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DSM-5 Disruptive Mood Dysregulation Disorder (DMDD) is a controversial new diagnosis. The DSM-5 conceptualizes DMDD as persistent and chronic, but the stability of the two DMDD symptoms (irritable-angry mood and temper outbursts) over time is not known. Mothers rated DMDD symptoms in a population-based sample of 376 children (54 % male) evaluated at 6-12 years (M 9) and again an average of 8 years later (M 16). Mean scores on irritable-angry mood plus temper outbursts at baseline and follow-up were below sometimes a problem, but were higher at baseline than follow-up. Irritable-angry mood and temper outbursts were both often or very often a problem for 9 % of children at baseline, 6 % at follow-up, and 3 % at baseline and follow-up. Only 29 % of children whose baseline symptoms were often or very often continued to have follow-up symptoms at this level (remission rate 71 %). Less than half (45 %) of the children whose symptoms were often or very often at follow-up had these symptoms 8 years earlier (55 % new cases). Our finding of 71 % remission and 55 % new cases indicates instability of DMDD symptoms over an 8-year period. However, the finding that 29 % still had symptoms often or very often 8 years later is clinically significant. DMDD symptoms were found in only one child who did not have symptoms of oppositional defiant disorder (ODD), conduct disorder, ADHD, anxiety, or depression. This suggests that DMDD symptoms are a feature of multiple disorders, particularly ODD, and do not occur in isolation, questioning the validity of DMDD as a unique and independent diagnosis.

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According to the DSM-IV, children with Asperger's disorder do not have significant cognitive or speech delays, whereas children with autistic disorder may or may not. In our study, children with normal intelligence who had clinical diagnoses of autism or Asperger syndrome were divided into two groups: those with and without a significant speech delay. The purpose was to determine if clinically meaningful differences existed between the two groups that would support absence of speech delay as a DSM-IV criterion for Asperger's disorder. No significant differences were found between the 23 children with a speech delay and the 24 children without a speech delay on any of the 71 variables analyzed, including autistic symptoms and expressive language. Results suggest that early speech delay may be irrelevant to later functioning in children who have normal intelligence and clinical diagnoses of autism or Asperger syndrome and that speech delay as a DSM-IV distinction between Asperger's disorder and autism may not be justified.

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Children (N = 110) hospitalized on a child psychiatric unit improved significantly in psychological functioning at discharge and 1- and 6-months follow-up relative to their functioning at admission. Children who were more impaired at admission made more progress during admission but were more impaired at follow-up than children who had milder symptoms at admission. Children without a behavior disorder had a better outcome than children with a behavior disorder. None of the other variables, alone or in combination, was significantly related to admission progress or follow-up outcome, including specific diagnoses, gender, race, age, IQ, family functioning, negative life events, parent education and employment, biological family history, length of hospitalization, parent involvement during admission and follow-up services.

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DSM-IV criteria for autistic and Asperger's disorders were applied to 157 children with clinical diagnoses of autism or Asperger's disorder. All children met the DSM-IV criteria for autistic disorder and none met criteria for Asperger's disorder, including those with normal intelligence and absence of early speech delay. The reason for this was that all children had social impairment and restricted and repetitive behavior and interests (required DSM-IV symptoms for both autistic and Asperger's disorders) and all had a DSM-IV communication impairment (which then qualified them for a diagnosis of autistic disorder and not Asperger's disorder). Communication problems exhibited by all children were impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both), which are DSM-IV criteria for autism. These findings are consistent with those of 5 other studies and indicate that a DSM-IV diagnosis of Asperger's disorder is unlikely or impossible.

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Admission, discharge, and follow-up evaluations of 110 children admitted to a child psychiatric unit (mean 14 days) showed that the children's psychological functioning improved significantly during hospitalization. Gains were not fully maintained at follow-up (1 and 6 months), but the children were still significantly less impaired after discharge than at admission. A nonsignificant difference existed between follow-up scores, indicating no loss of progress or decline in functioning from 1- to 6-month follow-up. The results are consistent with an ABA (A = no inpatient intervention, B = inpatient intervention, A = no inpatient intervention) treatment effect. They are not explained by removal from and return to an unsatisfactory home environment. Psychological functioning after admission was significantly better than after 1 to 6 months of post-discharge psychiatric services. This study offers a clinically feasible approach to evidence-based practice by documenting patient improvement during and after inpatient treatment using a simple, empirically supported assessment instrument.

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Clinical and psychoeducational data were analyzed for 119 children ages 8 to 16 years who were evaluated in a child diagnostic clinic. A learning disability (LD) was present in 70% of the children with attention-deficit/hyperactivity disorder (ADHD), with a learning disability in written expression two times more common (65%) than a learning disability in reading, math, or spelling. Children with LD and ADHD had more severe learning problems than children who had LD but no ADHD, and the former also had more severe attention problems than children who had ADHD but no LD. Further, children with ADHD but no LD had some degree of learning problem, and children with LD but no ADHD had some degree of attention problem. Results suggest that learning and attention problems are on a continuum, are interrelated, and usually coexist.

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Standard scores on the third and fourth editions of the Developmental Test of Visual-motor Integration (VMI-3 and VMI-4) were compared for a sample of 120 children (4-17 years of age) referred to an outpatient diagnostic clinic for developmental learning, attention, mood, and behavior problems. The two editions of the test have the same items, so the test was administered only once to each child, but the editions differ in their scoring systems and norms. The correlation between the pairs of standard scores on the two editions was .99, and the absolute mean difference between scores was only 1.5 points.

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Psychological and educational data were analyzed for all school-aged males with hemophilia at the Hemophilia Center of Central Pennsylvania (N = 66). Mean IQ (113.5) was higher than normal, and 2.4 times as many boys with hemophilia were enrolled in gifted programming than is the state average for boys. However, there was a disproportionately high prevalence of attention-deficit/hyperactivity disorder (ADHD; 28.3%), learning disability (LD; 15.8%), and graphomotor weakness. These were not significantly associated with HIV status or type and severity of coagulation disorder. School absenteeism was high but was not significantly related to academic achievement, IQ/achievement discrepancy, need for educational intervention, or diagnosis of ADHD or LD.

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Sixty-nine children with attention deficit hyperactivity disorder (ADHD) underwent blind methylphenidate trials. 36 had ADHD alone (with or without a learning disability) and 33 had additional neurodevelopmental disorders. Of the children with ADHD alone, 88 per cent improved significantly on methylphenidate. This did not differ significantly from the 69 per cent response rate for children with ADHD and other neurodevelopmental disorders. The results confirm and add to the research literature indicating that ADHD children who are of preschool age and/or who have co-existing neurological disorders may benefit from methylphenidate.

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Although some hemophiliacs in other studies have reported restricting blood product use because of fear of possible transmission of the human immunodeficiency virus (HIV), no overall change in the quantity of blood products infused between January 1981 through December 1985 was found in a sample of 40 hemophiliacs before or after they became aware of the risk of contracting the acquired immunodeficiency syndrome (AIDS). However, there was a significant linear increase in blood product use with time during the period of AIDS risk awareness. This may be a nonspecific, chance finding; or it may reflect an increase in spontaneous bleeds secondary to AIDS-related stress. The implications of these findings are discussed, and specific areas for future research are recommended.

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Agreement between raters using global impressions to assess methylphenidate response was analyzed for children with Attention-Deficit Hyperactivity Disorder (ADHD) undergoing double-blind, placebo-controlled, crossover methylphenidate trials. Caregivers were more likely to disagree than agree when asked to rate the children as "better, same, or worse" during each day of the trial. Over-all agreement was 42.9%, only 9.6% above what would be expected based on chance alone. Further, none of the interrater reliability coefficients (Cohen's kappa) for the individual children were statistically significant.

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About 12 percent of the women sex partners of hemophilic men who are seropositive for the human immunodeficiency virus (HIV) have themselves become seropositive. Questionnaires were completed in January 1988 by 15 women who were in long-term, monogamous relationships with HIV-positive hemophiliacs; 11 of the women were not HIV seropositive and 4 were. None of the couples was abstaining from sexual intercourse, and during the 4 weeks prior to responding, the couples had intercourse a mean of 6.2 times. Sixty percent always used condoms, 13 percent did so most of the time, and the remaining 27 percent did sometimes. Condom use was not significantly related to either frequency of intercourse, the women's knowledge of acquired immunodeficiency syndrome (AIDS) and AIDS-risk reduction, the actual HIV status of both partners and the women's perceived status of both, the extent of the women's worry about contracting AIDS, their reported degree of negative impact from AIDS, or to their mood, age, or education. All women who reported not always using condoms had been informed of their own and their partner's HIV status; were counseled repeatedly regarding risk reduction; acknowledged the possibility of heterosexual HIV transmission; said they knew of recommendations for the use of condoms; recognized their risk of HIV infection; claimed some degree of worry about acquiring HIV through sexual activity; had children at home; and were not, with one exception, trying to become pregnant. There were several possible factors influencing the decision by women at high risk for acquiring HIV not to use condoms. Among them were complaints that the women found condoms unpleasant or an unwanted reminder of AIDS, a sense of obligation or a drive to continue unaltered sexual relations, the false reassurance of HIV-negative test results for some of the women who did not always use condoms, a willingness to sacrifice and to share their partner's fate, a desire to avoid communicating rejection and adding to their partner's burdens, and difficulty changing long-standing behavior patterns despite logical understanding of the risks involved.

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The relationships between frequency of rumination in a boy with profound mental retardation and a variety of environmental, interpersonal, and temporal variables were investigated by collecting and analyzing data during all waking hours over a 4-week period. Low levels of rumination were associated with periods of special education programming (versus nonschool hours), individual attention (versus group activities and independent play), and time spent with caretakers who like the child (versus those who like him less). The findings also revealed a mealtime effect (decreasing rumination as time elapsed following meals) and a time of day effect (increasing rumination as the day progressed). Directions for future research and possible implications for the environmental management of rumination are discussed.

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Relationships among pre-injury ability, post-injury verbal intelligence, duration of coma and age were analysed in 34 closed-head injury patients, 7-28 years of age, whose coma lengths ranged from 5 to 180 days. The results obtained suggest that moderate to severe closed-head injury uniformly impairs verbal intellectual functioning without regard to premorbid status. Premorbid ability test scores had a markedly low correlation (0.04) with Wechsler Verbal IQs, obtained after patients had plateaued in intellectual recovery. Even when the effects of coma and age were controlled, the correlation was not significant. Mean post-injury IQs for patients grouped according to pre-injury intelligence (above average, average, below average) were all in the 80s. The findings do not support the prevailing assumption that the greater the premorbid ability, the greater the potential for intellectual recovery and the better the outcome. This study instead suggests that the higher the pre-injury IQ, the greater the IQ point loss. This has important implications for rehabilitation, counselling, discharge planning and follow-up. The greater the disparity between pre- and post-injury IQs, the more profound the loss and, hence, the greater the need for patient and family adjustments, coping and modifications of future personal, educational and vocational plans.

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Using standardized instruments, personality traits of twenty-two hemophilic boys and child-rearing attitudes and practices of their parents were evaluated at the beginning and end of a six-year period, during which psychosocial services were provided in a comprehensive care hemophilia program. The children changed significantly in a positive direction on two traits, enthusiasm and self-reliance. No significant negative personality trait changes were found. Scores remained within the normal range on the remaining traits, with the exception of a significant positive elevation on the intelligence dimension at both pre- and posttest. Mothers and fathers scored positively compared with parental attitude norms during both the initial and follow-up evaluations, without significant changes in overall mean scores. Strong relationships were revealed between individual changes in child personality and parent attitude scores. Despite the fact that between pre- and posttest boys with hemophilia and their parents became aware of the risk of contracting AIDS from blood product use, personality traits and parent child-rearing attitudes remained positive.

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Personality traits of 50 hemophilic boys were assessed with the Early School (ESPQ), Children's (CPQ), and High School (HSPQ) Personality Questionnaires. Compared to the norms for healthy, male age-mates, hemophiliacs were significantly more intelligent, stable, and secure. They did not deviate from the norm on the remaining eight traits assessed. The findings of higher intelligence may indicate that hemophilic boys are more motivated to excel intellectually because this avenue is more appropriate to them due to the risk of pain and disability from physical endeavors. Boys with severe hemophilia were significantly more self-controlled, serious, and submissive, compared to mild-to-moderate hemophiliacs. Possibly, this reflects the severe hemophiliacs' greater concern for the more serious nature of the medical sequelae they may experience from physical activity. Mild-to-moderate hemophiliacs were slightly below the norm on these traits, suggesting their attempt to overcompensate for or deny the physical implications of their hemophilia by being more assertive and impulsive.

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Personality patterns, signs of mental impairment, mental health correlates, and psychosocial consequences were assessed in 50 patients who had obstructive sleep apnea of sufficient severity to warrant recommendation for tracheostomy. The personality patterns of sleep apnea patients were consistently those of a somatic-neurotic type, similar to typical patterns for medical outpatients. The high level of psychologic distress demonstrated was clearly a consequence rather than a cause of the disorder. Most patients showed cognitive impairment; 76% had suspected or mild to severe deficits in terms of thinking, perception, memory, communication, or the ability to learn new information, resulting in a greater potential for being distractible, confused, and irritable. Finally, another striking finding was the high incidence of patients' reports of frequent, severe psychosocial disruption in their lives--involving the family, social interactions and work situations.

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