioral problems and academic performance contribute to the development of a more robust understanding of the impact of ASC on the development of disruptive behaviors in early adolescence.

Adolescent↗

PubMed1997

Residential behavior therapy for children with conduct disorders.

Children with conduct disorders are often referred to residential treatment centers (RTCs). RTCs shorten the length of treatment and thus feel they need to reconceptualize the purpose and process of treatment. Two intervention strategies have been found to affect conduct disorder in outpatient settings: parent training programs that are based on operant learning principles and cognitive-behavioral programs that focus on the relation between cognition and behavior. These strategies should not be transferred to the RTC but adapted to the characteristics of residentially treated conduct disordered children and their parents. These methods should be used together to integrate and strengthen the various learning processes that residential treatment can foster. An outline is given of a comprehensive and integrated residential treatment program based on behavioral methods that have been proven to affect conduct disorder.

Attention Deficit and Disruptive Behavior Disorder↗

PubMed2005

Low basal salivary cortisol is associated with teacher-reported symptoms of conduct disorder.

Cortisol has been implicated in psychobiological explanations of antisocial behavior. This study measured basal salivary cortisol in a sample of 25 children (age range 6 to 12 years) selected to vary in levels of antisocial behavior. Regression analyses were used to predict cortisol concentrations from parent- and teacher-reported symptoms. Parent-reported symptoms did not predict basal cortisol. Teacher-reported conduct disorder (CD) symptoms explained 38% of the variance in the cortisol concentrations, with high symptom severity associated with low cortisol. When a distinction was made between aggressive and non-aggressive CD symptoms, aggressive CD symptoms were more clearly related to low cortisol than non-aggressive CD symptoms. In contrast to previous research, no evidence was found for a mediating role of anxiety symptoms in the relationship between CD and cortisol. The results support biologically based models of antisocial behavior in children that involve reduced autonomic activity.

Adolescent↗

PubMed2004

Emotional understanding, cooperation, and social behavior in high-functioning children with autism.

In contrast to typically developing children, children with autism rarely exhibit cooperative social behavior. To examine whether this problem reflects global developmental delays or autism-specific deficits, the present study compared cooperation, emotional understanding, personality characteristics, and social behavior of 10 children with autism who had average IQ to those of 16 children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) and 10 typically developing children. In cooperative behavior, level of emotional understanding, and aloof behavior, the autism group outperformed the ADHD/ODD group and did not differ significantly from typically developing children. However, the autism group showed worse emotion recognition and more active-but-odd behavior than the other groups. The results indicate that high-functioning children with autism can develop cooperative social behavior and advanced theory of mind abilities, but continue to show deficits in identifying emotions and displaying socially appropriate behavior.

Affect↗

PubMed2005

Childhood antecedents to panic disorder in referred and nonreferred adults.

OBJECTIVE: We used a recursive partitioning method to examine antecedent childhood anxiety disorders in large samples of referred and nonreferred subjects with and without panic disorder. METHODS: Referred subjects included adults treated for panic disorder (n = 131) and comparison adults with neither major anxiety nor mood disorders (n = 61). The nonreferred adult group derived from an opportunistic sample originally ascertained through family studies of probands with and without attention-deficit/hyperactivity disorder (ADHD), yielding 58 adults with panic disorder and 587 who were free of major anxiety and mood disorders. RESULTS: The majority of referred (65%) and nonreferred (52%) adults with panic disorder had antecedent childhood anxiety or disruptive behavior disorders. Classification and Regression Trees (CART) analysis showed that both separation anxiety disorder and overanxious disorder were independent predictors of subsequent panic disorder in both referred and nonreferred samples. CONCLUSIONS: These results confirm and extend previously reported findings by documenting that childhood anxiety disorders are important antecedent risk factors for panic disorder, independently of referral bias.

Adult↗

PubMed2002

The influence of ADHD-hyperactivity/impulsivity symptoms on the development of oppositional defiant disorder symptoms in a 2-year longitudinal study.

The structural relations among ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (H/I), and oppositional defiant disorder (ODD) factors were examined in a 2-year longitudinal study with 752 children. Structural equation procedures showed that higher scores on the H/I factor in Year 1 were associated with higher scores on ODD factor in Years 2 and 3. Higher scores on the H/I factor in Year 2 were also associated with higher scores on ODD factor in Year 3. The ODD factor did not predict the H/I and IN factors in subsequent years. The IN factor did not predict the ODD and H/I factors in subsequent years and the H/I factor did not predict the IN factor. The ability of the H/I factor to predict the subsequent ODD factor occurred even after taking into account the ability of the ODD, H/I, and IN factors to predict themselves across time. These results suggest that the H/I aspect of ADHD influences the development of ODD behavior.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties.

Two variants of a behavioral family intervention (BFI) program known as Triple P were compared using 87 preschoolers with co-occurring disruptive behavior and attentional/hyperactive difficulties. Families were randomly allocated to enhanced BFI (EBFI), standard BFI (SBFI), or a waitlist (WL) control group. At postintervention both BFI programs were associated with significantly lower levels of parent-reported child behavior problems, lower levels of dysfunctional parenting, and greater parental competence than the WL condition. The EBFI condition was also associated with significantly less observed child negative behavior in comparison to the WL. The gains achieved at postintervention were maintained at 1-year follow-up. Contrary to predictions, the enhanced program was not shown to be superior to the standard program using any of the outcome measures at either postintervention or follow-up. Each of the programs produced significant reductions in children's co-occurring disruptive behavior and attentional/hyperactive difficulties with 80% of the children showing clinically reliable improvement in observed negative behavior from preintervention to follow-up.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Socioeconomic status as a common factor underlying the association between enuresis and psychopathology.

The association between enuresis and psychopathology (e.g., attention-deficit hyperactivity disorder) has been well studied. However, past research failed to adjust this relationship for the influence of sociodemographic variables underlying both problems. This study, using the Child Behavior Checklist and the Disruptive Behavior Disorder Rating Scale, compares 154 enuretic children with a control group of 153 children who had urinary control. The results reveal that enuretic children show significantly higher scores on both questionnaires. However, when sociodemographic variables are entered in the analysis, group differences disappear, and social class category, as a measure of socioeconomic status (SES), becomes a significant factor in explaining the variance in problem scores. Although children with enuresis have more internalizing, externalizing, and hyperactive/impulsive symptoms than continent children, when the analysis is performed controlling for SES, this relationship is no longer present.

Age Factors↗

PubMed1997

Impact of comorbid oppositional or conduct problems on attention-deficit hyperactivity disorder.

OBJECTIVE: To investigate whether the presence of comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) alters the correlates of attention-deficit hyperactivity disorder (ADHD). METHOD: Three groups of children (33 "pure" ADHD, 46 ADHD + ODD, and 12 ADHD + CD) were compared on measures of ADHD, aggression, anxiety, parental psychopathology, self-esteem, school, and social-emotional functioning. RESULTS: Findings indicated that the presence of comorbid oppositional or conduct problems in children with ADHD altered the correlates of ADHD across a number of areas, including greater ADHD symptom severity and social dysfunction. Nevertheless, some correlates were more closely linked with the comorbid condition of ADHD + CD (e.g., higher aggression, anxiety, and maternal pathology, as well as decreased self-esteem), while others appeared more closely linked with ADHD + ODD (e.g., social withdrawal, elevated academic achievement paired with higher perceived scholastic competence). CONCLUSIONS: Findings support the distinctive profiles of the disruptive behavior disorder groups and emphasize the deleterious effects on the quality of life experienced by the comorbid conditions. The need for syndrome-specific interventions is stressed.

Achievement↗

PubMed2000

Genetic and environmental causes of covariation in interview assessments of disruptive behavior in child and adolescent twins.

Multirater, face-to-face, interview data relating to conduct disorder (CD), oppositional-defiant disorder (ODD), and inattentive, impulsive, and hyperactive components of attention-deficit hyperactivity disorder (ADHD) in a population-based sample of 1376 pairs of 8- to 16-year-old MZ and DZ twins are analyzed to examine (1) the genetic and environmental causes of correlation among ratings of ODD and CD symptoms and (2) the pattern of genetic and environmental correlation among the three components of ADHD. Parental ratings of ADHD showed marked sibling contrast effects, specific within raters but partly common across components. After these effects were removed, there was a modest genetic correlation between maternal and paternal ratings, but genetic effects were virtually uncorrelated across boys and girls. Genetic correlations among inattention, impulsivity, and hyperactivity were all large but fell well short of unity. There was little evidence that counts of symptoms of CD and ODD were genetically independent but the genetic correlations among ratings of twins, mothers, and fathers were all relatively modest. ODD and CD showed much higher genetic correlations across sexes than did the measures of ADHD. There was no evidence of rater contrast effects or of shared family environment influences in the twin resemblance for ODD and CD.

Adolescent↗

PubMed2006

Disruptive behaviors and HPA-axis activity in young adolescent boys and girls from the general population.

It is important to investigate associations between biological factors and disruptive behaviors in children and adolescents. Antisocial, aggressive, and criminal behaviors in adults often begin early in life. Disruptive behaviors are often thought to be associated with low activity of the hypothalamic-pituitary-adrenal (HPA) axis. Cortisol, the end-product of this axis, can be measured to investigate HPA-axis activity. Previous studies on this topic concerned clinical or high risk samples. The aim of the present study was to investigate to which extent HPA-axis functioning plays a role in disruptive behaviors in pre-adolescents from the general population. One thousand seven hundred and sixty eight 10- to 12-year-olds from the Dutch general population were investigated. Disruptive behaviors were assessed with the Child Behavior Checklist, the Youth Self-Report, and the Antisocial Behavior Questionnaire. Baseline morning and evening salivary cortisol levels were assessed. Unexpectedly, small associations were found between disruptive behaviors, including attention problems, and higher cortisol levels. However, all effect sizes of significant effects were very small. Our study indicated that HPA-axis functioning may be more relevant in clinical or high risk samples than at the general population level. The association between HPA-axis functioning and attention problems, that has gotten less attention than that with aggressive or delinquent behaviors, requires further research. Furthermore, because effect sizes were relatively small, it can be concluded that, in pre-adolescence, the measures of baseline HPA-axis functioning that were used for the present study can not be used as biological markers for disruptive behaviors.

Adolescent↗

PubMed2001

Parsing pediatric bipolar disorder from its associated comorbidity with the disruptive behavior disorders.

The unique pattern of comorbidity found in pediatric mania greatly complicates accurate diagnosis, the course of the disorder, and its treatment. The pattern of comorbidity is unique by adult standards, especially its overlap with attention-deficit/hyperactivity disorder (ADHD), aggression, and conduct disorder. Clinically, symptoms of mania have been discounted as severe ADHD or ignored in the context of aggressive conduct disorder. This atypicality may lead to neglect of the mood component. The addition of high rates of additional disorders contributes to the severe morbidity, dysfunction, and incapacitation frequently observed in these children. A comprehensive approach to diagnostic evaluation is the keystone to establishing an effective treatment program because response to treatment differs with individual disorders. Recognition of the multiplicity of disorders guides therapeutic options in these often refractory conditions. What was previously considered refractory ADHD, oppositionality, aggression, and conduct disorder may respond after mood stabilization. We review these issues in this article.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

Assessing multitasking in children with ADHD using a modified Six Elements Test.

The study was designed to investigate whether children with Attention Deficit Hyperactivity Disorder (ADHD) demonstrate a deficit in multitasking, measured by their performance on a modified Six Elements Test designed for use with children (C-SET). The C-SET was administered to 38 children, aged 7-13. The subjects comprised two groups: an ADHD sample (n = 19) and a community control sample (n = 19). The results show that the ADHD group performed significantly worse on the C-SET, in that they attempted fewer tasks than the control group. However, they did not commit more rule breaks. These findings suggest that children with ADHD did not have problems with retrospective memory, as they were as able to remember the rules as the control group. Rather, the ADHD children appeared to have a specific deficit in monitoring their ongoing behaviors and generating useful strategies for task completion, as indicated by the decreased number of tasks attempted compared to the control group. The number of tasks tried on the C-SET correlated significantly with a measure of working memory, but not with a measure of response inhibition. C-SET total tasks tried also correlated with all subscales of the Conner's Parent Rating Scale-Revised (Short Version). The C-SET appears to be a useful measure of rule-governed multitasking behavior in children.

Adolescent↗

PubMed2006

The efficacy and tolerability of quetiapine versus divalproex for the treatment of impulsivity and reactive aggression in adolescents with co-occurring bipolar disorder and disruptive behavior disorder(s).

OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of quetiapine and divalproex for the treatment of impulsivity and reactive aggression in adolescents with co-occurring bipolar disorder and disruptive behavior disorders. METHOD: Patients were included in this post hoc analysis if they scored > or = 14 on the Positive and Negative Syndrome Scale (PANSS) Excited Component (EC) and > or = 4 on at least one of the PANSS EC items, had a current diagnosis of bipolar I disorder, manic or mixed episode, and had a lifetime and/or current diagnosis of a disruptive behavioral disorder (DBD) [conduct disorder (CD) or oppositional defiant disorder (ODD)]. Thirty-three (92%) of the 36 subjects with bipolar disorder and DBD met the PANSS EC inclusion criteria. These thirty-three adolescents were randomized to quetiapine (400-600 mg/day) or divalproex (serum level 80-120 microg/mL) for 28 days in this double-blinded study. The primary efficacy measure was change in PANSS Excited Component (EC) score over the study period and at each time point. RESULTS: Repeated measures analysis of variance (ANOVA) demonstrated statistically significant within-treatment-group effects for divalproex (baseline = 20.6, end point = 13.3, p < 0.0001) and quetiapine (baseline = 18.8, end point = 10.8, p < 0.0001) for the PANSS EC. There were no statistically significant treatment group differences in PANSS EC changes from baseline to end point scores (p = 0.7, d = 0.14). Mixed regression analyses (comparison of slopes, DAY*TREATMENT) revealed that there was no significant difference in the rate of improvement in the PANSS EC scores between the two treatment groups [F(1,31) = 0.78, p = 0.39, d = 0.28]. CONCLUSIONS: Quetiapine and divalproex showed similar efficacy for the treatment of impulsivity and reactive aggression related to co-occurring bipolar and disruptive behavior disorders in adolescents. Quetiapine and divalproex are both useful as monotherapy for the treatment of impulsivity and reactive aggression in adolescents with bipolar and disruptive behavior disorders. Placebo-controlled studies are necessary.

Adolescent↗

PubMed1998

The implications of different developmental patterns of disruptive behavior problems for school adjustment. Conduct Problems Prevention Research Group.

Based upon developmental models of disruptive behavior problems, this study examined the hypothesis that the nature of a child's externalizing problems at home may be important in predicting the probability of and nature of school adjustment problems at school entry. Parent ratings were collected for a sample of 631 behaviorally disruptive children using the Child Behavior Checklist. Confirmatory factor analyses revealed differentiated ratings of oppositional, aggressive, and hyperactive/inattentive behaviors at home. Teacher and peer nominations assessed school adjustment at the end of first grade. As expected from a developmental perspective, aggressive behaviors indicated more severe dysfunction and were more likely to generalize to the school setting than were oppositional behaviors. Hyperactive/inattentive behaviors at home led to more classroom disruption than did aggressive or oppositional behaviors. Co-occurring patterns of oppositional/aggressive and hyperactive/inattentive behaviors were more common than were single-problem patterns, and were associated with broad dysfunction in the social and classroom contexts. The results were interpreted within a developmental framework, in which oppositional, aggressive, and hyperactive/inattentive behaviors may reflect distinct (as well as shared) developmental processes that have implications for the home-to-school generalization of behavior problems and subsequent school adjustment.

Aggression↗

PubMed2001

Training in social skills: an alternative technique for handling disruptive child behavior.

The purposes of this study were to examine the type of response to different situations displayed by children with or without conduct disorders and to assess the efficacy of the social skills training program herein proposed for modifying styles of interpersonal relationship in children. The sample included 315 children, 8 to 12 years of age. Those exhibiting conduct problems were 164 boys, and those having no conduct problems were 151 boys. All participants shared a low socioeconomic and cultural status and attended schools located in poor districts of Mendoza City in Argentina. Analysis showed that the groups trained in social skills improved in social interaction by reducing disruptive behaviors, whereas the groups without social skills training showed no behavioral changes. These data were confirmed by the teachers' assessments. These results suggest social skills training seems an efficient therapeutic approach to the attenuation of behavior disorders of boys.

Argentina↗