RESUMEN

The use of DSM-IV based questionnaires in child psychopathology is on the increase. The internal construct validity of a DSM-IV based model of ADHD, CD, ODD, Generalised Anxiety, and Depression was investigated in 11 samples by confirmatory factor analysis. The factorial structure of these syndrome dimensions was supported by the data. However, the model did not meet absolute standards of good model fit. Two sources of error are discussed in detail: multidimensionality of syndrome scales, and the presence of many symptoms that are diagnostically ambiguous with regard to the targeted syndrome dimension. It is argued that measurement precision may be increased by more careful operationalisation of the symptoms in the questionnaire. Additional approaches towards improved conceptualisation of DSM-IV are briefly discussed. A sharper DSM-IV model may improve the accuracy of inferences based on scale scores and provide more precise research findings with regard to relations with variables external to the taxonomy.

Asunto(s)

RESUMEN

OBJECTIVE: To examine the prevalence of DSM-IV symptoms of attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder and age, gender, and comorbidity differences between ADHD subtypes. METHOD: Teachers completed a DSM-IV-referenced symptom inventory for 3,006 schoolchildren aged between 3 and 18 years. RESULTS: The screening prevalence rate of ADHD behaviors was 15.8%; rates for individual subtypes were 9.9% for inattentive, 2.4% for hyperactive-impulsive, and 3.6% for combined. The inattentive type was relatively uncommon in preschool children (3.9%), whereas the hyperactive-impulsive type was least common in teenagers (0.8%). Screening prevalence rates were higher for African-American (39.5%) than white (14.2%) students, but did not vary significantly (p < .05) as a function of geographic region or socioeconomic status. ADHD subtypes were rated as more impaired than the non-ADHD group on most measures and were easily differentiated on the basis of comorbid symptoms, social skills impairment, and special education services. CONCLUSIONS: The findings of this and similar studies show relatively high convergence for the prevalence of ADHD behaviors and differences between ADHD subtypes.

Asunto(s)

RESUMEN

OBJECTIVE: To describe and compare ratings of psychiatric symptoms in community and clinic samples (ages 3-6 years) using a DSM-IV-referenced rating scale. METHOD: Parent (/and teacher) ratings were obtained for community (N = 531/398) and special education (N = 64/140) samples (1995-1997) and an outpatient clinic (N = 224/189) sample (1994-1996). RESULTS: Age and socioeconomic status were only minimally (r< 0.20) correlated with ratings of psychopathology. The most commonly endorsed symptom categories were attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, anxiety disorder, conduct disorder (teacher), and pervasive developmental disorder (clinic). Groups were easily differentiated by the rate and severity of symptoms (clinic > special education > community). Males generally received higher scores than females (especially teacher ratings). Children with ADHD symptoms had higher ratings of impairment (developmental deficits) than the non-ADHD group. CONCLUSIONS: Although these findings share a number of similarities with studies of older children, there are also differences that attest to the uniqueness of this age group.

Asunto(s)

RESUMEN

OBJECTIVE: This study used a parent-completed, DSM-IV-referenced rating scale to examine prevalence rates of attention-deficit/hyperactivity disorder (ADHD) behaviors and differences between subtypes in 10- to 12-year-old Ukrainian children. METHOD: During 1997, a total of 600 parents and children residing in Kyiv, Ukraine, and their teachers participated in extensive clinical assessments using standard Western measures. RESULTS: The screening prevalence rate of ADHD behaviors was 19.8%: 7.2% for inattentive (I), 8.5% for hyperactive-impulsive (HI), and 4.2% for combined (C). Post hoc comparisons indicated a number of significant (p < .05) group differences. Mothers of children with ADHD symptoms reported higher rates of disruptive behavior, negative mother-child interactions, and physical punishment than the non-ADHD group. Teachers rated children with ADHD as more hyperactive and inattentive, but only the HI subtype was rated more oppositional than non-ADHD students. The I subtype was less academically proficient and socially adept (but less likely to have behavior problems). The C subtype was the most behaviorally disruptive (mother ratings), and their fathers were more likely to be aggressive and abuse alcohol. The HI subtype also had problems with disruptive behavior but were less socially impaired. CONCLUSIONS: Although symptom prevalence rates are higher in Ukraine than the United States, this study provides additional evidence supporting DSM-IV ADHD subtypes as distinct clinical entities.

Asunto(s)

RESUMEN

This study examined the relation between internalizing and externalizing symptoms in two groups of prepubertal boys (with and without multiple chronic tic disorder) with diagnosed attention-deficit hyperactivity disorder (ADHD). Parents and teachers completed the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF), respectively. Children were carefully evaluated for the absence of a chronic tic disorder. Boys with ADHD and chronic multiple tic disorder (ADHD/+tics) received significantly higher (p = .0032, Bonferroni correction) scores for the Anxious/Depressed, Thought Problems, and Attention Problem scales of the CBCL and the Delinquent Behavior, Thought Problems, and Somatic Complaints scales of the TRF than did boys without chronic tic disorder (ADHD/-tics). Although many of the individual items that differentiated (p < .05) the two groups of boys pertained to behaviors that characterize motor tics, obsessions, or compulsions, the ADHD/+tics group exhibited higher rates of anxious behavior (CBCL) and obscene language (TRF) than did the ADHD/-tics group. Anxiety/depressive symptoms were associated with aggressive/oppositional behavior in both samples. Children with mild tic disorder were more similar (CBCL) to ADHD/-tics boys than they were to children with more severe tic disorder. The relatively higher rate of comorbidity in the ADHD/+tics group suggests that tics may be a marker for more severe symptomatology in clinic-referred samples of children with ADHD. Furthermore, these data suggest that it is not the presence, per se, but rather the severity of tic disorder that is associated with higher rates of emotional and behavioral disturbances.

Asunto(s)

RESUMEN

OBJECTIVES: In this study we examined changes in attention-deficit hyperactivity disorder behaviors and motor and vocal tics during withdrawal from long-term maintenance therapy with stimulant medication. METHODS: Subjects were 19 children with attention-deficit hyperactivity disorder and chronic tic disorder who had received methylphenidate (n = 17) or dextroamphetamine (n = 2) for a minimum of 1 year. Children were switched to placebo under double-blind conditions. Treatment effects were assessed by using direct observations of child behavior in a simulated (clinic-based) classroom and behavior rating scales completed by parents and clinician. RESULTS: There was no change (group data) in the frequency or severity of motor tics or vocal tics during the placebo condition compared with maintenance dose of stimulant medication (ie, no evidence of tic exacerbation while receiving medication or of a withdrawal reaction). There was no evidence of tic exacerbation in the evening as a rebound effect. Treatment with the maintenance dose was also associated with behavioral improvement in attention-deficit hyperactivity disorder behaviors, indicating continued efficacy. CONCLUSIONS: Abrupt withdrawal of stimulant medication in children receiving long-term maintenance therapy does not appear to result in worsening of tic frequency or severity. Nevertheless, these findings do not preclude the possibility of drug withdrawal reactions in susceptible individuals.

Asunto(s)

RESUMEN

BACKGROUND: This study examined changes in attention-deficit hyperactivity (ADHD) behaviors and motor and vocal tics during long-term treatment with methylphenidate. METHODS: Thirty-four prepubertal children with ADHD and chronic multiple tic disorder (who had participated in an 8-week, double-blind, placebo-controlled methylphenidate evaluation) were evaluated at 6-month intervals for 2 years as part of a prospective, nonblind, follow-up study. Treatment effects were assessed using direct observations of child behavior in a simulated (clinic-based) classroom and behavior rating scales completed by parents and physician. Videotapes of the simulated classroom were scored by coders who were blind to treatment status. RESULTS: There was no evidence (group data) that motor tics or vocal tics changed in frequency or severity during maintenance therapy compared with diagnostic or initial double-blind placebo evaluations. Behavioral improvements demonstrated during the acute drug trial were maintained during follow-up. There was no evidence (group data) of clinically significant adverse drug effects on cardiovascular function or growth at the end of 2 years of treatment. CONCLUSIONS: Long-term treatment with methylphenidate seems to be safe and effective for the management of ADHD behaviors in many (but not necessarily all) children with mild to moderate tic disorder. Nevertheless, careful clinical monitoring is mandatory to rule out the possibility of drug-induced tic exacerbation in individual patients.

Asunto(s)

RESUMEN

OBJECTIVE: To examine the relation between severity of tic disorder and comorbid psychopathology in 47 prepubertal children with tic disorder who were referred for clinical evaluation of and treatment for attention-deficit hyperactivity disorder (ADHD), oppositional behaviors, and aggressive behaviors. METHOD: Parents and teachers completed the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) for each child. RESULTS: Seventy-five percent of the sample was in the clinical range in at least two categories of psychopathology. When the children were divided into two groups on the basis of tic severity, significantly higher scores were obtained for children with more severe tics on the narrow-band Depressed, Uncommunicative, Obsessive-Compulsive, and Aggressive scales, and the broad-band internalizing scale of the CBCL. The severity groups did not differ on TRF scores. Children who were more aggressive also received higher CBCL scores. CONCLUSIONS: The findings from this study suggest that the severity of chronic tics is a clinical indicator of complex psychopathology in children with ADHD who are referred for psychiatric evaluation.

Asunto(s)

RESUMEN

Although placebo controls and double-blind conditions are considered to be essential for the unbiased scientific assessment of drug effects, there is very little research on these procedures in the pediatric psychopharmacology literature. To examine the impact of controlled assessment procedures on the magnitude of observed drug effects, two groups of children with attention-deficit hyperactivity disorder (ADHD) were evaluated for response to methylphenidate under two different assessment procedures. One group (n = 33) was part of a placebo-controlled, double-blind crossover research protocol, with randomized dose sequences, compliance checks, numerous dependent measures, written informed consent, and a considerable amount of staff involvement. The other group (n = 43) received pharmacotherapy at a community-based child psychiatry outpatient service where they were followed in a routine clinical manner, with "no treatment" as the only control condition, standard fixed-dose titration, parental responsibility for data collection, use of form letters, and minimal staff involvement. Each individual in both groups received divided doses of 0.3 and 0.5/0.6 mg/kg daily for a minimum of 1 week at each dose. Comparisons of teacher ratings obtained for the two assessment procedures revealed highly similar findings. The results of this study are discussed with regard to both their methodological and clinical implications.

Asunto(s)

RESUMEN

Although the findings from recent controlled studies suggest that methylphenidate is a safe and effective treatment for many children with attention-deficit hyperactivity disorder (ADHD) and comorbid tic disorder, relatively little is known about drug effects on school behavior. Thirty-four prepubertal children with ADHD and tic disorder received placebo and 3 doses of methylphenidate (0.1, 0.3, and 0.5 mg/kg) twice daily for 2 weeks each under double-blind conditions. Treatment effects were assessed using direct observations of child behavior in classroom, lunchroom, and playground settings. Treatment with methylphenidate resulted in marked reductions of hyperactive, disruptive, and aggressive behavior, which was evident even for the 0.1 mg/kg dose. There were no "nonresponders." The only observed changes in tics were a small but statistically significant increase in the frequency of motor tics (classroom, 0.1 mg/kg dose) and a tendency for fewer vocal tics (lunchroom). However, these changes in motor tic frequency were not perceived by care providers as a worsening in the severity of the child's tic disorder. Most dose-response relationships were linear, but the mean (operationally defined) minimal effective dose (MED) was 0.3 mg/kg. In summary, the findings support the conclusions that (1) methylphenidate suppresses ADHD behaviors in the classroom and aggressive behavior in all settings and that (2) a low dose may have a weak exacerbation effect on the frequency of motor tics; but, in general, the majority of youngsters do not experience clinically significant tic worsening with a MED.

Asunto(s)

RESUMEN

BACKGROUND: The findings from case reports and patient questionnaire surveys have been interpreted as indicating that administration of stimulants is ill-advised for the treatment of attention-deficit hyperactivity disorder in children with tic disorder. METHODS: Thirty-four prepubertal children with attention-deficit hyperactivity disorder and tic disorder received placebo and three dosages of methylphenidate hydrochloride (0.1, 0.3, and 0.5 mg/kg) twice daily for 2 weeks each, under double-blind conditions. Treatment effects were assessed using direct observations of child behavior in a simulated (clinic-based) classroom and using rating scales completed by the parents, teachers, and physician. RESULTS: Methylphenidate effectively suppressed hyperactive, disruptive, and aggressive behavior. There was no evidence that methylphenidate altered the severity of tic disorder, but it may have a weak effect on the frequency of motor (increase) and vocal (decrease) tics. CONCLUSION: Methylphenidate appears to be a safe and effective treatment for attention-deficit hyperactivity disorder in the majority of children with comorbid tic disorder.

Asunto(s)

Asunto(s)

RESUMEN

ABSTRACT The present study examines the indirect "spillover" effects of methylphenidate on the behavior of the classmates of drug-treated children in public school settings, and it measures the extent to which medication normalizes hyperactive and noncompliant-aggressive behaviors. Eleven aggressive hyperactive boys, who met DSM-III diagnostic criteria for attention deficit disorder, received placebo and methylphenidate in a double-blind crossover design. Medication effects were assessed by conducting observations of the drug-treated boy and his peers in the classroom and lunchroom settings. In most classrooms, a spillover effect did not occur for most of the behaviors assessed, but there was a decrease in the rate of nonphysical aggression exhibited by peers as a function of the hyperactive child's methylphenidate dose. Peers were generally less aggressive when the hyperactive boys were receiving methylphenidate than when they received placebo. In the lunchroom, in contrast, peers appeared slightly more noncompliant and aggressive when the aggressive hyperactive boys were receiving medication compared with placebo, but these differences did not attain statistical significance. Methylphenidate effectively normalized the negativistic behaviors of the aggressive hyperactive boys in the classroom. In some cases, the frequency of occurrence of certain behaviors dropped significantly below the level of the hyperactive child's peers. This "supranormalization" may reflect behavioral toxicity of the psychostimulant.

RESUMEN

One of the least documented "known" effects of methylphenidate in hyperactive children is the suppression of peer aggression. In this study, 11 aggressive-hyperactive children received a low (0.3 mg/kg) and moderate (0.6 mg/kg) dose of methylphenidate and placebo for 2 weeks each under double-blind conditions. Children were observed in public school settings during classroom seatwork activities, lunch, and recess. Results showed that methylphenidate suppressed nonphysical aggression (p = 0.06) in the classroom, and a moderate dose decreased physical aggression (p less than 0.01) and verbal aggression (p = 0.07) on the playground. The effect on the rate of appropriate social interaction was variable. The majority of subjects exhibited either the same or higher levels of appropriate social interaction on the 0.6 mg/kg dose compared with placebo. In the classroom, both doses of methylphenidate also resulted in reduced levels of motor movement, off-task behavior, noncompliance, and disruptiveness. Teacher ratings of hyperactivity and conduct problem symptoms revealed drug effects, whereas parallel parent instruments did not.

Asunto(s)

Asunto(s)

RESUMEN

The purpose of this study was to assess the effects of video presentations on the acquisition of both spoken and manually signed lexical items by students with mental retardation. A 10-lesson curriculum in which lexical items were introduced and reviewed by one of three pedagogical methods (therapist only, therapist plus video, or video only) was implemented over a four week period. Pretest and posttest measures of expressive and receptive vocabulary of 35 students with mental retardation revealed that all three methods resulted in significant increases in both spoken and manual sign production of the targeted lexical items compared to control items which were not taught. The therapist only and therapist plus video methods yielded significantly higher sign production scores than the video only method. Receptive vocabulary was not significantly improved by the intervention.

Asunto(s)

RESUMEN

The findings from 20 field experiments were examined to determine the short-term effects of viewing aggression-laden television shows on child social behavior. The available literature provides little support for an effect that is peculiar to aggressive content. In fact, although almost all studies showed elevated levels of antisocial behavior following the viewing of similar material, they also revealed similar, and sometimes greater, effects in response to low or nonaggressive fare. These findings are discussed with regard to their clinical relevance for preventive medicine and implications for imposing "wholesome" television programming on child viewers.

Asunto(s)

Asunto(s)

RESUMEN

The immediate impact of viewing aggressive cartoons on emotionally disturbed (ED) and learning disabled (LD) children's willingness to hurt another child was assessed. Fifteen ED and 23 LD children (M = 7.25 years old) viewed either an aggressive or a comparison cartoon and then played the Help-Hurt game. The children who watched the aggressive cartoon pressed the Hurt button for significantly more time than did those who were exposed to the comparison cartoon. Across cartoon conditions, the ED children pressed the Hurt button significantly longer than did their LD peers.

Asunto(s)

RESUMEN

Four classes of emotionally disturbed (ED) children (20 boys and 6 girls, age: M = 8.1 yr) were exposed to six aggressive and six control cartoons. Treatment effects were assessed using direct observations of five categories of behavior during lunch and recess for baseline and the two cartoon conditions. The results revealed significantly more nonphysical aggression following the control cartoons than during baseline across setting and more physical aggression following the control cartoons relative to the aggressive cartoon and baseline conditions in the recess setting. The findings are discussed with regard to their clinical implications and comparability with other field experiments.

Asunto(s)