Showing papers in "Journal of the American Academy of Child and Adolescent Psychiatry in 2001"

Psychometric properties of the strengths and difficulties questionnaire.

Abstract: Objective To describe the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a brief measure of the prosocial behavior and psychopathology of 3–16-year-olds that can be completed by parents, teachers, or youths. Method A nationwide epidemiological sample of 10,438 British 5–15-year-olds obtained SDQs from 96% of parents, 70% of teachers, and 91% of 11–15-year-olds. Blind to the SDQ findings, all subjects were also assigned DSM-IV diagnoses based on a clinical review of detailed interview measures. Results The predicted five-factor structure (emotional, conduct, hyperactivity-inattention, peer, prosocial) was confirmed. Internalizing and externalizing scales were relatively "uncontaminated" by one another. Reliability was generally satisfactory, whether judged by internal consistency (mean Cronbach α: .73), cross-informant correlation (mean: 0.34), or retest stability after 4 to 6 months (mean: 0.62). SDQ scores above the 90th percentile predicted a substantially raised probability of independently diagnosed psychiatric disorders (mean odds ratio: 15.7 for parent scales, 15.2 for teacher scales, 6.2 for youth scales). Conclusion The reliability and validity of the SDQ make it a useful brief measure of the adjustment and psychopathology of children and adolescents.

Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions.

Abstract: Objective To examine the test-retest reliability of the DSM-IV anxiety symptoms and disorders in children with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions (ADIS for DSM-IV: C/P). Method Sixty-two children (aged 7–16 years) and their parents underwent two administrations of the ADIS for DSM-IV: C/P with a test-retest interval of 7 to 14 days. Results and Conclusions Results revealed that the ADIS for DSM-IV: C/P is a reliable instrument for deriving DSM-IV anxiety disorder symptoms and diagnoses in children. The ADIS for DSM-IV: C/P was found to have excellent reliability in symptom scale scores for separation anxiety disorder, social phobia, specific phobia, and generalized anxiety disorder and good to excellent reliability for deriving combined diagnoses of these disorders, as well as using child-only and parent-only interview information. Reliability coefficients were generally similar and, in most instances, superior to those found in previous ADIS-C/P reliability studies. Limitations and directions for future research are discussed.

Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment.

Abstract: Objectives To develop a categorical outcome measure related to clinical decisions and to perform secondary analyses to supplement the primary analyses of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA). Method End-of-treatment status was summarized by averaging the parent and teacher ratings of attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms on the Swanson, Nolan, and Pelham, version IV (SNAP-IV) scale, and low symptom-severity ("Just a Little") on this continuous measure was set as a clinical cutoff to form a categorical outcome measure reflecting successful treatment. Three orthogonal comparisons of the treatment groups (combined treatment [Comb], medication management [MedMgt], behavioral treatment [Beh], and community comparison [CC]) evaluated hypotheses about the MTA medication algorithm ("Comb + MedMgt versus Beh + CC"), multimodality superiority ("Comb versus MedMgt"), and psychosocial substitution ("Beh versus CC"). Results The summary of SNAP-IV ratings across sources and domains increased the precision of measurement by 30%. The secondary analyses of group differences in success rates (Comb = 68%; MedMgt=56%; Beh=34%; CC=25%) confirmed the large effect of the MTA medication algorithm and a smaller effect of multimodality superiority, which was now statistically significant ( p Conclusion These secondary analyses confirm the primary findings and clarify clinical decisions about the choice between multimodal and unimodal treatment with medication.

Life course outcomes of young people with anxiety disorders in adolescence.

Abstract: Objective This study examined associations between the extent of anxiety disorder in adolescence (14–16 years) and young people's later risks of a range of mental health, educational, and social role outcomes (16–21 years). Method Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1,265 New Zealand children. Measures collected included (1) an assessment of DSM-III-R anxiety disorders between the ages of 14 and 16 years; (2) assessments of mental health, educational achievement, and social functioning between the ages of 16 and 21 years; and (3) measures of potentially confounding social, family, and individual factors. Results Significant linear associations were found between the number of anxiety disorders reported in adolescence and later risks of anxiety disorder; major depression; nicotine, alcohol, and illicit drug dependence; suicidal behavior; educational underachievement; and early parenthood. Associations between the extent of adolescent anxiety disorder and later risks of anxiety disorder, depression, illicit drug dependence, and failure to attend university were shown to persist after statistical control for the confounding effects of sociofamilial and individual factors. Conclusions Findings suggest that adolescents with anxiety disorders are at an increased risk of subsequent anxiety, depression, illicit drug dependence, and educational underachievement as young adults. Clinical and research implications are considered.

ADHD Comorbidity Findings From the MTA Study: Comparing Comorbid Subgroups

Abstract: Objectives Previous research has been inconclusive whether attention-deficit/hyperactivity disorder (ADHD), when comorbid with disruptive disorders (oppositional defiant disorder [ODD] or conduct disorder [CD]), with the internalizing disorders (anxiety and/or depression), or with both, should constitute separate clinical entities. Determination of the clinical significance of potential ADHD + internalizing disorder or ADHD + ODD/CD syndromes could yield better diagnostic decision-making, treatment planning, and treatment outcomes. Method Drawing upon cross-sectional and longitudinal information from 579 children (aged 7–9.9 years) with ADHD participating in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA), investigators applied validational criteria to compare ADHD subjects with and without comorbid internalizing disorders and ODD/CD. Results Substantial evidence of main effects of internalizing and externalizing comorbid disorders was found. Moderate evidence of interactions of parent-reported anxiety and ODD/CD status were noted on response to treatment, indicating that children with ADHD and anxiety disorders (but no ODD/CD) were likely to respond equally well to the MTA behavioral and medication treatments. Children with ADHD-only or ADHD with ODD/CD (but without anxiety disorders) responded best to MTA medication treatments (with or without behavioral treatments), while children with multiple comorbid disorders (anxiety and ODD/CD) responded optimally to combined (medication and behavioral) treatments. Conclusions Findings indicate that three clinical profiles, ADHD co-occurring with internalizing disorders (principally parent-reported anxiety disorders) absent any concurrent disruptive disorder (ADHD + ANX), ADHD co-occurring with ODD/CD but no anxiety (ADHD + ODD/CD), and ADHD with both anxiety and ODD/CD (ADHD + ANX + ODD/CD) may be sufficiently distinct to warrant classification as ADHD subtypes different from "pure" ADHD with neither comorbidity. Future clinical, etiological, and genetics research should explore the merits of these three ADHD classification options.

Preschool children with attention-deficit/hyperactivity disorder: impairments in behavioral, social, and school functioning.

Abstract: Objective To examine differences in home, school, and medical functioning between preschool-age children with attention-deficit/hyperactivity disorder (ADHD) and normal control children. Method A sample of 94 children (58 with ADHD, 36 normal controls) between 3 and 5 years old participated. Dependent measures included parent and teacher ratings of problem behavior and social skills, parent ratings of stress and family functioning, medical functioning data, observations of parent–child interactions and classroom behavior, and a test of preacademic skills. Results Young children with ADHD exhibited more problem behavior and were less socially skilled than their normal counterparts according to behavior ratings. Parents of children with ADHD experienced greater stress and were coping less adaptively than parents of non-ADHD children. Children with ADHD exhibited more noncompliant and inappropriate behavior than normal controls, particularly during task situations. Parents of children with ADHD were more likely to display negative behavior toward their children. Children with ADHD exhibited more negative social behavior in preschool settings and scored significantly lower on a test of preacademic skills. No significant differences in injuries or utilization of medical services were found. Conclusions Preschool-age children with ADHD are at significant risk for behavioral, social, familial, and academic difficulties relative to their normal counterparts.

Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial.

Abstract: Objective To compare paroxetine with placebo and imipramine with placebo for the treatment of adolescent depression. Method After a 7- to 14-day screening period, 275 adolescents with major depression began 8 weeks of double-blind paroxetine (20–40 mg), imipramine (gradual upward titration to 200–300 mg), or placebo. The two primary outcome measures were endpoint response (Hamilton Rating Scale for Depression [HAM-D] score ≤8 or ≥50% reduction in baseline HAM-D) and change from baseline HAM-D score. Other depression-related variables were (1) HAM-D depressed mood item; (2) depression item of the Schedule for Affective Disorders and Schizophrenia for Adolescents-Lifetime version (K-SADS-L); (3) Clinical Global Impression (CGI) improvement scores of 1 or 2; (4) nine-item depression subscale of K-SADS-L; and (5) mean CGI improvement scores. Results Paroxetine demonstrated significantly greater improvement compared with placebo in HAM-D total score ≤8, HAM-D depressed mood item, K-SADS-L depressed mood item, and CGI score of 1 or 2. The response to imipramine was not significantly different from placebo for any measure. Neither paroxetine nor imipramine differed significantly from placebo on parent-or self-rating measures. Withdrawal rates for adverse effects were 9.7% and 6.9% for paroxetine and placebo, respectively. Of 31.5% of subjects stopping imipramine therapy because of adverse effects, nearly one third did so because of adverse cardiovascular effects. Conclusions Paroxetine is generally well tolerated and effective for major depression in adolescents.

Attention-deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence.

Abstract: Objective To determine whether childhood attention-deficit hyperactivity disorder (ADHD) and persistence of the disorder are associated with later difficulty in adolescent peer relations. Method One hundred eleven children with ADHD were interviewed as adolescents and compared with 100 adolescents without an ADHD history (aged 13–18 years). The multi-informant assessment strategy included parents, teachers, and adolescents. Results Parents of probands reported fewer close friendships and greater peer rejection compared with the non-ADHD group. Probands reported that their friends were less involved in conventional activities compared with the non-ADHD group. Childhood aggression predicted less self-perceived social competence for probands. The long-term effects of ADHD on social functioning were more pronounced for probands with persistent ADHD or conduct disorder in adolescence. Conclusions Impairments in peer relations for ADHD youths, known to be common in childhood, also exist in adolescence. Given the developmental significance of peer relations, further research into the causes and treatment of poor social functioning in youths with ADHD is recommended.

Prevalence of Psychiatric Disorders in Youths Across Five Sectors of Care

Abstract: Objective To examine the prevalence of psychiatric disorders among youths from the following five public sectors of care: alcohol and drug services (AD), child welfare (CW), juvenile justice (JJ), mental health (MH), and public school services for youths with serious emotional disturbance (SED) in San Diego, California. Method The Diagnostic Interview Schedule for Children was administered between October 1997 and January 1999 for 1,618 randomly selected youths aged 6–18 years who were active in at least one of the five sectors. Results Fifty-four percent of the participants met criteria for at least one study disorder. Attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (50%) were much more common than anxiety (10%) or mood (7%) disorders. Youths who were active in the MH and SED sectors were more likely than those not in these sectors to meet criteria for a disorder; youths in the CW sector were least likely. Conclusions Rates of psychiatric disorders, specifically ADHD and disruptive behavior disorders, are extremely high for youths in public sectors of care. Rates are generally higher in sectors designed to serve youths with psychiatric needs, but the prevalence of disorders was also high in sectors not specifically designed for this need (e.g., CW and JJ).

Behavioral and neural consequences of prenatal exposure to nicotine.

Abstract: Objective To review evidence for the neurodevelopmental effects of in utero exposure to nicotine. Concerns about long-term cognitive and behavioral effects of prenatal exposure to nicotine arise from reports of increased rates of disruptive behavioral disorders in children whose mothers smoked during pregnancy. The relatively high rate of tobacco smoking among pregnant women (25% of all pregnancies in the U.S.) underlines the seriousness of these concerns. Method This review examines the largest and most recent epidemiological and clinical studies that investigated the association of prenatal nicotine exposure with health, behavioral, and cognitive problems. Because of the numerous potential confounding variables in human research, findings from animal studies, in which environmental factors are strictly controlled, are also discussed. Finally, neural and molecular mechanisms that are likely to underlie neurodevelopmental disruptions produced by prenatal nicotine exposure are outlined. Results A dose-response relationship between maternal smoking rates and low birth weight (potentially associated with lower cognitive ability) and spontaneous abortion is consistently found, whereas long-term developmental and behavioral effects in the offspring are still controversial, perhaps because of the difficulty of separating them from other genetic and environmental factors. Despite the wide variability of experimental paradigms used in animal studies, common physical and behavioral effects of prenatal exposure to nicotine have been observed, including low birth weight, enhanced locomotor activity, and cognitive impairment. Finally, disturbances in neuronal pathfinding, abnormalities in cell proliferation and differentiation, and disruptions in the development of the cholinergic and catecholaminergic systems all have been reported in molecular animal studies of in utero exposure to nicotine. Conclusions Prenatal exposure to nicotine may lead to dysregulation in neurodevelopment and can indicate higher risk for psychiatric problems, including substance abuse. Knowledge of prenatal exposure to nicotine should prompt child psychiatrists to closely monitor at-risk patients.

Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies.

Abstract: Objective To examine relations between maternal depression (in pure and comorbid forms) and mother–infant interactions, infant attachment, and toddler social-emotional problems and competencies. A second objective was to explore sex differences. Method Sixty-nine mother–infant dyads were followed from pregnancy to 30 months postpartum. Depression was measured at multiple times with self-report and interview assessments. Play was assessed at 4 months and attachment status at 14 months postpartum. At 30 months, mothers completed the Child Behavior Checklist and Infant-Toddler Social and Emotional Assessment. Results Lifetime maternal depression predicted less optimal mother–infant interactions and insecure infant attachment. However, this “depression effect” was accounted for by mothers with comorbid diagnoses, who had less optimal interactions, and infants with higher rates of insecurity than either mothers with depression only or mothers with no psychopathology. Prenatal and postpartum depressive symptoms were associated with problem behaviors and lower competencies for boys. In contrast, quality of early interactions predicted problem behaviors in girls. Conclusions It is important to examine the context of maternal depression with respect to additional psychopathology and environmental risks. Maternal depression in the presence of other psychopathology confers risk to the mother–child dyad. Consistent with previous work, risk pathways appear to differ for boys and girls. Early identification and prevention efforts are warranted.

Longitudinal study of maternal depressive symptoms and child well-being.

Abstract: Objective To investigate whether prenatal, postnatal, and/or current maternal depressive symptoms are associated with low level of psychosocial functioning or high level of emotional/behavioral problems in school-age children. Method As part of a prospective longitudinal study, maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, and when the children were 8 to 9 years old. The original sample of 349 mothers was collected in 1989–1990 in Tampere, Finland. Of the 270 mother–child pairs at the latest stage of the study in 1997–1998, 188 mother–child pairs participated and 147 were included. The associations between maternal depressive symptoms at different points in time and the level of children's psychosocial functioning and problems reported on the Child Behavior Checklist and Teacher's Report Form were examined. Results Children's low social competence and low adaptive functioning were associated with concurrent maternal depressive symptoms. Maternal postnatal depressive symptoms predicted low social competence. The presence of prenatal depressive symptoms in the mother was a strong predictor of child's high externalizing and total problem levels (odds ratio 3.1, 95% confidence interval 1.1–8.9 and odds ratio 8.5, 95% confidence interval 2.7–26.5). Prenatal as well as recurrent maternal depressive symptoms were associated with the least favorable child outcome. Conclusions Maternal depressive symptomatology at any time, especially prenatally, is a risk factor for the child's well-being. This should be noted already in prenatal care. The timing and the recurrence of maternal depressive symptoms affect the outcome for the child.

Fourteen-Year Follow-up of Speech/Language-Impaired and Control Children: Psychiatric Outcome

Abstract: Objective To examine the association between early childhood speech and language disorders and young adult psychiatric disorders. Method In a longitudinal community study conducted in the Ottawa-Carleton region of Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech-impaired only, language-impaired, or nonimpaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This report examines the association between early childhood speech/language status and young adult psychiatric outcome. Results Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with nonimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language-impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech/language status. The majority of participants with a disorder had more than one. Conclusions Results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14-year period. This association underscores the importance of effective and early interventions.

Psychosocial and Risk Behavior Correlates of Youth Suicide Attempts and Suicidal Ideation

Abstract: Objective To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts. Method The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Results Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting. Conclusion Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior

Abstract: These guidelines review what is known about the epidemiology, causes, management, and prevention of suicide and attempted suicide in young people. Detailed guidelines are provided concerning the assessment and emergency management of the children and adolescents who present with suicidal behavior. The guidelines also present suggestions on how the clinician may interface with the community. Crisis hotlines, method restriction, educational programs, and screening/ case-finding suicide prevention strategies are examined, and the clinician is advised on media counseling. Intervention in the community after a suicide, minimization of suicide contagion or imitation, and the training of primary care physicians and other gatekeepers to recognize and refer the potentially suicidal child and adolescent are discussed.

Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections.

Abstract: Objective To investigate the reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections. Method The 1986 version of the KSADS was modified and expanded to include onset and offset of each symptom for both current and lifetime episodes, expanded prepubertal mania and rapid cycling sections, and categories for attention-deficit/hyperactivity disorder and other DSM-IV diagnoses. To optimize diagnostic research, skip-outs were minimized. Subjects participated in the ongoing "Phenomenology and Course of Pediatric Bipolar Disorder" study. Mothers and children were interviewed separately by research nurses who were blind to diagnostic group status. In addition, ratings of off-site child psychiatrists, made from the narrative documentation given for each WASH-U-KSADS item, were compared with research nurse ratings. This work was performed between 1995 and 2000. Results There was 100% interrater reliability, five consecutive times, as both interviewer and observer after 10 to 15 trials. The κ values of comparisons between research nurse and off-site blind best-estimate ratings of mania and rapid cycling sections were excellent (0.74–1.00). High 6-month stability for mania diagnoses (85.7%) and for individual mania items and validity against parental and teacher reports were previously reported. Conclusions The WASH-U-KSADS mania and rapid cycling sections have acceptable reliability.

Impact of media on children and adolescents: a 10-year review of the research.

Abstract: Objective To review the research literature published within the past 10 years regarding the impact of media on children and adolescents. Method Media categories researched with computer technology included television and movies, rock music and music videos, advertising, video games, and computers and the Internet. Results Research prior to 1990 documented that children learn behaviors and have their value systems shaped by media. Media research since has focused on content and viewing patterns. Conclusions The primary effects of media exposure are increased violent and aggressive behavior, increased high-risk behaviors, including alcohol and tobacco use, and accelerated onset of sexual activity. The newer forms of media have not been adequately studied, but concern is warranted through the logical extension of earlier research on other media forms and the amount of time the average child spends with increasingly sophisticated media.

Symptom profiles in children with ADHD: effects of comorbidity and gender

Abstract: Objective To examine ratings and objective measures of attention-deficit/hyperactivity disorder (ADHD) symptoms to assess whether ADHD children with and without comorbid conditions have equally high levels of core symptoms and whether symptom profiles differ as a function of comorbidity and gender. Method Four hundred ninety-eight children from the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA) were divided into comorbid groups based on the parent Diagnostic Interview Schedule for Children and assessed via parents' and teachers' Swanson, Nolan, and Pelham (SNAP) ratings and a continuous performance test (CPT). Comorbidity and gender effects were examined using analyses of covariance controlled for age and site. Results CPT inattention, impulsivity, and dyscontrol errors were high in all ADHD groups. Children with ADHD + oppositional defiant or conduct disorder were rated as more impulsive than inattentive, while children with ADHD + anxiety disorders (ANX) were relatively more inattentive than impulsive. Girls were less impaired than boys on most ratings and several CPT indices, particularly impulsivity, and girls with ADHD + ANX made fewer CPT impulsivity errors than girls with ADHD-only. Conclusions Children with ADHD have high levels of core symptoms as measured by rating scales and CPT, irrespective of comorbidity. However, there are important differences in symptomatology as a function of comorbidity and gender.

Anatomical MRI of the developing human brain: what have we learned?

Abstract: Objective: To critically review and integrate the existing literature on magnetic resonance imaging (MRI) studies of the normally developing brain in childhood and adolescence and discuss the implications for clinical MRI studies. Method: Changes in regional brain volume with age and differences between the sexes are summarized from reports in refereed journal articles pertaining to MRI of the developing human brain. Results: White matter volume increases with age. Gray matter volumes increase during childhood and then decrease before adulthood. On average, boys have larger brains than girls; after correction for overall brain volume the caudate is relatively larger in girls, and the amygdala is relatively larger in boys. Differences are of clinical interest given gender-related differences in the age of onset, symptomatology, and prevalence noted for nearly all childhood-onset psychiatric disorders. Attention-deficit/hyperactivity disorder is frequently used as an example to demonstrate these points. Conclusions: Understanding the developmental trajectories of normal brain development and differences between the sexes is important for the interpretation of clinical imaging studies. J. Am. Acad. Child Adolesc. Psychiatry, 2001, 40(9):1012‐1020. Key Words: brain, development, magnetic resonance imaging, review.

Parent-Based Therapies for Preschool Attention-Deficit/Hyperactivity Disorder: A Randomized, Controlled Trial With a Community Sample

Abstract: Objective To evaluate two different parent-based therapies for preschool attention-deficit/hyperactivity disorder (ADHD) in a community sample. Method Three-year-old children displaying a preschool equivalent of ADHD ( n = 78) were randomly assigned to either a parent training (PT; n = 30), a parent counseling and support (PCS n = 28), or a waiting-list control group ( n = 20). The PT group received coaching in child management techniques. The PCS p F 2,74 = 10.32; p 2 = 4.08; p = .048). Conclusions PT is a valuable treatment for preschool ADHD. PC&S had little effect on children's behavior. Constructive training in parenting strategies is an important element in the success of parent-based interventions. Psychostimulants are not a necessary component of effective treatment for many children with preschool ADHD.

Gender differences in suicide attempts from adolescence to young adulthood

Abstract: Objective To examine associations of age, gender, and psychosocial factors during adolescence with risk of suicide attempt between ages 19 and 23 years Method Initial assessments were conducted with 1,709 adolescents (aged 14–18) in western Oregon between 1987 and 1989 One year later, 1,507 participants returned for a second assessment A subset of participants ( n = 941; 572% women) had a third diagnostic assessment after turning 24 (between 1993 and 1999) Information on suicidal behavior, psychosocial risk factors, and lifetime DSM-III-R psychiatric diagnosis was collected at each assessment Results The suicide attempt hazard rate for female adolescents was significantly higher than for male adolescents (Wilcoxon χ 2 1 [ n = 941] = 1269, p Conclusions Unlike depression, the elevated incidence rate of suicide attempts by adolescent girls is not maintained into young adulthood Screening and prevention implications are discussed

The DISC Predictive Scales (DPS): efficiently screening for diagnoses.

Abstract: Objective To derive and test a series of brief diagnosis-specific scales to identify subjects who are at high probability of meeting diagnostic criteria and those who may safely be spared more extensive diagnostic inquiry. Method Secondary data analysis of a large epidemiological data set ( n = 1,286) produced a series of gate and contingent items for each diagnosis. Findings were replicated in a second retrospective analysis from a residential care sample ( n = 884). The DISC Predictive Scales (DPS) were then used prospectively as a self-report questionnaire in two studies, in which parents ( n = 128) and/or adolescents ( n = 208) had subsequent diagnostic interviewing with the Diagnostic Interview Schedule for Children or the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Results All analyses showed that gate item selection was valid and that any missed cases were due solely to inconsistent reports on the same questions. Screening performance of the full scales was shown to be good, and substantial reductions in scale length were not associated with significant changes in discriminatory power. Conclusions The DPS can accurately determine subjects who can safely be spared further diagnostic inquiry in any diagnostic area. This has the potential to speed up structured diagnostic interviewing considerably. The full DPS can be used to screen accurately for cases of specific DSM-III-R disorders.

Longitudinal relationships between childhood, adolescent, and adult eating disorders.

Abstract: Objective This study investigates the longitudinal course of eating problems from childhood though adulthood. The following questions are answered: (1) How stable are eating disorder symptoms and diagnoses over a 17-year interval from childhood to adulthood? (2) Do early childhood eating problems predict the occurrence of eating disorders in adulthood? Method An epidemiologically selected sample of approximately 800 children and their mothers received DSM -based structured psychiatric assessments in 1975, 1983, 1985, and 1992. The stability of full DSM diagnostic criteria for anorexia nervosa and bulimia nervosa, symptom scales derived from DSM criteria, and individual symptoms such as binge eating or dieting between early adolescence, late adolescence, and young adulthood was examined. Results Early adolescent bulimia nervosa is associated with a 9-fold increase in risk for late adolescent bulimia nervosa and a 20-fold increase in risk for adult bulimia nervosa. Late adolescent bulimia nervosa is associated with a 35-fold increase in risk for adult bulimia nervosa. Symptom scale scores for anorexia nervosa and bulimia nervosa correlate in the 0.3 to 0.5 range from early to late adolescence and young adulthood. For both anorexia nervosa and bulimia nervosa, gender, as well as eating symptoms at early and late adolescence, all predict young-adult eating disorder symptoms. Risk factors for the later development of eating disorders comprise eating conflicts, struggles with food, and unpleasant meals in early childhood. Conclusion The presence of eating problems in early childhood or an eating disorder in adolescence confers a strong risk for an eating disorder in young adulthood.

Prevalence of Social-Emotional and Behavioral Problems in a Community Sample of 1- and 2-Year-Old Children

Abstract: Objective To examine the prevalence of infant-toddler social-emotional and behavioral problems and associations with social-emotional competence, interference in family life, and parental worry Method The sample consisted of 1-and 2-year-old children (mean [MN] age=248 months) from the baseline survey of a representative sample of healthy births ( N = 1,280) Parent questionnaires included the Child Behavior Checklist (CBCL/2–3), Parenting Stress Index Short Form (PSI/SF), and Infant-Toddler Social and Emotional Assessment social-emotional competence scales, as well as questions about parental worry and family activities Results Approximately 80% of eligible subjects participated The weighted prevalence of parent-reported subclinical/clinical CBCL/2–3 scores was 118% for 2-year-olds Approximately 6% of parents of 1-and 2-year-olds reported clinical-level scores on the PSI Difficult Child (PSI/DC) scale, which was included as a proxy for behavior problems among 1-year-olds, for whom measures were limited Sex differences were not observed CBCL/2–3 and PSI/DC scores were uniquely associated with economic disadvantage (relative risk=189 and 224, respectively) Approximately 32% of 2-year-olds with subclinical/clinical CBCL/2–3 scores had delayed social-emotional competence Problems were also associated with parental worry about child behavior and interference in family activities Conclusions A significant need for early identification of emotional/behavioral problems in very young children is highlighted by associations with delayed competence and disruptions in family life that may further contribute to risk for persistent problems

Infant and Toddler Pathways Leading to Early Externalizing Disorders

Abstract: Objective To examine pathways leading to specific types of early externalizing disorders. Method Longitudinal data were collected on 310 low-income, male subjects followed from infancy until age 6 years. Results Support across informants was found for the importance of the caregiving environment during infancy in relation to the development of externalizing disorders at school entry. Support was also found for the significance of early child factors, but this was limited to child behavior at home. Conclusions The results are consistent with social learning and attachment models, which suggest that severe conduct problems in early childhood are the result of deficits in the caregiving environment. Support was also found for Moffitt's hypothesis that children with the comorbid attention-deficit/hyperactivity disorder–oppositional defiant disorder/ conduct disorder pattern experience multiple child and psychosocial risk factors that begin during infancy.

Prospective, Longitudinal Study of Tic, Obsessive-Compulsive, and Attention-Deficit/Hyperactivity Disorders in an Epidemiological Sample

Abstract: Objective Understanding the interrelatedness of tics, obsessive-compulsive disorder (OCD), and attention-deficit/ hyperactivity disorder (ADHD) has been complicated by studying only cross-sectional samples of clinically referred subjects. The authors report the cross-sectional and longitudinal associations of these disorders in an epidemiological sample of children followed prospectively into early adulthood. Method Structured diagnostic interview information was acquired on 976 children, aged 1 to 10 years, who were randomly selected from families living in upstate New York in 1975. Reassessments were acquired in 776 of these subjects 8, 10, and 15 years later. Diagnostic prevalences were estimated at each time point. The associations among tics, OCD, and ADHD were assessed within and across time points, as were their associations with comorbid illnesses and demographic risk factors. Results In temporal cross-section, tics and ADHD symptoms were associated with OCD symptoms in late adolescence and early adulthood after demographic features and comorbid psychiatric symptoms were controlled. In prospective analyses, tics in childhood and early adolescence predicted an increase in OCD symptoms in late adolescence and early adulthood. ADHD symptoms in adolescence predicted more OCD symptoms in early adulthood, and OCD in adolescence predicted more ADHD symptoms in adulthood. The associations of tics with ADHD were unimpressive in temporal cross-section and were not significant in prospective analyses. Tics, OCD, and ADHD shared numerous complex associations with demographic and psychopathological risk factors. ADHD was associated with lower IQ and lower social status, whereas OCD was associated with higher IQ. Conclusions Tics and OCD were significantly associated in this sample, as were OCD and ADHD. These findings are in general consistent with those from family studies, and they help to define the natural history, comorbid illnesses, and interrelatedness of these conditions.

Fluvoxamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial.

Abstract: Objective To determine the safety and efficacy of fluvoxamine for the treatment of children and adolescents with obsessive-compulsive disorder (OCD) with a double-blind, placebo-controlled, multicenter study. Method Subjects, aged 8 to 17 years, meeting DSM-III-R criteria for OCD were recruited from July 1991 to August 1994. After a 7-to 14-day single-blind, placebo washout/screening period, subjects were randomly assigned to fluvoxamine 50 to 200 mg/day or placebo for 10 weeks. Subjects who had not responded after 6 weeks could discontinue the double-blind phase of the study and enter a long-term, open-label trial of fluvoxamine. Analyses used an intent-to-treat sample with a last-observation-carried-forward method. Results Mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores with fluvoxamine were significantly ( p p Conclusions Fluvoxamine has a rapid onset of action and is well tolerated and efficacious for the short-term treatment of pediatric OCD.

Child maltreatment: risk of adjustment problems and dating violence in adolescence.

Abstract: Objective To examine the relationship between child maltreatment, clinically relevant adjustment problems, and dating violence in a community sample of adolescents Method Adolescents from 10 high schools ( N = 1,419; response rate=62%) in southwestern Ontario completed questionnaires that assessed past maltreatment, current adjustment, and dating violence Logistic regression was used to compare maltreated and nonmaltreated youths across outcome domains Results One third ( n = 462) of the school sample reported levels of maltreatment above the cutoff score on the Childhood Trauma Questionnaire Girls with a history of maltreatment had a higher risk of emotional distress compared with girls without such histories (eg, odds ratios [OR] for anger, depression, anxiety, and posttraumatic stress–related problems were 71, 72, 93, and 98, respectively) They were also at greater risk of violent and nonviolent delinquency (OR = 27) and carrying concealed weapons (OR = 71) Boys with histories of maltreatment were 25 to 35 times as likely to report clinical levels of depression, posttraumatic stress, and overt dissociation as were boys without a maltreatment history They also had a significantly greater risk of using threatening behaviors (OR = 28) or physical abuse (OR = 34) against their dating partners Conclusions Maltreatment is a significant risk factor for adolescent maladjustment and shows a differential pattern for male and female adolescents

Relationship Between Acute Morphine and the Course of PTSD in Children With Burns

Abstract: Objective: To investigate the relationship between the dose of morphine administered during a child’s hospitalization for an acute burn and the course of posttraumatic stress disorder (PTSD) symptoms over the 6-month period following discharge from the hospital. Method: Twenty-four children admitted to the hospital for an acute burn were assessed twice with the Child PTSD Reaction Index: while in the hospital and 6 months after discharge.The Colored Analogue Pain Scale was also administered during the hospitalization. All patients received morphine while in the hospital. The mean dose of morphine (mg/kg/ day) was calculated for each subject through chart review. Results: The Pearson product moment correlation revealed a significant association between the dose of morphine received while in the hospital and a 6-month reduction in PTSD symptoms. Children receiving higher doses of morphine had a greater reduction in PTSD symptoms over 6 months. Conclusions: This study suggests the possibility that acute treatment with morphine can secondarily prevent PTSD. This result is discussed in terms of the possible effect of morphine on fear conditioning and the consolidation of traumatic memory. J. Am.

Massachusetts Youth Screening Instrument for mental health needs of juvenile justice youths.

Abstract: Objective This report describes the development of the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2), a brief screening measure to identify youths with potential mental, emotional, or behavioral problems at entry points in the juvenile justice system. Method This 52-item self-report measure, with content relevant to common mental health problems in delinquent populations, was administered to 1,279 male and female youths, aged 12 to 17, in Massachusetts juvenile justice facilities. A subsample of youths also received the Millon Adolescent Clinical Inventory (MACI) and the Youth Self-Report (YSR). The instrument was subsequently administered to 3,804 male and female youths in California Youth Authority custody. Results Factor analyses of the 52 items identified seven scales that were conceptually associated with various mental, emotional, and behavioral problems of youths, which were generally confirmed by separate factor analyses with the California sample. The scales manifested adequate internal consistency and test-retest reliability. Most scales were substantially correlated with conceptually similar scales in the MACI and YSR, and they identified most youths who scored at clinically significant levels on those instruments. Conclusions The MAYSI-2 shows promise as a reliable and valid screening tool to assist juvenile justice staff in identifying youths who may need an immediate response to mental or emotional problems.