Showing papers in "Journal of the American Academy of Child and Adolescent Psychiatry in 1990"
TL;DR: The use of research criteria for diagnosing children as hyperactive identifies a pattern of behavioral symptoms that is highly stable over time and associated with considerably greater risk for family disturbance and negative academic and social outcomes in adolescence than has been previously reported.
Abstract: The psychiatric outcome is reported for a large sample of hyperactive children (N = 123), meeting research diagnostic criteria, and normal control children (N = 66) followed prospectively over an 8-year period into adolescence. Over 80% of the hyperactives were attention deficit hyperactivity disorder (ADHD) and 60% had either oppositional defiant disorder and/or conduct disorder at outcome. Rates of antisocial acts were considerably higher among hyperactives than normals, as were cigarette and marijuana use and negative academic outcomes. The presence of conduct disorder accounted for much though not all of these outcomes. Family status of hyperactives was much less stable over time than in the normal subjects. The use of research criteria for diagnosing children as hyperactive identifies a pattern of behavioral symptoms that is highly stable over time and associated with considerably greater risk for family disturbance and negative academic and social outcomes in adolescence than has been previously reported.
1,467 citations
TL;DR: It is likely that major depressive disorder is relatively uncommon in prepubertal children, increases in frequency in adolescents, and is significantly associated with such variables as family dysfunction and low self-esteem.
Abstract: The methodology of 14 recent epidemiological studies of childhood and adolescent depressive disorders was critically reviewed and findings summarized for prevalence, comorbidity, correlates, risk factors, and outcome. Shortcomings in sampling and considerable inconsistency in the measurement of depression in the studies made it difficult to draw firm conclusions about the prevalence and correlates of depression in young people. Nonetheless, it is likely that major depressive disorder is relatively uncommon in prepubertal children, increases in frequency in adolescents, and is significantly associated with such variables as family dysfunction and low self-esteem. Comorbidity of depression with other psychiatric disorders was also high in these nonpatient samples and it will be important in future work to assess the implications of this for the etiology, treatment, and prognosis of depressive disorders in children and adolescents.
696 citations
TL;DR: A model of parental confirmation of disorder was developed suggesting that confirmation was more likely where the mother was depressed, the family low in social support, and the adolescent less socially competent.
Abstract: The prevalence of DSM-III disorders was studied in 943 adolescents aged 15 years from a general population. Prevalence rates of disorder of 25.9% for girls and 18.2% for boys were found. The most prevalent disorders were overanxious disorder, nonaggressive conduct disorder, and simple phobia. Marked differences were noted among the disorders in terms of associated social competence, with multiple disorders and primarily "externalizing" disorders being related to poorer competence. A model of parental confirmation of disorder was developed suggesting that confirmation was more likely where the mother was depressed, the family low in social support, and the adolescent less socially competent.
648 citations
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646 citations
TL;DR: Relatives of ADD probands had a higher morbidity risk for ADD than did relatives of psychiatric and normal controls and could not be accounted for by gender or generation of relative, the age of proband, social class, or the intactness of the family.
Abstract: Using family study methodology and assessments made by blind raters, this study evaluated family-genetic and psychosocial risk factors for DSM-III attention deficit disorder (ADD) among the 457 first-degree relatives of clinically referred children and adolescents with ADD ( N = 73), compared with psychiatric ( N = 26) and normal controls ( N = 26). Relatives of ADD probands had a higher morbidity risk for ADD (25.1% versus 5.3% versus 4.6%, ps ps p = 0.038 and 27.1% versus 3.6%, p = 0.00001) than did relatives of psychiatric and normal controls. The increased risk for ADD could not be accounted for by gender or generation of relative, the age of proband, social class, or the intactness of the family. These results confirm and extend previous findings indicating important family-genetic risk factors in ADD.
476 citations
TL;DR: Findings regarding prospective risks implicate pica and problem meals in early childhood for later bulimia nervosa and anorexia nervosa; suggesting problems in self-control of eating behavior as well as eating-related family struggles.
Abstract: Maladaptive eating patterns were traced longitudinally in a large random sample of children. Pickiness and concern with weight were more common in girls than in boys, and the prevalence of pickiness declined with age. No age or sex differences in family contention around meals nor in bingeing were shown. All problem behaviors showed significant stability over the 10-year span studied, beginning at ages 1 to 10. Certain eating and digestive problems in early childhood were predictive of symptoms of bulimia nervosa and anorexia nervosa in adolescence. Findings regarding prospective risks implicate pica and problem meals in early childhood for later bulimia nervosa; suggesting problems in self-control of eating behavior as well as eating-related family struggles. Risks in early childhood for subsequent symptoms of anorexia nervosa include picky eating and digestive problems.
416 citations
TL;DR: Age specific incidence revealed a 3- to 22-fold increase in risk for seizure relative to the normal population and risk for developing seizures was highest during early childhood although it was also elevated during early adolescence.
Abstract: Several reports have suggested that autistic individuals are at greater risk for developing seizure disorders, particularly in adolescence. In this study the frequency of seizures in a series of 192 autistic individuals was examined; 21% of cases had exhibited a seizure disorder. Seizure disorders were more common among individuals with lower IQ. Age specific incidence revealed a 3- to 22-fold increase in risk for seizure relative to the normal population. In contrast to previous studies, risk for developing seizures was highest during early childhood although it was also elevated during early adolescence.
410 citations
TL;DR: Whether children with Asperger's Syndrome have similar neurocognitive deficits compared to nonretarded, or high-functioning autistic children; and whether the essential cognitive deficit among these children is in language or abstract problem solving are examined.
Abstract: The objectives of this study were to see: (1) whether children with Asperger's Syndrome (AS) have similar neurocognitive deficits compared to nonretarded, or high-functioning autistic (HFA) children; and (2) whether the essential cognitive deficit among these children is in language or abstract problem solving. Subjects with AS, HFA, and a control group of socially impaired child psychiatric outpatient controls (OPC) were compared on a battery of neuropsychological tests. The results indicated that the AS and HFA groups differed little but that large differences from the OPC were observed on all tests. When the AS and HFA with FSIQ above 85 were compared to the OPC, outstanding deficits on motor coordination, language comprehension, and facial recognition were observed. Finally, some evidence is presented to suggest that the pattern of deficits of AS and HFA subjects varied by developmental level. The implications of these results for a neurological theory of autism are discussed.
335 citations
TL;DR: The majority of overall prevalence estimates of moderate to severe disorder range from 14 to 20%, and investigations that use multiple methods to define caseness show greatest promise in identifying true cases in community samples.
Abstract: . While sharing a new emphasis upon identifying discrete psychiatric disorders in children and adolescents, epidemiological field studies conducted during the past decade have used diverse methods of case ascertainment and definition. Half used the multimethod-multistage approach to ascertain cases. Severity rating scales and measures of pervasiveness, parent-child concordance, and global functional impairment were employed to enhance the specificity of case definition. The majority of overall prevalence estimates of moderate to severe disorder range from 14 to 20%. Those investigations that use multiple methods to define caseness show greatest promise in identifying true cases in community samples.
297 citations
TL;DR: There are two primary diagnostic "subgroups" of school refusers--separation anxious and phobic, and anxiety-based school refusal is classified as separation anxious or phobic.
Abstract: The characteristics of anxiety-based school refusal were examined in 63 school refusing children and adolescents referred to an outpatient anxiety disorder clinic. Patients were assessed on sociodemographic, diagnostic, and personality variables, as well as familial history of school refusal. Results suggest that there are two primary diagnostic "subgroups" of school refusers--separation anxious and phobic. Phobic school refusers had a later age of onset and showed more pervasive (severe) school refusal than separation anxious school refusers. By contrast, separation anxious school refusers were more likely than phobic school refusers to have mothers who had a history of school refusal problems. The implications of these findings are discussed.
272 citations
TL;DR: The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns, and controlling behaviors involving other family members were seen in 57% of the patients.
Abstract: Phenomenology and family history in 21 clinically referred children and adolescents with obsessive compulsive disorder are described. Each child and family participated in a standard clinical psychiatric assessment. The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns. Controlling behaviors involving other family members were seen in 57% of the patients. Associated psychopathology was common: 38% received an anxiety disorder diagnosis; 29% received a mood disorder diagnosis; tics were observed in 24%. Fifteen (71%) of the children had a parent with either obsessive compulsive disorder ( N = 4) or obsessive-compulsive symptoms ( N = 11). The clinical and research implications of these findings are discussed. J. Am. Acad. Child Adolesc. Psychiatry, 1990, 29, 5:766–772.
TL;DR: As part of a longitudinal study of depression in adolescents, the Center for Epidemiologic Studies Depression Scale (CES-D) was administered to 550 students 3 times, at the beginning of the seventh, eighth, and ninth grades.
Abstract: As part of a longitudinal study of depression in adolescents, the Center for Epidemiologic Studies Depression Scale (CES-D) was administered to 550 students 3 times, at the beginning of the seventh, eighth, and ninth grades Blacks and females had higher scores than did whites and males Scores of blacks and males declined more over the 3 year period than did those of females and whites The stability of individual students' depression scores was less consistent than the overall distributions with 1 and 2 year correlations reaching only 053 and 036, respectively The best predictor of subsequent year CES-D scores was the previous year's score Undesirable life events and family adaptability were significant but less important predictors
TL;DR: The increased familial rate of OCD over that expected from a general population, and over that found in parents of conduct disordered patients, is consistent with a genetic factor in OCD.
Abstract: One hundred and forty-five first-degree relatives (89 parents [96%] and 56 siblings [98%]) of 46 children and adolescents with severe primary obsessive compulsive disorder (OCD) were personally interviewed with clinical and structured psychiatric interviews. Parent interviews were scored by a rater blind to proband diagnosis. Thirty percent of probands had at least one first-degree relative with OCD: 25% of fathers and 9% of mothers received this diagnosis. Forty-five percent of fathers and 65% of mothers received one or more other psychiatric diagnoses. The increased familial rate of OCD over that expected from a general population, and over that found in parents of conduct disordered patients, is consistent with a genetic factor in OCD. Presenting obsessive compulsive symptoms of probands and their parents were usually dissimilar, arguing against any simple social or cultural transmission.
TL;DR: In contrast to the effect of parental occupational level on competent scores for normative American and Dutch samples, adopted children from lower SES showed better academic performance, were less often referred to special classes, and had less other school problems than adoptedChildren from higher SES.
Abstract: Behavioral/emotional problems and competencies in 2,148 international adoptees aged 10 to 15 years were compared with those in a same-aged sample of 933 children from the general population using the Achenbach Child Behavior Checklist. Parents reported more externalizing problem behavior for adopted than nonadopted children. More than twice as many 12- to 15-year-old adopted boys were scored above the cutoff criterion for problem behavior than nonadopted boys of the same age. For adopted boys in this age range especially high scores were obtained on the Delinquent and Hyperactive syndromes. Adopted children were scored less competent than nonadopted children in their social and academic functioning, whereas adopted children were found to be more active in nonsports activities and to function somewhat better than nonadopted children in sports and nonsports activities. In contrast to the effect of parental occupational level on competent scores for normative American and Dutch samples, adopted children from lower SES showed better academic performance, were less often referred to special classes, and had less other school problems than adopted children from higher SES.
TL;DR: The present investigation examined the effectiveness of a cognitive behavioral treatment program designed for sexually abused children suffering post-traumatic stress disorder, and revealed significant improvements at post-treatment on all measures.
Abstract: The present investigation examined the effectiveness of a cognitive behavioral treatment program designed for sexually abused children suffering post-traumatic stress disorder. Nineteen girls who suffered contact sexual abuse and met DSM-III-R criteria for post-traumatic stress disorder were included in the study. Subjects ranged in age from 3 to 16 years old. Structured interviews were conducted to assess the presence or absence of post-traumatic stress disorder symptoms before, during, and following the abuse. Additionally, parents completed the Child Behavior Checklist, and subjects at least 6 years of age were administered the Child Depression Inventory and the Spielberger State-Trait Anxiety Inventory at the initial evaluation and again approximately 2 to 3 weeks later before the initiation of treatment. The baseline data collected at these two points were compared, and no significant changes were found over time. The above measures were readministered following 12 treatment sessions. The results revealed significant improvements at post-treatment on all measures. J. Am. Acad. Child Adolesc. Psychiatry, 1990, 29, 5:747–752.
TL;DR: Language functions, rather than the social behaviors examined, carried the greatest predictive power regarding short-term outcomes in children with autism or other pervasive developmental disorders.
Abstract: Data from 39 young children with autism or other pervasive developmental disorders were examined to determine the relevance of the age of social symptom onset and language symptom onset to other developmental variables. Contrary to the authors' hypotheses, earlier onset of social symptoms was not indicative of a greater severity of autistic symptoms, retardation, or incidence of insecure attachments. Early speech loss was associated with lower IQ, greater social deficits, and poorer language development, while the presence of useful speech at age 2 was related to better functioning in multiple domains. Thus, language functions, rather than the social behaviors examined, carried the greatest predictive power regarding short-term outcomes. J. Am. Acad. Child Adolesc. Psychiatry , 1990, 29, 6:863–872.
TL;DR: Both groups of children with recurrent abdominal pain had significantly more psychiatric disorders (predominantly anxiety and depression) than did the healthy group and psychiatric children were rated as significantly more maladjusted on the Children's Global Assessment Scale.
Abstract: Approximately 12% of children report recurrent episodes of abdominal pain. In only about 10% of these cases, however, can an organic etiology be identified, and therefore it often is assumed that these children have emotional problems. To test this hypothesis, children with recurrent abdominal pain (RAP) with no identifiable organic cause were compared to children with an organic diagnosis for their abdominal pain, children with psychiatric disorders, and healthy controls. Both groups of children with abdominal pain had significantly more psychiatric disorders (predominantly anxiety and depression) than did the healthy group. Both RAP and psychiatric children had significantly higher Child Behavior Checklist internalizing scores; psychiatric children were rated as significantly more maladjusted on the Children's Global Assessment Scale. Mothers of RAP children were significantly more anxious than mothers of organic pain and healthy children. Psychiatric children were significantly more likely than the other three groups to underreport their psychiatric symptoms relative to their mothers.
TL;DR: The desirability of incorporating a measure of impairment to the categorization of childhood psychopathology in the community is examined and the use of the Children's Global Assessment Scale (CGAS) for this purpose is recommended.
Abstract: The desirability of incorporating a measure of impairment to the categorization of childhood psychopathology in the community is examined. The use of the Children's Global Assessment Scale (CGAS) for this purpose is recommended. The choice of 61 (definite case) and 71 (probable case) as cutpoints on the Children's Global Assessment Scale is supported empirically by the data on service utilization, parental perceived need, and behavior problem scores obtained in the Puerto Rico Child Psychiatry Epidemiological Study. J. Am. Acad. Child Adolesc. Psychiatry, 1990, 29. 5:796–803.
TL;DR: The parent-child relationship was associated with children's disturbance in both harmonious and disharmonious homes, and factors which interacted with the quality of parental marriage were children having a relationship with an adult outside the family, an activity for which they received much positive recognition, and good sibling relationships.
Abstract: This study investigated factors which were protective to children living in disharmonious homes. The sample was drawn from a representative sample of children aged 9 to 12 who took part in a previous general population study. Semi-structured interviews with both parents were used to assess the quality of the parental marriage. Mothers provided information on children's emotional and behavioral problems and putative protective factors. Fifty-seven families were in the disharmonious marriage group and 62 were in the harmonious marriage group. Putative protective factors, hypothesized to be beneficial for children, were either an aspect of social support or related to children's activities. Data were analyzed using a two-way analysis of variance with parental marriage and the putative protective factor as main effects. A differentiation was made between protective factors which interacted with parental marriage and those that acted independently. Factors which interacted with the quality of parental marriage were children having a relationship with an adult outside the family, an activity for which they received much positive recognition, and good sibling relationships. The parent-child relationship was associated with children's disturbance in both harmonious and disharmonious homes.
TL;DR: All outcome studies of child and adolescent residential treatment and inpatient psychiatric hospitalization reported in the literature from 1975 to the present were examined and recommendations to guide future researchers are offered that will provide new insights into better understanding in patient psychiatric treatment.
Abstract: All outcome studies of child and adolescent residential treatment and inpatient psychiatric hospitalization reported in the literature from 1975 to the present were examined. A set of statistical procedures was developed to integrate the findings of the 34 studies, which provided a weighted predictive value for 10 variables. Psychiatric hospitalization was often beneficial, particularly if a specialized treatment program and aftercare were available and if the child presented with a less pathological clinical picture. Age at admission and sex bore no relationship to favorable outcome, and IQ and length of stay yielded only a modest relationship to outcome. Recommendations to guide future researchers are offered that will provide new insights into better understanding inpatient psychiatric treatment. J. Am. Acad. Child Adolesc. Psychiatry , 1990, 29, 6:847–853.
TL;DR: This study is the first to investigate the frequency of disorders in the adult siblings of autistic probands, and results suggest aggregation of a variety of neuropsychiatric Disorders in theiblings of autistic individuals.
Abstract: The family history method was used to obtain developmental, social, and psychiatric histories on the 67 adult siblings of 37 autistic probands. Two of 67 siblings (3.0%) were autistic, three siblings (4.4%) had severe social dysfunction and isolation, 10 (15%) had cognitive disorders, and 10 (15%) had received treatment for affective disorder. This study is the first to investigate the frequency of disorders in the adult siblings of autistic probands. These results suggest aggregation of a variety of neuropsychiatric disorders in the siblings of autistic individuals.
TL;DR: Examination of prevalence, expression, and developmental patterns of DSM-III-R anxiety disorder symptoms in never-psychiatrically-ill children found subclinically anxious children showed greater individual and family psychopathology than nonanxious children, though differences decreased at 12-month follow-up.
Abstract: The present study examined prevalence, expression, and developmental patterns of DSM-III-R anxiety disorder symptoms in 62 never-psychiatrically-ill children. Subclinical phobias and overanxious disorder symptoms were fairly common, while symptoms of other anxiety disorders were less common. Direction of sex and age differences was generally consistent with previous literature, but few reached statistical significance. Nonanxious and subclinically anxious subsamples of never-psychiatrically-ill subjects were compared on individual and family psychopathology. Subclinically anxious children showed greater individual and family psychopathology than nonanxious children, though differences decreased at 12-month follow-up. Anxiety as a normal developmental phenomenon is discussed. J. Am. Acad. Child Adolesc. Psychiatry, 1990, 29, 5:759–765.
TL;DR: The hypothesis that disturbances in frontal lobe function related to impulse control may be responsible for the cognitive impairments observed in ADHD was not supported andability to control and direct attention appears to be more central to the pathophysiology of this disorder.
Abstract: The performances of 20 children with attention deficit hyperactivity disorder (ADHD) were compared with those of 20 matched normal controls on a battery of neuropsychological tests. The ADHD children exhibited impaired function in reading comprehension, verbal learning and memory, and on the Information, Arithmetic, Digit Span, Block Design, and Coding subtests of the Wechsler Intelligence Scale for Children-Revised, but they performed nearly normally on measures of verbal and design fluency and on the Wisconsin Card Sorting Test. The hypothesis that disturbances in frontal lobe function related to impulse control may be responsible for the cognitive impairments observed in ADHD was not supported. Inability to control and direct attention appears to be more central to the pathophysiology of this disorder.
TL;DR: Examination of factors which influence the likelihood that a pediatrician will identify a psychiatric problem and refer an identified child to a mental health specialist for further evaluation and treatment found parental level of distress, family psychiatric history, and discussion of parental concerns with the pediatrician important.
Abstract: Data from a study of children seen for pediatric care in a Health Maintenance Organization are used to examine factors which influence the likelihood that a pediatrician will identify a psychiatric problem and refer an identified child to a mental health specialist for further evaluation and treatment. Parental level of distress, family psychiatric history, and discussion of parental concerns with the pediatrician were found to be important. Characteristics of the service delivery system which may impede appropriate identification and referral are discussed. Implications for participation of child and adolescent psychiatrists in the training of pediatricians are presented.
TL;DR: Parents of the OCD children reported significantly more "marked" patterns of early ritualistic behavior than did parents of normal controls, leaving open the possibility that such behaviors were early manifestations of the disorder.
Abstract: . The symptoms of obsessive compulsive disorder (OCD) have been viewed as extreme variants of normal developmental rituals and superstitiousness; however, difference in timing, content, and severity argue against this continuum. In a systematic comparison of 38 children with severe primary OCD and 22 matched normal controls, parents were interviewed about their child's early developmental rituals and current superstitions. Children were asked about superstitious beliefs. Children with OCD did not differ significantly from controls in number or type of superstitions. However, parents of the OCD children reported significantly more “marked” patterns of early ritualistic behavior than did parents of normal controls. When behaviors resembling primary OCD symptoms were excluded, other rituals did not differ leaving open the possibility that such behaviors were early manifestations of the disorder. Only a prospective study can determine whether these results reflect preclinical OCD or are an artifact of biased recall.
TL;DR: Most of the significant cross-cultural differences in parent, teacher, and self-ratings of competencies showed more favorable scores for the mainland subjects, but were significantly lower in self-Ratings by Puerto Rican adolescents.
Abstract: U.S. mainland and Puerto Rican nonreferred samples were compared via the Child Behavior Checklist (ages 4 to 16), Teacher's Report Form (ages 6 to 16), and Youth Self-Report (ages 12 to 16). Problem scores were significantly higher in parent and teacher ratings of Puerto Rican than mainland subjects, but were significantly lower in self-ratings by Puerto Rican adolescents. Adolescents in both cultures reported significantly more problems than their parents or teachers did. Most of the significant cross-cultural differences in parent, teacher, and self-ratings of competencies showed more favorable scores for the mainland subjects. High referral rates, a high prevalence of DSM diagnoses, and low scores on the Children's Global Assessment Scale are consistent with the high problem rates reported by Puerto Rican parents and teachers but not with the lower rates reported by adolescents. Different clinical cutoffs may be needed for all assessments in the mainland versus Puerto Rico.
TL;DR: Severity of maternal life stress during pregnancy, gender of the child, and severe nausea and/or vomiting during the first trimester were found to be significantly associated with current tic severity.
Abstract: The search for nongenetic factors that mediate the expression of a genetic vulnerability to Tourette's syndrome (TS) is an important undertaking that may provide valuable clues concerning the pathophysiology of this disorder as well as potential treatment approaches. In a direct interview study, the perinatal experiences of 31 TS patients were compiled in an effort to identify risk factors associated with tic severity. Severity of maternal life stress during pregnancy, gender of the child, and severe nausea and/or vomiting during the first trimester were found to be significantly associated with current tic severity. Future longitudinal studies of “at-risk” children are needed to confirm these findings. Set in the context of a known chromosomal site for the TS diathesis, such studies will permit the identification and quantification of risk and protective factors in the expression of TS and further develop TS as a model neuropsychiatric disorder for the study of gene–environment interactions.
TL;DR: This study, like others, failed to provide strong support for differences in background characteristics among children with different diagnoses, which may reflect the degree of overlap among disorders.
Abstract: The relationship between risk factors and behavioral and emotional disorder was examined in 792 11-year-old children. Background characteristics such as sex, maternal depression, marital status of the parents, and reading problems distinguished between children with and without disorder. It also appeared that disorder was related to the number of risk factors experienced. This study, like others, failed to provide strong support for differences in background characteristics among children with different diagnoses. This may reflect the degree of overlap among disorders, because even children with only a single disorder may not be entirely free of the symptomatology of other disorders. For this reason it is important to assess children for multiple disorders or at least consider impaired functioning in other dimensions.