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Showing papers in "Journal of the American Academy of Child and Adolescent Psychiatry in 2005"


Journal ArticleDOI
TL;DR: In this article, the effect of computerized, systematic practice of working memory tasks on children with Attention Deficit/Hyperactivity Disorder (ADHD) has been investigated using a randomized, controlled, double-blind trial.
Abstract: Objective Deficits in executive functioning, including working memory (WM) deficits, have been suggested to be important in attention-deficit/hyperactivity disorder (ADHD). During 2002 to 2003, the authors conducted a multicenter, randomized, controlled, double-blind trial to investigate the effect of improving WM by computerized, systematic practice of WM tasks. Method Included in the trial were 53 children with ADHD (9 girls; 15 of 53 inattentive subtype), aged 7 to 12 years, without stimulant medication. The compliance criterion (>20 days of training) was met by 44 subjects, 42 of whom were also evaluated at follow-up 3 months later. Participants were randomly assigned to use either the treatment computer program for training WM or a comparison program. The main outcome measure was the span-board task, a visuospatial WM task that was not part of the training program. Results For the span-board task, there was a significant treatment effect both post-intervention and at follow-up. In addition, there were significant effects for secondary outcome tasks measuring verbal WM, response inhibition, and complex reasoning. Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity, both post-intervention and at follow-up. Conclusions This study shows that WM can be improved by training in children with ADHD. This training also improved response inhibition and reasoning and resulted in a reduction of the parent-rated inattentive symptoms of ADHD.

1,724 citations


Journal Article
TL;DR: This study shows that WM can be improved by training in children with ADHD, and this training also improved response inhibition and reasoning and resulted in a reduction of the parent-rated inattentive symptoms of ADHD.
Abstract: Computerized Training of Working Memory in Children With ADHD - A Randomized, Controlled Trial

1,718 citations


Journal ArticleDOI
TL;DR: Evidence of WM impairments in children with ADHD supports recent theoretical models implicating WM processes in ADHD and is needed to more clearly delineate the nature, severity, and specificity of the impairments to ADHD.
Abstract: Objective To determine the empirical evidence for deficits in working memory (WM) processes in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Method Exploratory meta-analytic procedures were used to investigate whether children with ADHD exhibit WM impairments. Twenty-six empirical research studies published from 1997 to December, 2003 (subsequent to a previous review) met our inclusion criteria. WM measures were categorized according to both modality (verbal, spatial) and type of processing required (storage versus storage/manipulation). Results Children with ADHD exhibited deficits in multiple components of WM that were independent of comorbidity with language learning disorders and weaknesses in general intellectual ability. Overall effect sizes for spatial storage (effect size=0.85, CI=0.62 − 1.08) and spatial central executive WM (effect size=1.06, confidence interval=0.72-1.39) were greater than those obtained for verbal storage (effect size=0.47, confidence interval=0.36-0.59) and verbal central executive WM (effect size=0.43, confidence interval=0.24-0.62). Conclusion: Evidence of WM impairments in children with ADHD supports recent theoretical models implicating WM processes in ADHD. Future research is needed to more clearly delineate the nature, severity, and specificity of the impairments to ADHD.

1,198 citations


Journal ArticleDOI
TL;DR: There is mounting evidence that many, if not most, lifetime psychiatric disorders will first appear in childhood or adolescence and methods are now available to monitor youths and to make early intervention feasible.
Abstract: Objective To review recent progress in child and adolescent psychiatric epidemiology in the area of prevalence and burden. Method The literature published in the past decade was reviewed under two headings: methods and findings. Results Methods for assessing the prevalence and community burden of child and adolescent psychiatric disorders have improved dramatically in the past decade. There are now available a broad range of interviews that generate DSM and ICD diagnoses with good reliability and validity. Clinicians and researchers can choose among interview styles (respondent based, interviewer based, best estimate) and methods of data collection (paper and pencil, computer assisted, interviewer or self-completion) that best meet their needs. Work is also in progress to develop brief screens to identify children in need of more detailed assessment, for use by teachers, pediatricians, and other professionals. The median prevalence estimate of functionally impairing child and adolescent psychiatric disorders is 12%, although the range of estimates is wide. Disorders that often appear first in childhood or adolescence are among those ranked highest in the World Health Organization's estimates of the global burden of disease. Conclusions There is mounting evidence that many, if not most, lifetime psychiatric disorders will first appear in childhood or adolescence. Methods are now available to monitor youths and to make early intervention feasible.

1,050 citations


Journal ArticleDOI
TL;DR: Repeated-measures analysis of variance demonstrated the efficacy of CPP with significant group x time interactions on children's total behavior problems, traumatic stress symptoms, and diagnostic status, and mothers' avoidance symptoms and trends toward significant group·time interactions on mothers' PTSD symptoms and general distress.
Abstract: Objective Treatment outcome for preschool-age children exposed to marital violence was assessed, comparing the efficacy of Child-Parent Psychotherapy (CPP) with case management plus treatment as usual in the community. Method Seventy-five multiethnic preschool mother dyads from diverse socioeconomic backgrounds were randomly assigned to (1) CPP or (2) case management plus community referral for individual treatment. CPP consisted of weekly parent-child sessions for 1 year monitored for integrity with the use of a treatment manual and intensive training and supervision. Parents completed the Child Behavior Checklist and participated in the Structured Clinical Interview for DC:0-3 to assess children's emotional and behavioral problems and posttraumatic stress disorder (PTSD) symptoms. Mothers completed the Symptom Checklist-90 and the Clinician Administered PTSD Scale interview to assess their general psychiatric and PTSD symptoms. Results Repeated-measures analysis of variance demonstrated the efficacy of CPP with significant group × time interactions on children's total behavior problems, traumatic stress symptoms, and diagnostic status, and mothers' avoidance symptoms and trends toward significant group × time interactions on mothers' PTSD symptoms and general distress. Conclusions The findings provide evidence of the efficacy of CPP with this population and highlight the importance of a relationship focus in the treatment of traumatized preschoolers.

554 citations


Journal ArticleDOI
TL;DR: This study supports the usefulness of the Strengths and Difficulties Questionnaire as an effective and efficient screener for child and adolescent mental health problems in the United States.
Abstract: Objective To evaluate the Strengths and Difficulties Questionnaire in a U.S. national population sample of children and adolescents, develop normative scoring bands, and test the association of high-scoring groups with service contacts or use for mental health reasons. Method An Americanized version of the Strengths and Difficulties Questionnaire parent report was administered to parents of 10,367 4- to 17-year-olds in the 2001 National Health Interview Survey. Scoring bands were developed to differentiate low, medium, and high levels of emotional or behavioral difficulties. Children at high risk of serious difficulties were identified by three different scoring methods: (1) high symptom scores, (2) parental perception of definite or severe difficulties, and (3) high symptoms plus impairment. These ratings were validated against service contact or use and other well-established demographic and broader risk factors for child emotional and behavioral problems. Results Results indicated good acceptability and internal consistency. Normative scoring bands were similar, though not identical, to the original British bands. Results of each scoring method had a strong association with service contact/use. Conclusions This study supports the usefulness of the Strengths and Difficulties Questionnaire as an effective and efficient screener for child and adolescent mental health problems in the United States.

503 citations


Journal ArticleDOI
TL;DR: Older youths in the foster care system have disproportionately high rates of lifetime and past year psychiatric disorders, and recommendations for initial and periodic mental health assessments for these youths and mechanisms to continue mental health services for young adults transitioning out of the Foster care system are supported.
Abstract: Objective: To estimate the lifetime and past year prevalence rates of major psychiatric disorders in a sample of older youths in the foster care system, to examine the timing of disorder onset and system entry, and to explore variations in past year prevalence rates. Method: Using the Diagnostic Interview Schedule for DSM-IV , interviews were conducted with 373 17-year-old youths (90% of those eligible) in one state's foster care system between December 2001 and June 2003. Results: Sixty-one percent of the youths qualified as having at least one psychiatric disorder during their lifetime; of these youths, 62% reported onset of their earliest disorder before entering the foster care system. In addition, 37% of youths met criteria for a psychiatric disorder in the past year. The number of types of maltreatment experienced was the most robust predictor of psychiatric disorder among several maltreatment variables. There were no differences in prevalence rates for youths in kinship care and those in nonkin foster families. Conclusions: Older youths in the foster care system have disproportionately high rates of lifetime and past year psychiatric disorders. Results support recommendations for initial and periodic mental health assessments for these youths and mechanisms to continue mental health services for young adults transitioning out of the foster care system.

443 citations


Journal ArticleDOI
TL;DR: The four sections of these guidelines include diagnosis, comorbidity, acute treatment, and maintenance treatment as discussed by the authors, which are not intended to serve as an absolute standard of medical or psychological care but rather to provide clinically useful guidelines for evaluation and treatment of children and adolescents with bipolar disorder.
Abstract: Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute treatment, and maintenance treatment. These guidelines are not intended to serve as an absolute standard of medical or psychological care but rather to serve as clinically useful guidelines for evaluation and treatment that can be used in the care of children and adolescents with bipolar disorder. These guidelines are subject to change as our evidence base increases and practice patterns evolve.

409 citations


Journal ArticleDOI
TL;DR: A short-term course of family therapy appears to be as effective as a long- term course for adolescents with short-duration anorexia nervosa, however, there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment.
Abstract: Objective Research suggests that family treatment for adolescents with anorexia nervosa may be effective. This study was designed to determine the optimal length of such family therapy. Method Eighty-six adolescents (12-18 years of age) diagnosed with anorexia nervosa were allocated at random to either a short-term (10 sessions over 6 months) or long-term treatment (20 sessions over 12 months) and evaluated at the end of 1 year using the Eating Disorder Examination (EDE) between 1999 and 2002. Results Although adequately powered to detect differences between treatment groups, an intent-to-treat analysis found no significant differences between the short-term and long-term treatment groups. Although a nonsignificant finding does not prove the null hypothesis, in no instance does the confidence interval on the effect size on the difference between the groups approach a moderate .5 level. However, post hoc analyses suggest that subjects with severe eating-related obsessive-compulsive features or who come from nonintact families respond better to long-term treatment. Conclusions A short-term course of family therapy appears to be as effective as a long-term course for adolescents with short-duration anorexia nervosa. However, there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment.

380 citations


Journal ArticleDOI
TL;DR: Phenomenological and longitudinal studies and biological validation using genetic, neurochemical, neurophysiological, and neuroimaging methods may strengthen the understanding of the phenocopy.
Abstract: Objective To review the literature of the past decade covering the epidemiology, clinical characteristics, assessment, longitudinal course, biological and psychosocial correlates, and treatment and prevention of pediatric bipolar disorder (BD). Method A computerized search for articles published during the past 10 years was made and selected studies are presented. Results Pediatric BD is increasingly recognized, and there are several prevailing views on core features of this disorder. The incidence and prevalence of the disorder and the associated comorbidities vary according to study setting and criteria used. This disorder is highly recurrent and accompanied by substantial psychiatric and psychosocial morbidity. Familial studies, including “top down” (offspring of parents with BD) and “bottom up” (relatives of youths with BD) studies indicate that pediatric BD is aggregated in families with adult or later-onset BD and suggest the existence of genetic predisposition. Greater understanding of the risk factors for early onset BD and recognition of the phenomenology of prodromal symptoms offers hope for early identification and prevention. Neuroimaging studies indicate frontotemporal and frontostriatal pathology, but none of these findings seems to be disorder specific. Combination pharmacotherapies appear promising, and the field awaits further short- and long-term randomized, placebo-controlled trials. Preliminary studies of various psychotherapies, including psychoeducation strategies tailored specifically for BD in youths, look encouraging. Conclusions Considerable advances have been made in our knowledge of pediatric BD; however, differing viewpoints on the clinical presentation of BD in children are the rule. Phenomenological and longitudinal studies and biological validation using genetic, neurochemical, neurophysiological, and neuroimaging methods may strengthen our understanding of the phenocopy. Randomized, controlled treatment studies for the acute and maintenance treatment of BD disorder are warranted.

342 citations


Journal ArticleDOI
TL;DR: To consider the research design requirements needed to provide a rigorous test of environmental mediation hypotheses and to summarize the main findings from research using such designs, selective review of empirical evidence dealing with psychopathology is selected.
Abstract: Objective: To consider the research design requirements needed to provide a rigorous test of environmental mediation hypotheses and to summarize the main findings from research using such designs. Method: Selective review of empirical evidence dealing with psychopathology. Results: There is robust evidence of environmentally mediated risks for psychopathology. There are major individual differences in people's responses to risk experiences. Effects are often dependent on genetic susceptibility (operating through gene-environment interactions). Conclusions: Many of the risks deriving from adverse experiences are reliant on nature-nurture interplay, and one of the main research needs concerns the diverse effects of the environment on the organism.

Journal ArticleDOI
TL;DR: HIV/AIDS has significant mental health implications, and psychiatry can play a critical role in curbing the epidemic.
Abstract: Objective To review the past 10 years of published research on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the United States, including psychosocial and psychiatric risk factors, epidemiology, biology, neurocognitive and psychiatric sequelae, disclosure issues, prevention strategies, and biological and behavioral treatments. Method Researchers reviewed the English-language literature with a focus on child and adolescent risk factors associated with HIV/AIDS, prevention, and treatment. Results Substantial scientific advances have occurred over the past two decades leading to decreased morbidity and mortality in the United States from AIDS-related opportunistic infections. At the same time, rates of HIV infection are increasing in teenagers, young women, and minorities, and growing numbers of youths are living with an infected family member. Understanding HIV risk behavior requires a broad theoretical framework. Comprehensive HIV prevention programs have led to reduced risk behavior among HIV-affected youths and teens at risk of infection. Biological and behavioral treatments of HIV infection continue to evolve and have led to longer life span, improved quality of life, and fewer psychiatric problems. Conclusions HIV/AIDS has significant mental health implications, and psychiatry can play a critical role in curbing the epidemic. With minimal effort, mental health professionals can adapt and apply the strategies that they use to treat psychiatric symptoms to prevent HIV transmission behaviors.

Journal ArticleDOI
TL;DR: Although comorbidity differs among ADHD subtypes, there were no significant gender differences in comorbridity for externalizing disorders.
Abstract: Objective To examine gender differences in attention-deficit/hyperactivity disorder (“ADHD”) symptom comorbidity with “oppositional defiant disorder”, “conduct disorder”, “separation anxiety disorder”, “generalized anxiety disorder”, speech therapy, and remedial reading in children. Method From 1994 to 1995, data from a large sample (N = 4,371) of twins and siblings studied in the Australian Twin ADHD Project were obtained by mailed DSM-IV-based questionnaires, investigating patterns of comorbidity in the three subtypes of “ADHD”: “inattentive”, “hyperactive/impulsive”, and “combined”. A total of 1,550 questionnaires were returned (87%) over the next 12 to 18 months. Results Analysis of variance showed significant between-group differences in males and females for inattention and hyperactive/impulsive symptom counts with higher rates of “oppositional defiant disorder” and “conduct disorder” in males, and higher rates of “separation anxiety disorder” in females indicating internalizing disorders are more common in females and externalizing disorders are occurring more often in males. Differences were found between the “ADHD” subtypes and the no ADHD category for all comorbid conditions, for both males and females. Children without ADHD consistently had fewer symptoms, while children with the combined subtype showed consistently more comorbid symptoms indicating a strong relationship between high rates of externalizing symptoms and high rates of internalizing symptoms. Gender differences in speech therapy were significant only for the children without ADHD. The rates of “separation anxiety disorder” were higher in females with the “inattention” subtype and the rate of “generalized anxiety disorder” higher for females with the “combined” subtype, indicating that the subtypes of ADHD were associated with these internalizing disorders in different ways. Conclusions Although comorbidity differs among ADHD subtypes, there were no significant gender differences in comorbidity for externalizing disorders. Inattentive girls may present with anxiety. Clinical approaches for both males and females should be sensitive to possible language and reading problems.

Journal ArticleDOI
TL;DR: Children and adolescents with early-onset BD may have reduced amygdalar volumes, consistent with other studies in this population, and prolonged medication exposure to lithium or valproate may account for findings in adults with BD of increased amygdAlar volume relative to controls.
Abstract: Objective: Subcortical limbic structures have been proposed to be involved in the pathophysiology of adult and pediatric bipolar disorder (BD). We sought to study morphometric characteristics of these structures in pediatric subjects with familial BD compared with healthy controls. Method: Twenty children and adolescents with BD I (mean age = 14.6 years, four females) and 20 healthy age, gender, and IQ-matched controls underwent high-resolution magnetic resonance imaging at 3 T. Patients were mostly euthymic and most were taking medications. Amygdala, hippocampus, thalamus, and caudate volumes were determined by manual tracings from researchers blinded to diagnosis. Analyses of covariance were performed, with total brain volume, age, and gender as covariates. Results: No differences were found in the volumes of hippocampus, caudate, and thalamus between subjects with BD and controls. Subjects with BD had smaller volumes in the left and right amygdala, driven by reductions in gray matter volume. Exploratory analyses revealed that subjects with BD with past lithium or valproate exposure tended to have greater amygdalar gray matter volume than subjects with BD without such exposure. Conclusions: Children and adolescents with early-onset BD may have reduced amygdalar volumes, consistent with other studies in this population. Prolonged medication exposure to lithium or valproate may account for findings in adults with BD of increased amygdalar volume relative to controls. J. Am. Acad. Child Adolesc. Psy

Journal ArticleDOI
TL;DR: The SCARED not only had the best fit for the general adolescent population but also for the age, gender, and ethnic groups and for Dutch and ethnic minorities.
Abstract: Objective: This study examined the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a large sample of adolescents from the general population. Method: In 2001, 1,340 junior high and high school adolescents in the Netherlands completed the SCARED. The SCARED is a questionnaire that purports to measure five child and adolescent anxiety symptom dimensions. The factor structure of the SCARED was investigated by means of confirmatory factor analyses that were conducted for males and females, early (10-13 years) and middle (14-18 years) adolescent groups, and for Dutch and ethnic minorities. Analyses of variance were carried out to compare mean scores for the various groups. Results: The five-factor structure of the SCARED not only had the best fit for the general adolescent population but also for the age, gender, and ethnic groups. It was also found that the SCARED scores of the adolescent subgroups differed from one another in agreement with previous studies on adolescent anxiety disorder symptoms. Conclusions: The findings of this study support the claim that the SCARED has a five-factor structure. The usefulness of the SCARED was also demonstrated.

Journal ArticleDOI
TL;DR: Parents report that sleep problems are significantly more prevalent and severe in children of normal intelligence with PDDs compared with normally developing children, and the pattern appears diverse.
Abstract: Objective This study compares parents' perceptions of the prevalence, severity, and pattern of sleep problems in children of normal intelligence with pervasive developmental disorders (PDDs) with a normative comparison group of children Method A survey including the Children's Sleep Habits Questionnaire was mailed to a sample of parents of children (age range 5-12 years) with PDDs (diagnosed by the Autism Diagnostic Interview-Revised) obtained by chart review of the past 7 years and to parents of comparison children matched on age, gender, and postal code Results The response rate in the PDD group was 822% (37/45) and 558% (43/77) in the comparison group By individually matching, 23 pairs were obtained The prevalence of sleep problems in the PDD group was reported by parents as being significantly higher than in the comparison group (78% and 26%, respectively; p p Conclusions Parents report that sleep problems are significantly more prevalent and severe in children of normal intelligence with PDDs compared with normally developing children, and the pattern appears diverse Sleep problems in children with PDDs require further research and clinical attention

Journal ArticleDOI
TL;DR: Small, incremental improvements over monotherapy, such as observed in this study, most likely represent the new norm in adolescent depression treatment research.
Abstract: Objective To test a collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in HMO pediatric primary care. Method A randomized effectiveness trial comparing a treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the experimental protocol ( n = 75) versus TAU SSRI plus brief CBT ( n = 77). Participants were identified by a recent dispense of SSRI medication followed by telephone screening. Adolescents with a diagnosis of major depressive disorder ( n = 152) were enrolled. The CBT program employed cognitive restructuring and/or behavioral activation training. Therapists consulted with prescribing pediatricians to improve medication adherence. Results Through 1-year follow-up, the authors found CBT advantages on the Short Form-12 Mental Component Scale ( p = .04), reductions in TAU outpatient visits ( p = .02), and days' supply of all medications ( p = .01). No effects were detected for major depressive disorder episodes; a nonsignificant trend favoring CBT was detected on the Center for Epidemiology Depression Scale ( p = .07). Conclusions The authors detected a weak CBT effect, possibly rendered less significant by the small sample and likely attenuated by the unexpected reduction in SSRI pharmacotherapy in the CBT condition. Small, incremental improvements over monotherapy, such as observed in this study, most likely represent the new norm in adolescent depression treatment research.

Journal Article
TL;DR: In this article, the authors investigate what patterns of bruising are diagnostic or suggestive of child abuse by means of a systematic review and conclude that the prevalence, number, and location of bruises is related to increased motor development.
Abstract: Aims: To investigate what patterns of bruising are diagnostic or suggestive of child abuse by means of a systematic review Methods: All language literature search 1951–2004 Included: studies that defined patterns of bruising in non-abused or abused children <18 years Excluded: personal practice, review articles, single case reports, inadequate confirmation of abuse Two independent full text reviews using standardised data extraction and critical appraisal forms Studies ranked by study design and definition of abuse used Results: Twenty three studies included: seven non-abusive bruising, 14 abusive bruising, and two both Non-abusive: The prevalence, number, and location of bruises is related to increased motor development Bruising in non-independently mobile babies is very uncommon (<1%) Seventeen per cent of infants who are starting to mobilise, 53% of walkers, and the majority of schoolchildren have bruises These are small, sustained over bony prominences, and found on the front of the body Abuse: Bruising is common in children who are abused Any part of the body is vulnerable Bruises are away from bony prominences; the commonest site is head and neck (particularly face) followed by the buttocks, trunk, and arms Bruises are large, commonly multiple, and occur in clusters They are often associated with other injury types that may be older Some bruises carry the imprint of the implement used Conclusion: When abuse is suspected, bruising must be assessed in the context of medical, social, and developmental history, the explanation given, and the patterns of non-abusive bruising Bruises in non-mobile infants, over soft tissue areas, that carry the imprint of an implement and multiple bruises of uniform shape are suggestive of abuse Quality research across the whole spectrum of children is urgently needed

Journal ArticleDOI
TL;DR: Long-term behavioral symptoms of attention problems are related to the cognitive deficits in attention and executive functions that often occur in association with childhood TBI, and Childhood TBI exacerbates premorbid attention problems.
Abstract: Objective To examine long-term attention problems and their cognitive correlates after childhood traumatic brain injury (TBI). Method Data were drawn from a prospective, longitudinal study conducted between 1992 and 2002. Participants included 41 children with severe TBI, 41 with moderate TBI, and 50 with orthopedic injury (OI), who were all between 6 and 12 years of age at the time of injury. Parent ratings of attention problems were obtained at a long-term follow-up on average 4 years post-injury and compared with ratings of premorbid attention problems obtained shortly after injury. At the long-term follow-up, children also completed several cognitive tests of attention and executive functions. Results Hierarchical linear and logistic regression analyses indicated that the severe TBI group displayed significantly more attention problems than the OI group at 4 years post-injury, both behaviorally and cognitively, after controlling for race, socioeconomic status, and premorbid attention problems. At long-term follow-up, 46% of the severe TBI group displayed significant attention problems on the Child Behavior Checklist, as opposed to 26% of the OI group (odds ratio = 3.38; 95% confidence interval, 1.15-9.94). On the Attention-Deficit/Hyperactivity Disorder Rating Scale, 20% of the severe TBI group displayed clinically significant attention problems compared with 4% in the OI group (odds ratio = 9.59; 95% confidence interval, 1.24-73.99). However, group differences in behavioral symptoms were significantly larger for children with more premorbid symptoms than for children with fewer premorbid problems. Measures of executive functions were significantly related to behavioral attention problems, after controlling for group membership, race, and socioeconomic status. Conclusions Childhood TBI exacerbates premorbid attention problems. Long-term behavioral symptoms of attention problems are related to the cognitive deficits in attention and executive functions that often occur in association with childhood TBI.

Journal ArticleDOI
TL;DR: The increased prevalence of antipsychotic use in children and adolescents from 1996 to 2001 was attributed to increased use of atypical antipsychotics, and the need for additional studies of these agents and other treatment modalities in this population is emphasized.
Abstract: Objective To estimate prevalence rates of antipsychotic use in children and adolescents from 1996 to 2001 in three state Medicaid programs (midwestern [MM], southern [SM], and western [WM]) and one private managed care organization (MCO). Method Prescription claims were used to evaluate antipsychotic prevalence, defined as the number of children and adolescents up to the age of 19 years with at least one prescription claim for an antipsychotic per 1,000 enrolled youths. Results From 1996 to 2001, the prevalence of total antipsychotic use increased in each program (MM: 4.7 to 14.3 per 1,000; SM: 6.3 to 15.5; WM: 4.5 to 6.9; and MCO: 1.5 to 3.4). Typical antipsychotic use decreased (MM: 3.7 to 2.0 per 1,000; SM: 4.6 to 1.5; WM: 4.4 to 1.3; and MCO: 1.2 to 0.9), while atypical antipsychotic use dramatically increased (MM: 1.4 to 13.1 per 1,000; SM: 2.5 to 14.9; WM: 0.3 to 6.2; and MCO: 0.4 to 2.7). Conclusions The increased prevalence of antipsychotic use in children and adolescents from 1996 to 2001 was attributed to increased use of atypical antipsychotics. Given the limited data with atypical antipsychotics in youths, this emphasizes the need for additional studies of these agents and other treatment modalities in this population.

Journal ArticleDOI
TL;DR: Models of the etiology of childhood anxiety disorders tracing continuity and change over time should consider differences in the developmental expression of childhood fears and anxiety symptoms.
Abstract: Objective To examine age differences in the expression of childhood fears and anxiety symptoms. Method A cross-sectional design was used to test recently formulated developmental hypotheses regarding the differential expression of childhood anxiety symptoms and fears in a community sample of youths ( N = 145). Three groups of youths were compared: children aged 6-9 years ( n = 47), preteens aged 10-13 years ( n = 52), and adolescents aged 14-17 years ( n = 46). Symptoms of separation anxiety, generalized anxiety, and social anxiety were assessed using a dimensional approach by both parent and child report. Fears were assessed by child report. Results The results indicated that there are systematic age differences in the expression of childhood fears and anxiety symptoms. Results also point toward specific symptoms predominant at certain ages (i.e., separation anxiety symptoms in youths aged 6-9 years, death and danger fears in youths aged 10-13 years, and social anxiety symptoms as well as failure and criticism fears in youths aged 14-17 years) in partial support of predictions. Conclusions Models of the etiology of childhood anxiety disorders tracing continuity and change over time should consider differences in the developmental expression of childhood fears and anxiety symptoms. Attention to developmental issues concerning symptom expression may be important in the clinical understanding of childhood anxiety.

Journal ArticleDOI
TL;DR: The unremitting course of PTSD symptomatology in preschool children and rates of impairment that are higher than rates of diagnosis indicate the need for efficacious treatment.
Abstract: Objective To examine the predictive validity of an alternative to the DSM-IV for diagnosing posttraumatic stress disorder (PTSD) in preschool children and prospectively explore the course of PTSD symptomatology. Method Sixty-two traumatized children, ages 20 months through 6 years, were assessed three times in 2 years with caregiver diagnostic interviews. Results PTSD diagnosis at visit 1 significantly predicted degree of functional impairment 1 and 2 years later and predicted PTSD diagnosis 2 years later but not 1 year later. The lack of 1-year diagnostic continuity may be explained by children with new traumas. Unexpectedly, overall PTSD symptoms did not remit over time, regardless of community treatment; however, reexperiencing symptoms decreased and avoidance/numbing symptoms increased with time, with avoidance/numbing symptoms increasing at a faster rate in children with PTSD at visit 1. The previous finding that arousal may cause emotional numbing was not replicated. Significantly more children were functionally impaired at visits 2 (48.9%) and 3 (74.3%) than were diagnosed with PTSD (23.4% and 22.9%, respectively). Conclusions This study demonstrates predictive validity for the alternative method of diagnosing PTSD in preschool children. The unremitting course of PTSD symptomatology in preschool children and rates of impairment that are higher than rates of diagnosis indicate the need for efficacious treatment.

Journal ArticleDOI
TL;DR: Clinician-report, child- report, and parent-report measures of child anxiety demonstrated significant benefits of CBT treatments over the no-treatment control group, and several instruments showed significantly greater improvement in child anxiety for group CBT plus parent training over groupCBT alone.
Abstract: Objective To compare the effectiveness of three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT) for children, group CBT for children plus parent training group, and no-treatment control.

Journal ArticleDOI
TL;DR: The data indicate that telephone administration of the ADIS-C-IV is a valid way to differentiate children who have anxiety disorders from those who have no disorder or other disorders, providing a less resource-demanding alternative to face-to-face assessment.
Abstract: Objective: The current study determined the viability of using the telephone to facilitate assessment of children using the Anxiety Disorders Interview Schedule for children for DSM-IV (ADIS-C-IV). Method: Diagnoses established during telephone administration of the ADIS-C-IV-Parent version were compared with diagnoses obtained during standard administration of the ADIS-C-IV using both Child and Parent versions. Seventy-three children and their parents participated in counterbalanced, repeated assessments. Results: The level of agreement between telephone and standard administration for principal diagnosis (κ = 0.86), individual anxiety disorders (κ = 0.63-0.86), and other disorders (κ = 0.79-0.91) were in the good to excellent range. Additionally, agreement on overall suitability for an anxiety treatment program was excellent (κ = 0.97). Conclusions: The data indicate that telephone administration of the ADIS-C-IV is a valid way to differentiate children who have anxiety disorders from those who have no disorder or other disorders, providing a less resource-demanding alternative to face-to-face assessment.

Journal ArticleDOI
TL;DR: Family adversity is related to ADHD combined type in children and may be related specifically to ADHD symptoms in addition to conduct disorder symptoms.
Abstract: Objective This study evaluated the relationship between a family adversity index and DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes and associated behavior problems The relationship of family adversity to symptoms and subtypes of ADHD was examined Method Parents and 206 children aged 7-13 completed diagnostic interviews and rating scales about socioeconomic status, parental lifetime psychiatric disorders, marital conflict, and stressful life events Results Children with ADHD combined type experienced more risk factors than community controls ( p = 002) or children with ADHD predominantly inattentive type ( p = 02) The families of children with ADHD combined type described more risk factors associated with family adversity than the families of children with ADHD inattentive type and the control group Parent-rated symptoms of child inattention/disorganization were related uniquely to the adversity index score independently of conduct disorder symptoms Children's perceptions of marital conflict were independently related to inattention and hyperactivity behaviors as rated by parents and teachers after control of all other risk factors Oppositional defiant symptoms were independently related to marital conflict and maternal psychopathology, whereas conduct disorder symptoms were uniquely related to low socioeconomic status and maternal psychopathology Conclusions Family adversity is related to ADHD combined type in children and may be related specifically to ADHD symptoms in addition to conduct disorder symptoms

Journal ArticleDOI
TL;DR: DVPX was not found to be superior to Li+ as maintenance treatment in youths who stabilized on combination Li+ and DVPX pharmacotherapy in youths diagnosed with bipolar I or II disorder.
Abstract: Objective To determine whether divalproex sodium (DVPX) was superior to lithium carbonate (Li + ) in the maintenance monotherapy treatment of youths diagnosed with bipolar disorder who had been previously stabilized on combination Li + and DVPX (Li + /DVPX) pharmacotherapy. Method Youths ages 5-17 years with bipolar I or II disorder were initially treated with Li + /DVPX. Patients meeting remission criteria for four consecutive weeks were then randomized in a double-blind fashion to treatment with either Li + or DVPX for up to 76 weeks. Study participation ended if the subject required additional clinical intervention or if the subject did not adhere to study procedures. Results Patients were recruited between July 1998 and May 2002. One hundred thirty-nine youths with a mean (SD) age of 10.8 (3.5) years were initially treated with Li + /DVPX for a mean (SD) duration of 10.7 (5.4) weeks. Sixty youths were then randomized to receive monotherapy with Li + ( n = 30) or DVPX ( n = 30). The Li + and DVPX treatment groups did not differ in survival time until emerging symptoms of relapse ( p = .55) or survival time until discontinuation for any reason ( p = .72). Conclusions DVPX was not found to be superior to Li + as maintenance treatment in youths who stabilized on combination Li + /DVPX pharmacotherapy.

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TL;DR: The effectiveness of risperidone during a period of several months is indicated, reducing disruptive behavior in about half of the children with autism spectrum disorders, although considerable weight gain can limit the use of this agent.
Abstract: OBJECTIVE: The short-term benefit of risperidone in ameliorating severe disruptive behavior in pediatric patients with autism spectrum disorders is well established; however, only one placebo-controlled, long-term study of efficacy is available. METHOD: Thirty-six children with an autism spectrum disorder (5-17 years old) accompanied by severe tantrums, aggression, or self-injurious behavior, started 8-week open-label treatment with risperidone. Responders (n = 26) continued treatment for another 16 weeks, followed by a double-blind discontinuation (n = 24; two patients discontinued treatment because of weight gain) consisting of either 3 weeks of taper and 5 weeks of placebo only or continuing use of risperidone. Relapse was defined as a significant deterioration of symptoms based on clinical judgment and a parent questionnaire. RESULTS: Risperidone was superior to placebo in preventing relapse: this occurred in 3 of 12 patients continuing on risperidone versus 8 of 12 who switched to placebo (p = .049). Weight gain, increased appetite, anxiety, and fatigue were the most frequently reported side effects. CONCLUSIONS: This study indicates the effectiveness of risperidone during a period of several months, reducing disruptive behavior in about half of the children with autism spectrum disorders. The results provide a rationale for the continuing use of risperidone beyond 6 months, although considerable weight gain can limit the use of this agent.

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TL;DR: Youths with ADHD and comorbid ODD showed statistically significant improvement in ADHD, ODD, and quality-of-life measures, although the COMorbid group may require higher doses of atomoxetine.
Abstract: Objective: To examine (1) moderating effects of oppositional defiant disorder (ODD) on attention-deficit/hyperactivity disorder (ADHD) treatment response and (2) responses of ODD symptoms to atomoxetine. Method: Children and adolescents (ages 8-18) with ADHD were treated for approximately 8 weeks with placebo or atomoxetine (fixed dosing: 0.5, 1.2, or 1.8 mg/kg/day, b.i.d.) under randomized, double-blind conditions. Among patients with lifetime diagnostic information ( n = 293), 39% were diagnosed with comorbid ODD and 61% were not. Treatment-group differences and differences between patients with and without comorbid ODD were examined post hoc for changes on the Attention-Deficit/Hyperactivity Disorder Rating Scale IV-Parent version, investigator-administered and -scored; Conners' Parent Rating Scale-Revised Short Form; Clinical Global Impressions Severity of ADHD Scale; and the parent-rated Child Health Questionnaire. Results: Youths with ADHD and comorbid ODD showed statistically significant improvement in ADHD, ODD, and quality-of-life measures. Treatment response was similar in youths with and without ODD, except that the comorbid group showed improvement compared with placebo at 1.8 mg/kg/day but not 1.2 mg/kg/day. In contrast, youths without ODD showed improvement at 1.2 mg/kg/day and no incremental benefit at 1.8 mg/kg/day. Conclusions: Atomoxetine treatment improves ADHD and ODD symptoms in youths with ADHD and ODD, although the comorbid group may require higher doses.

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TL;DR: The results suggest that cognitive-behavioral family therapy for obsessive-compulsive disorder provides long-term relief that it is equally effective in individual and group-based therapy.
Abstract: Objective: The aims were to (1) evaluate the long-term durability of individual and group cognitive-behavioral family therapy for childhood obsessive-compulsive disorder and (2) investigate pretreatment predictors of long-term outcome. Method: Undertaken at a university-based clinic, this study involved 48 participants (8–19 years old) who had received individual or group cognitive-behavioral family therapy. Participants and parents were assessed at 12 and 18 months following treatment with standardized assessments, including diagnostic and symptom severity interviews, child self-report measures of anxiety and depression, and parental self-report of distress. Pretreatment data were used for the prediction of long-term outcome. Results: Analyses indicated treatment gains were maintained, with a total of 70% of participants in individual therapy and 84% in group therapy diagnosis free at follow-up. There were no significant differences between the individual or group conditions across measures. Results indicated that higher pretreatment severity and higher family dysfunction predicted worse long-term outcome. Conclusions: The results suggest that cognitive-behavioral family therapy for obsessive-compulsive disorder provides long-term relief that it is equally effective in individual and group-based therapy. Focusing on family dysfunction may improve long-term prognosis. J. Am. Acad. Child Adolesc. Psychiatry, 2005;44(10):

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TL;DR: It may be that the mothers' symptoms are associated with a stressful home environment, thus exacerbating child disruptive behavior problems and eventually leading to a reciprocal relation between symptomatology in mothers and children.
Abstract: Objective: The current study examined how self-reported maternal stress and distress are associated with child disruptive behaviors. Method: Mother and teacher ratings of child disruptive behavior problems (attention problems, aggression, and delinquency) were collected for 215 male participants, ranging in age from 9 to 12 years. Participating mothers also provided self-report data on socioeconomic status (SES), parenting stress, and distress (depression and anxiety/somatization). Results: Low SES was significantly associated with both mother- and teacher-reported child disruptive behavior problems. Regression analyses indicated a relation between parenting stress and mother-reported child disruptive behavior problems, even when controlling for SES. Results also indicated a significant relation between maternal distress and mother-reported child disruptive behavior problems (particularly attention problems), even when controlling for SES and parenting stress. Maternal stress and distress were not significantly related to teacher-reported child disruptive behavior problems. Conclusions: Although the lack of an association between teacher-reported behavior problems and maternal stress and distress could be interpreted as a rater bias by these mothers, it may be that the mothers' symptoms are associated with a stressful home environment, thus exacerbating child disruptive behavior problems and eventually leading to a reciprocal relation between symptomatology in mothers and children.