Comorbidity of Disorders in Children and Adolescents
01 Jan 1995-pp 109-155
TL;DR: In this article, the authors examined the significance of comorbid disorders in children and adolescents and evaluated the classification system based on which they are based, including the Diagnostic and Statistical Manual of Mental Disorders (DSM-III and DSM-III-R).
Abstract: Since the advent of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition and Third Edition, Revised (DSM-III and DSM-III-R), clinicians and investigators have shown increasing interest in the significance of comorbid disorders in children and adolescents. Coincident with a sharpened focus on comorbidity, some investigators have developed detailed data on child and adolescent comorbid diagnoses in clinical and epidemiological studies (e.g., Bird, Gould, & Staghezza, 1993; Cohen, 1993; Pfeffer & Plutchik, 1989); and comorbidity has been the subject of recent reviews of child and adolescent disorders research (e.g., Biederman, New-corn, & Sprich, 1991; Zoccolillo, 1992). Accumulating evidence suggests that comorbidity is pervasive. Concerns about weaknesses of the nosological system are being advanced to account for the high rates of comorbidity in general (Achenbach, 1990/1991; Caron & Rutter, 1991; Pfeffer & Plutchik, 1989; Rutter, 1989), as well as for the co-occurrence of specific disorders (e.g., Biederman et al., 1991; Carlson, 1990). With respect to children and adolescents, these concerns intersect with developmental and methodological issues. For the advancement of knowledge about child and adolescent disorders, it is essential that comorbidity patterns be identified and examined, not only for their implications for prognosis and treatment, but also for evaluation of the classification system on which they are based.
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TL;DR: Evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood.
Abstract: We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children.
1,365 citations
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...…1999a; Caron & Rutter, 1991; Hinshaw, Lahey, & Hart, 1993; Kendall, Kortlander, Chansky, & Brady, 1992; Klein & Riso, 1993; Loeber & Keenan, 1994; Nottelmann & Jensen, 1995; Rutter, 1997) have demonstrated the importance of comorbidity for understanding the etiology, course, and treatment of…...
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TL;DR: A child version of the Positive and Negative Affect Schedule (PANAS-C) was developed using students in Grades 4-8 (N = 707) as mentioned in this paper, and the resulting Negative Affect and Positive Affect scales demonstrated good convergent and discriminant validity with existing self-report measures of childhood anxiety and depression.
Abstract: A child version of the Positive and Negative Affect Schedule (PANAS: D. Watson, L. A. Clark, & A. Tellegen, 1988), the PANAS-C, was developed using students in Grades 4-8 (N = 707). Item selection was based on psychometric and theoretical grounds. The resulting Negative Affect (NA) and Positive Affect (PA) scales demonstrated good convergent and discriminant validity with existing self-report measures of childhood anxiety and depression; the PANAS-C performed much like its adult namesake. Overall, the PANAS-C, like the adult PANAS, is a brief, useful measure that can be used to differentiate anxiety from depression in youngsters. As such, this instrument addresses the shortcomings of existing measures of childhood anxiety and depression.
1,009 citations
TL;DR: The need to study anxiety and depression within a developmental psychopathology framework, as well as to include both categorical and dimensional assessments of these problems in the same research designs, will be essential for understanding the complex interplay of biological and environmental processes that contribute to the emergence, progression, and amelioration of internalizing problems over time.
Abstract: The focus of this article is on internalizing problems that are experienced by children and adolescents. We provide an historical perspective, selectively examine the current state of knowledge, consider advances and gaps in what is known, and identify new research directions. Diagnosis, epidemiology, theory, and research first are considered separately for anxiety and depressive disorders. These internalizing problems, however, whether clinical or subclinical, share many common features and show high comorbidity rates. We emphasize the importance of systematic analysis of comorbid anxiety and depression, including their comorbidity with externalizing problems. This could lead to more valid classification of subtypes of internalizing problems and further an understanding of the diverse conditions that constitute internalized distress. We highlight the need to study anxiety and depression within a developmental psychopathology framework, as well as to include both categorical and dimensional assessments of these problems in the same research designs. This will be essential for understanding the complex interplay of biological and environmental processes that contribute to the emergence, progression, and amelioration of internalizing problems over time.
727 citations
TL;DR: Comorbid psychiatric disorders are a major health problem among detained youth and the odds of having comorbid disorders were higher than expected by chance for most demographic subgroups, except when base rates of disorders were already high or when cell sizes were small.
Abstract: Objective To estimate 6-month prevalence of comorbid psychiatric disorders among juvenile detainees by demographic subgroups (sex, race/ethnicity, and age). Design Epidemiologic study of juvenile detainees. Master's level clinical research interviewers administered the Diagnostic Interview Schedule for Children Version 2.3 to randomly selected detainees. Setting A large temporary detention center for juveniles in Cook County, Illinois (which includes Chicago and surrounding suburbs). Participants Randomly selected, stratified sample of 1829 African American, non-Hispanic white, and Hispanic youth (1172 males, 657 females, aged 10-18 years) arrested and newly detained. Main Outcome Measure Diagnostic Interview Schedule for Children. Results Significantly more females (56.5%) than males (45.9%) met criteria for 2 or more of the following disorders: major depressive, dysthymic, manic, psychotic, panic, separation anxiety, overanxious, generalized anxiety, obsessive-compulsive, attention-deficit/hyperactivity, conduct, oppositional defiant, alcohol, marijuana, and other substance; 17.3% of females and 20.4% of males had only one disorder. We also examined types of disorder: affective, anxiety, substance use, and attention-deficit/hyperactivity or behavioral. The odds of having comorbid disorders were higher than expected by chance for most demographic subgroups, except when base rates of disorders were already high or when cell sizes were small. Nearly 14% of females and 11% of males had both a major mental disorder (psychosis, manic episode, or major depressive episode) and a substance use disorder. Compared with participants with no major mental disorder (the residual category), those with a major mental disorder had significantly greater odds(1.8-4.1) of having substance use disorders. Nearly 30% of females and more than 20% of males with substance use disorders had major mental disorders. Rates of some types of comorbidity were higher among non-Hispanic whites and older adolescents. Conclusions Comorbid psychiatric disorders are a major health problem among detained youth. We recommend directions for research and discuss how to improve treatment and reduce health disparities in the juvenile justice and mental health systems.
549 citations
Cites background from "Comorbidity of Disorders in Childre..."
...Longitudinal studies that identify the most common developmental sequences will demonstrate when primary and secondary preventive interventions may be most beneficial.(67) 2....
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...We must develop more effective treatments for comorbid disorders and identify which treatments work best for special populations (eg, females, minorities, and younger adolescents).(67) Despite the escalating numbers of females in the justice system,(5,103) few sex-specific services are available....
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TL;DR: It was revealed that the strongest predictor of future social–psychological adjustment problems and increases in these problems from third to fourth was the combination of relational and physical aggression.
Abstract: Although great strides have recently been made in our understanding of relational aggression and its consequences, one significant limitation has been the lack of prospective studies. The present research addressed this issue by identifying and assessing groups of relationally aggressive, physically aggressive, relationally plus physically aggressive (co-morbid), and nonaggressive children during their third grade year in elementary school and then reassessing them a year later, during fourth-grade (N = 224, 113 girls). Two aspects of social-psychological adjustment were assessed during both assessment periods including internalizing difficulties (i.e., withdrawal, depression/anxiety, and somatic complaints) and externalizing problems (i.e., aggressive behavior, delinquency). It was revealed that the strongest predictor of future social-psychological adjustment problems and increases in these problems from third to fourth was the combination of relational and physical aggression. Relational aggression also contributed unique information, relative to physical aggression, in the prediction of future maladjustment. Implications of these findings for future research and prevention efforts, particularly for aggressive girls, are discussed.
396 citations
References
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TL;DR: Etude de la coherence entre differentes sources (269 echantillons utilisees dans 119 etudes) concernant les evaluations des problemes affectifs et comportementaux d'enfants et d'adolescents âges de 1 1/2 a 19 ans.
Abstract: Etude de la coherence entre differentes sources (269 echantillons utilisees dans 119 etudes) concernant les evaluations des problemes affectifs et comportementaux d'enfants et d'adolescents âges de 1 1/2 a 19 ans
5,254 citations
Book•
01 Jan 1989
TL;DR: The state-of-the-art in child psychotherapy with children and adolescents is described in this paper, where the authors present a review of the state of the art in the field.
Abstract: Continuities and Discontinuities in Antisocial Behavior from Childhood to Adult Life B. Maughan, M. Rutter. Psychotherapy Outcome Research with Children and Adolescents: The State of the Art J.R. Weisz, et al. Child Psychotherapy Process Research R.L. Russell, S.R. Shirk. Parent-Child Interaction Approaches to the Treatment of Child Behavior Problems R. Foote, et al. Children's Perception of Physical Symptoms: The Example of Asthma S. Rietveld, J.M. Prins. Common Feeding Problems in Young Children K.S. Budd, C.S. Chugh. New Developments in Assessing Pediatric Anxiety Disorders J.S. March, A.M. Albano. Conceptualization and Measurement of Coping in Children and Adolescents T.S. Ayers, et al. New Developments in Services Delivery Research for Children, Adolescents, and Their Families A.J. Pumariega, S. Glover. Index.
1,930 citations
TL;DR: The literature supports considerable comorbidity of attention deficit hyperactivity disorder with conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, learning disabilities, and other disorders, such as mental retardation, Tourette's syndrome, and borderline personality disorder.
Abstract: Objective Attention deficit hyperactivity disorder is a heterogeneous disorder of unknown etiology Little is known about the comorbidity of this disorder with disorders other than conduct Therefore, the authors made a systematic search of the psychiatric and psychological literature for empirical studies dealing with the comorbidity of attention deficit hyperactivity disorder with other disorders Data collection The search terms included hyperactivity, hyperkinesis, attention deficit disorder, and attention deficit hyperactivity disorder, cross-referenced with antisocial disorder (aggression, conduct disorder, antisocial disorder), depression (depression, mania, depressive disorder, bipolar), anxiety (anxiety disorder, anxiety), learning problems (learning, learning disability, academic achievement), substance abuse (alcoholism, drug abuse), mental retardation, and Tourette's disorder Findings The literature supports considerable comorbidity of attention deficit hyperactivity disorder with conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, learning disabilities, and other disorders, such as mental retardation, Tourette's syndrome, and borderline personality disorder Conclusions Subgroups of children with attention deficit hyperactivity disorder might be delineated on the basis of the disorder's comorbidity with other disorders These subgroups may have differing risk factors, clinical courses, and pharmacological responses Thus, their proper identification may lead to refinements in preventive and treatment strategies Investigation of these issues should help to clarify the etiology, course, and outcome of attention deficit hyperactivity disorder
1,728 citations
TL;DR: The most prevalent disorders were attention deficit, oppositional, and separation anxiety disorders, and the least prevalent were depression and social phobia.
Abstract: • We investigated the prevalence of DSM-III disorders in 792 children aged 11 years from the general population and found an overall prevalence of disorder of 17.6% with a sex ratio (boys-girls) of 1.7:1. The most prevalent disorders were attention deficit, oppositional, and separation anxiety disorders, and the least prevalent were depression and social phobia. Conduct disorder, overanxious disorder, and simple phobia had intermediate prevalences. Pervasive disorders, reported by more than one source, had an overall prevalence of 7.3%. Examination of background behavioral data disclosed that children identified at 11 years as having multiple disorders had a history of behavior problems since 5 years of age on parent and teacher reports. Fifty-five percent of the disorders occurred in combination with one or more other disorders, and 45% as a single disorder.
1,425 citations
TL;DR: In this paper, the authors provide a historical perspective on the discipline of developmental psychopathology and discuss the root causes of developmental risk in children and the role of family relations in the development of psychopathology.
Abstract: List of contributors Preface Part I. Introduction: Historical and Theoretical Roots of Developmental Psychopathology: 1. A historical perspective on the discipline of developmental psychopathology Dante Cicchetti 2. What is 'developmental' about developmental psychopathology? Thomas M. Achenbach Part II. Contributions of the High-Risk Child Paradigm: Continuities and Changes in Adaptation During Development: 3. Early contributors to developmental risk Arnold J. Sameroff and Ronald Seifer 4. Beyond diathesis: toward an understanding of high-risk environments John Richters and Sheldon Weintraub 5. Hard growing: children who survive Marian Radke-Yarrow and Tracy Sherman 6. Children born at medical risk: factors affecting vulnerability and resilience Margaret O'Dougherty and Francis S. Wright 7. A mediational model for boys' depressed mood Gerald R. Patterson and Deborah M. Capaldi 8. A temperamental disposition to the state of uncertainty Jerome Kagan, Jane L. Gibbons, Maureen O. Johnson, J. Steven Reznick and Nancy Snidman Part III. Competence Under Adversity: Individual and Family Differences in Resilience: 9. Psychosocial resilience and protective mechanisms Michael Rutter 10. Maternal stress and children's development: prediction of school outcomes and identification of protective factors Robert C. Pianta, Byron Egeland and L. Alan Sroufe 11. Competence under stress: risk and protective factors Ann S. Masten, Patricia Morison, David Pellegrini and Auke Tellegen 12. Stress-resistant families and stress-resistant children Alfred L. Baldwin, Clara Baldwin and Robert E. Cole 13. Children's adjustments to parental divorce: self-image, social relations and school performance Norman F. Watt, Olivia Moorehead-Slaughter, Debra M. Japzon and Gloria G. Keller Part IV. The Challenge of Adolescence for Developmental Psychopathology: 14. The development of psychopathology in adolescence Aaron T. Ebata, Anne C. Petersen and John J. Conger 15. Depressive symptoms in late adolescence: a longitudinal perspective on personality antecedents Jack Block and Per F. Gjerde 16. Vulnerability and resilience in the age of eating disorders: risk and protective factors for bulimia nervosa Judith Rodin, Ruth H. Striegel-Moore and Lisa R. Silberstein 17. Protected or vulnerable: the challenges of AIDS to developmental psychopathology Jon Rolf and Jeannette Johnson Part V. Factors in the Development of Schizophrenia and Other Severe Psychopathology in Late Adolescence and Adulthood: 18. Family relations as risk factors for the onset and course of schizophrenia Michael J. Goldstein 19. Long-range schizophrenia forecasting: many a slip twixt cup and lip Daniel R. Hanson, Irving I. Gottesman and Leonard L. Heston 20. Vulnerability factors in children at risk: anomalies in attentional functioning and social behaviour Keith H. Nuechterlein, Susan Phipps-Yonas, Regina Driscoll and Norman Garmezy 21. Schizophrenia: a new model of its transmission and its variations Philip S. Holzman 22. Premorbid competence and the courses and outcomes of psychiatric disorders Marion Glick and Edward Zigler 23. Relationships between adult development and the course of mental disorder John S. Strauss and Courtenay M. Harding A closing note: reflections on the future Norman Garmezy Author index Subject index.
1,107 citations