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PubMed2003

Response inhibition and disruptive behaviors: toward a multiprocess conception of etiological heterogeneity for ADHD combined type and conduct disorder early-onset type.

Response disinhibition is one of several processes that may account for disruptive behavior problems. It is associated with both attention deficits/hyperactivity (ADHD-C) and early onset, unsocialized conduct disorder (CD-E). Response inhibition is not a unitary construct. It is best understood via a dual process model of regulatory control. Executive inhibition refers to deliberate suppression of immediate motor behavior in the service of a distal goal in working memory, with relatively low anxiety activation. It is instantiated in the same frontal-striatal-thalamic neural loops as executive function and corresponds in temperament theory to effortful control. Motivational or reactive inhibition refers to anxiety-provoked interruption of behavior in the context of unexpected, novel, or punishment-cue indicators. Along with reward-response and hostile/angry response it corresponds to reactivity in temperament theory, and invokes limbic responsivity. With regard to these types of inhibitory control, ADHD-combined type is predominantly associated with dysfunctional executive inhibition. CD-E is predominantly associated with dysfunctions in the motivational inhibition process, with smaller, secondary effects in executive control. However, in both syndromes etiological heterogeneity is notable. For example, recent evidence indicates that executive inhibitory control is familial, but characterizes only a subset of children with ADHD-C. Recent dual-process models for both ADHD-C and CD-E are therefore important; they are noted and integrated. Examination of the correlates of behavioral inhibition in the subgroups with these inhibitory deficits may prove fruitful in clarifying the diverse routes to disruptive psychopathology in children.

Attention Deficit Disorder with Hyperactivity↗

PubMed1997

[Assessment of problem situations in the family].

Goal of the study is the analysis of the German version of Barkle's Home Situations Questionnaire. The analysis is accomplished in a clinical sample of N = 76 children at the age of six to ten years with the diagnosis of a hyperkinetic disorder according to ICD-10 or an Attention deficit-/hyperactivity disorder according to DSM-III-R and in a representative sample of N = 263 children aged seven to ten years. Parents of hyperkinetic children experience many family situations with their child as very problematic which is essentially more often than parents in the representative sample. Analyses of the factorial structure of the questionnaire yielded no clear and well interpretable solutions. The instrument has a good internal consistency. The HSQ-D scores correlate significantly with other parent questionnaires for the assessment of behaviour problems, the highest correlations were found with scales for the assessment of hyperkinetic behaviour problems and social problems. In the clinical practice the instrument has proven helpful within symptom-specific assessment of children with hyperkinetic and oppositional behavior disorders and for the planning of interventions.

Attention Deficit Disorder with Hyperactivity↗

PubMed2004

Does referral bias impact findings in high-risk offspring for anxiety disorders? A controlled study of high-risk children of non-referred parents with panic disorder/agoraphobia and major depression.

BACKGROUND: Previous findings in referred samples documented significant diagnostic specificity in patterns of transmission between parents with panic disorder (PD) and parents with major depression (MD) and their offspring. This study evaluated whether these patterns of transmission between parents and high-risk offspring are moderated by referral bias. METHODS: Parental PD/agoraphobia (AG) and parental MD were used to predict rates of offspring psychiatric disorders and functional outcomes using data from an opportunistic sample of parents (n = 991) and offspring (n = 734) ascertained from case-control family genetic studies of youth with and without attention-deficit hyperactivity disorder. Subjects were comprehensively assessed with structured diagnostic interview methodology to evaluate psychiatric disorders in parents and offspring. RESULTS: Parental PD/AG increased the risk for anxiety disorders in offspring, independently of parental MD while parental MD increased the risk for mood and disruptive behavior disorders in offspring, independently of parental PD/AG. Parental psychopathology was also associated with functional impairment in offspring. LIMITATIONS: The use of a sample ascertained by ADHD and control probands, and parent psychiatric diagnostic reports for children under 12. CONCLUSIONS: These results extend to non-referred samples previous findings from referred samples documenting diagnostic specificity in the familial transmission of PD/AG and MD from parents to offspring, suggesting that these patterns of transmission are not due to referral bias. These results could inform and enhance community programs aimed at screening for and treating pediatric psychopathology.

Adolescent↗

PubMed2005

Trajectories of peer-nominated aggression: risk status, predictors and outcomes.

Developmental trajectories of peer-nominated aggression, risk factors at baseline, and outcomes were studied. Peer nominations of aggression were obtained annually from grades 1 to 3. Three developmental trajectories were identified: an early-onset/increasers trajectory with high levels of peer-nominated aggression at elementary school entry and increasing levels throughout follow-up; a moderate-persistent trajectory of aggression in which children were characterized by moderate levels of physical aggression at baseline; and a third trajectory with stable low levels of aggression. Children following the early-onset/increasers trajectory showed physical forms of aggression at baseline. Male gender and comorbid attention deficit/hyperactivity problems, oppositional defiant problems and poor prosocial behavior plus negative life events predicted which children would follow the early-onset/increasers trajectory of aggression. The outcomes associated with the early-onset/increaser children suggest high risk for chronically high levels of aggressive behavior.

Aggression↗

PubMed1998

Is instrumental variability abnormally high in children exhibiting ADHD and aggressive behavior?

To test whether instrumental behavior of some children with attention deficit hyperactivity disorder (ADHD) is more variable than control subjects, the sequences of responses by three groups of children were compared: (i) those diagnosed with ADHD who lived in a residential treatment facility for children demonstrating aggressive behavior; (ii) age-matched children from the same facility who did not have an ADHD diagnosis but who had also demonstrated abnormal levels of aggression; and (iii) normal children from a local school. The experiment consisted of rewarding children for responding in a computer 'game' on two keys of a keyboard during each of three phases. In phase 1, rewards were provided independently of sequence variability (IND). In phase 2, rewards depended upon highly variable sequences of left and right responses. Phase 3 was a return to the IND contingencies. The results showed that sequence variability was higher in the sequence variability (VARY) phase than in the preceding IND phase, but remained high when the contingencies returned to IND, thus replicating previous findings. In none of the phases did the ADHD children respond more variably than the controls. However, ADHD subjects made more off-task responses than did controls. Thus, although the present research showed differences between ADHD and control subjects, there was no evidence to support higher behavioral variability in the ADHD subjects.

Aggression↗

PubMed2002

Reduced salivary cortisol in children with comorbid Attention deficit hyperactivity disorder and oppositional defiant disorder.

OBJECTIVES: There is growing interest in the role of the hypothalamic-pituitary-adrenal (HPA) axis in neuropsychiatric disorders and there is some evidence that the HPA axis may be underfunctional in behaviorally disturbed children. However, co-morbidity is common in childhood neuropsychiatric disorders. Stimulant medication is widely used in the treatment of Attention-deficit hyperactivity disorder (ADHD) and can increase cortisol secretion when given acutely. We therefore set out to determine the whether salivary cortisol would be reduced in a group of children with ADHD/ODD (Oppositional-defiant disorder) and to examine the effect of stimulant medication on any such relationship. DESIGN: Salivary cortisol was determined in thirty-two children with co-morbid ADHD and Oppositional-defiant disorder (ODD) according to DSM-IV criteria, compared to twenty-five healthy controls of similar age and ethnic background. Data were analysed according to prescription of stimulant medication in the patient group. RESULTS: Salivary cortisol was significantly lower in the ADHD/ODD group than in the controls. Further analysis revealed that this reduction was restricted to the subgroup of patients not prescribed stimulant medication. CONCLUSIONS: The results support the possibility of a dysfunction of control of the HPA axis in these behaviorally disturbed children. A reduction in salivary cortisol could reflect underarousal, an elevated threshold for detection of stressors or a subsensitivity of the HPA axis itself. It remains to be determined whether the ability of stimulant medications to negate the apparent deficit in cortisol secretion in these ADHD/ODD patients is an unrelated consequence of increased dopamine release or a reflection of their therapeutic benefit. The use of stimulant medication for co-existing ADHD should be taken into account in future studies of cortisol in behaviorally disturbed children.

Attention Deficit Disorder with Hyperactivity↗

PubMedDate not supplied

Verbal deficits and disruptive behavior disorders among children of opiate-dependent parents.

In order to explore the association between verbal deficits and disruptive behavior disorders among children of addicted parents, 283 6-17-year-old children and their opiate-dependent parents completed diagnostic interviews and standardized measures of vocabulary. Unexpectedly, racial differences in the scores confounded the exploration of the relationship between cognitive scores and disruptive behavior disorders. An interaction between disruptive behavior disorder and race is explored; among Caucasian youths, low verbal scores are associated with disruptive behavior disorders, but this association was not found among African- and Hispanic-American youths. Further analysis and research are needed to understand the clinical significance of relationships between verbal deficits and disruptive behavior disorders within racially diverse groups.

Adolescent↗

PubMed2003

Discriminative validity of the general behavior inventory using youth report.

The present study investigated the ability of the General Behavior Inventory (GBI) to discriminate between diagnostic groups using youth self-report. One hundred and ninety-seven youths ages 10-17 years presenting at a midwestern urban outpatient clinic specializing in mood disorders completed the GBI as part of the intake process. Diagnoses were determined by a structured clinical interview (K-SADS) administered by either a child and adolescent psychiatrist or a research assistant trained to a high level of interrater reliability (kappa > .85). Games-Howell post hoc tests showed that the diagnostic groups significantly differed on the GBI's 2 subscales, Depression and Hypomanic-Biphasic. Logistic regression demonstrated that the scales discriminated between bipolar and disruptive behavior disorders, unipolar and bipolar depression, and mood and disruptive behavior disorders or no diagnosis. Receiver Operating Characteristic (ROC) curves further indicated the good diagnostic efficiency of the scales. Results indicate that the GBI's subscales might aid in making traditionally difficult differential diagnoses, such as between bipolar disorder and Attention Deficit Hyperactivity Disorder (ADHD) and between unipolar and bipolar depression.

Adolescent↗

PubMed2001

Comorbidity among individuals classified with attention disorders.

This study examined the frequency of comorbidity among ADHD and ADHD subtypes. Specific aspects of comorbidity were examined in the areas of learning disorders, disruptive behavior disorders, and affective disorders. Two analyses were performed. The first analysis compared the comorbid second and third diagnoses for 287 individuals with a primary diagnosis of ADHD (Predominately Inattentive Type or Predominately Hyperactive-Impulsive Type) with a comparison sample (n = 290) who did not have a primary diagnosis of ADHD. The second analysis examined the comorbidity with specific ADHD subtypes. This analysis compared the comorbid second and third diagnosis of individuals with a primary ADHD subtype diagnosis of Predominately Inattentive (n = 143) with individuals who have a primary ADHD subtype diagnosis of Predominately Hyperactive-Impulsive (n = 143). Results from the first analysis indicated significant overlap between the diagnosis of ADHD and the diagnosis of learning disorders and disruptive behavior disorders but not for affective disorders. Results from the second analysis indicated that only conduct disorders were comorbid with certain ADHD subtypes, with disruptive behavior disorders being more likely to be diagnosed with ADHD Hyperactive-Impulsive Type than with ADHD Inattentive Type.

Adolescent↗

PubMed2004

Preventing disruptive behavior in elementary schoolchildren: impact of a universal classroom-based intervention.

A population-based, randomized universal classroom intervention trial for the prevention of disruptive behavior (i.e., attention-deficit/hyperactivity problems, oppositional defiant problems, and conduct problems) is described. Impact on developmental trajectories in young elementary schoolchildren was studied. Three trajectories were identified in children with high, intermediate, or low levels of problems on all 3 disruptive behaviors at baseline. The intervention had a positive impact on the development of all disruptive behavior problems in children with intermediate levels of these problems at baseline. Effect sizes of mean difference at outcome were medium or small. In children with the highest levels of disruptive behavior at baseline, a positive impact of the intervention was found for conduct problems.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Mother-son interactions in families of boys with Attention-Deficit/Hyperactivity Disorder with and without oppositional behavior.

Parenting responsiveness and over-reactivity were assessed among 25 mothers of 7-9-year-old sons with Attention-Deficit/Hyperactivity Disorder (ADHD) and oppositional behavior (Oppositional Defiant, OD), 24 mothers of sons with ADHD only, and 38 mothers of nonproblem sons. Responsiveness was observed during mother-son play and clean-up interactions and over-reactivity was assessed using self-reports of parenting in discipline situations. Mothers of sons with ADHD/OD were less responsive and more over-reactive than mothers of nonproblem sons, and mothers of sons with ADHD only did not differ from the other groups. Mothers of sons with ADHD/OD reported more hostility than mothers of nonproblem sons, and controlling for maternal hostility eliminated the significant group differences in responsiveness during clean-up and in over-reactivity. Controlling for the child's ADHD subtype did not alter the pattern of results. The implications for addressing responsiveness and over-reactivity as components of parent-mediated behavioral treatments for ADHD are considered.

Adult↗

PubMed2001

Social-cognitive processes in preschool boys with and without oppositional defiant disorder.

The social-cognitive characteristics of 88 preschool boys with Oppositional Defiant Disorder (ODD) and 80 nondisruptive boys were assessed 3 times over a 2-year period. Three questions were addressed: (1) Do social-cognitive processes (encoding, attribution, problem solving, and response evaluation) distinguish clinic-referred preschool boys from peers without behavior problems? (2) What is the relation between preschoolers' social-cognitive processes and observed problem behavior? (3) Are the social-cognitive processes of clinic boys with ODD influenced by comorbidity with Attention Deficit Hyperactivity Disorder (ADHD)? Boys were presented hypothetical, peer-oriented social dilemmas to resolve. At all 3 assessments, clinic boys were twice as likely as were comparison group boys to generate aggressive solutions. Relative to comparison boys, clinic boys' encoding of social information was less accurate. The groups did not differ in their attributions or response evaluations. Verbal IQ and language skills were modestly correlated with problem solving and encoding. Within the clinic group, social-cognitive processes were not affected by ADHD comorbidity and they showed little relation to later diagnostic status or severity of behavior problems.

Aggression↗

PubMed2002

Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: family, parenting, and behavioral correlates.

This community study assigned 129 4-year-olds to groups at risk for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), both ADHD and ODD, or no problems. Mothers of children at risk for ODD reported more family dysfunction, felt less competent as parents, suggested fewer solutions to child behavior problems, demonstrated a less assertive approach to child management, and reported more child internalizing problems than did mothers of children not elevated on ODD symptoms. Mothers of children at risk for ADHD reported higher personal depression scores than did those of the non-ADHD subgroup. Children at risk for ADHD evidenced the most difficulties in school where teachers reported more social behavior, classroom management, and internalizing problems relative to other children not at risk for ADHD. When solving child management problems, mothers of children in all groups suggested twice as many controlling/negative management strategies as positive/preventive strategies. In addition, faced with oppositional and conduct problems, mothers of children in all groups increased controlling/negative suggestions and decreased positive/preventive suggestions. Mothers of girls at risk for ADHD, ODD, and ADHD/ODD gave more rewards per positive behavior than did mothers of boys.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

The influence of activity choice on problem behaviors maintained by escape versus attention.

This study assessed whether the function of an individual's problem behavior was related to the effectiveness of an intervention involving choice among tasks. Analogue functional analyses were conducted with 7 students with various diagnoses to determine whether problem behaviors were maintained by escape or attention. Following identification of the function of each student's problem behavior, reversal designs were used to assess the effectiveness of an intervention that allowed the students to choose their own instructional tasks. Results showed that students who displayed escape-maintained problem behavior showed substantial reductions in such behavior when they were provided with opportunities to choose among tasks. On the other hand, students who displayed attention-maintained problem behavior did not show any effects as a result of the choice intervention. These findings are discussed in terms of the effective use of behavior management programs involving choice and the reduction of problem behavior.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder.

BACKGROUND: Hypomania/mania and depression are hypothesized to correspond to high and low expressions of behavioral activation system (BAS) activity, respectively, in bipolar individuals. In contrast, behavioral inhibition system (BIS) activity is hypothesized to regulate anxiety. The aim of the present study was to examine whether self-reported levels of BAS functioning in bipolar adolescents corresponded with levels of concurrent manic and depressive symptomatology. The secondary aim was to investigate whether self-reported BIS levels were associated with self-reported anxiety symptoms. METHODS: Twenty-five adolescents diagnosed with bipolar I, II or not otherwise specified were recruited from a treatment-development study. Adolescents were interviewed using the Depression and Mania Rating Scales of the Kiddie Schedule for Affective Disorders and Schizophrenia and given the Self-Report for Childhood Anxiety Related Disorders. Next, they completed the Behavioral Inhibition/Activation Scales. RESULTS: Contrary to hypotheses, adolescents with higher BAS levels exhibited less severe concurrent mania symptoms. Furthermore, levels of BAS sensitivity were not associated with concurrent levels of depression. As predicted, BIS scores correlated positively with self-reported anxiety scores. Adolescents reporting higher levels of the motor activity symptoms of mania also reported higher levels of anxiety symptoms. LIMITATIONS: The conclusions are based upon cross-sectional analyses in a small sample. CONCLUSIONS: In bipolar adolescents, mania and depression appear to be independent of self-reported behavioral activation levels. However, mood symptoms in adolescent patients are closely tied to components of anxiety, which may lead to diminished approach behaviors.

Adolescent↗

PubMed2005

Classes of adolescents with disruptive behaviors in a general population sample.

BACKGROUND: To study disruptive behaviors adequately, we need to distinguish between individuals with different types of problems that may have a different etiology. The availability of a taxonomic system that helps in identifying homogeneous groups of individuals, with similar patterns of disruptive behaviors, is crucial to achieve this goal. Therefore, we examine which classes of preadolescents with symptoms of Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) can be identified in the general population. METHODS: Disruptive behaviors of 2,230 10-12 year olds from the Dutch general population were assessed with the Child Behavior Checklist and Youth Self-Report. RESULTS: Latent class analysis revealed three classes of preadolescents: the first characterized by high scores on ADHD, ODD, and CD items; a second by high probabilities of ADHD and ODD symptoms; a third with low scores on all items. CONCLUSIONS: Because classes of preadolescents with symptoms of only one type of disruptive behavior problems could not be identified, it can be questioned how useful separate diagnostic distinctions are in general population studies.

Adolescent↗

PubMed2002

Preschool children with disruptive behavior: three-year outcome as a function of adaptive disability.

A significant discrepancy between intelligence and daily adaptive functioning, or adaptive disability (AD), has been previously found to be a associated with significant psychological morbidity in preschool children with disruptive behavior (DB). The utility of AD as a predictor of later developmental risks was examined in a 3-year longitudinal study of normal (N = 43) and DB preschool children. The DB children were grouped into those with AD (DB+AD; N = 28) and those without AD (DB-only; N = 98). All children were followed with annual evaluations to the end of second grade. Both DB groups demonstrated substantial and pervasive psychological and educational morbidity at 3-year follow-up. In comparison to DB-only children, DB+AD children had more symptoms of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD), more severe and pervasive behavior problems at home, more parent-rated externalizing and internalizing, and lower academic competence and more behavioral problems at school. Parents of DB+AD children also reported greater parenting stress than did parents in the other groups. A significant contribution of AD to adverse outcomes in the DB group remained on some measures even after controlling for initial severity of DB. AD also contributed significantly to CD symptoms at follow-up after controlling for initial DB severity and initial CD symptoms. The results corroborate and extend earlier findings of the utility of AD as a risk indicator above severity of DB alone. They also imply that AD in the context of normal intellectual development may arise from both the deficient self-regulation associated with ADHD and from disrupted parenting. with exposure to kindergarten moderating these adverse effects.

Adaptation, Psychological↗

PubMed2006

Childhood antecedent disorders to bipolar disorder in adults: a controlled study.

OBJECTIVE: The aim of the study was to examine antecedent childhood psychiatric disorders in adult patients with bipolar disorder. METHOD: Using structured diagnostic interviews, childhood psychiatric diagnoses of 83 referred patients with diagnosed DSM-IV bipolar disorder were compared to those of 308 adults without mood disorders. RESULTS: Patients with bipolar disorder had significantly higher rates of childhood disruptive behavior disorders (ADHD, oppositional-defiant disorder, and conduct disorder), childhood anxiety disorders (separation anxiety and overanxious disorder), and enuresis, compared to patients without mood disorders. The presence of these childhood disorders was associated with an earlier age of onset of bipolar illness. LIMITATIONS: The retrospective nature of the study may have affected both the rates of disorders recalled, as well as the ages of onset of disorders. Different referral sources for bipolar and comparison participants may have also impacted findings. CONCLUSIONS: Bipolar disorder in adults is frequently preceded by childhood disruptive behavior and anxiety disorders. These childhood disorders may be important markers of risk for adult bipolar disorder.

Adult↗