Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment

Jeffrey A. Gray has proposed a model in which conduct disorder (CD) is viewed as the result of both excessive activity of a behavioral activation system that mediates appetitive and aggressive behavior and deficient activity of a behavioral inhibition system that mediates both anxiety and the inhibition of behavior in the presence of cues signalling impending punishment or frustration. The relation of anxiety to antisocial behavior was examined in 177 clinic-referred boys, aged 7 to 12 years, 68 of whom met DSM-III-R criteria for CD. As predicted by Gray's model, boys with CD and comorbid anxiety disorder were markedly less impaired than boys with CD alone.

Anxiety, inhibition, and conduct disorder in children: II. Relation to salivary cortisol

The relation of symptoms of conduct disorder (CD) and anxiety to salivary cortisol was explored in 67 clinic-referred boys aged 8 to 13 years. Children with anxiety disorder had higher levels of cortisol, but this main effect was qualified by a significant CD x anxiety disorder interaction. Consistent with Gray's biological model of the behavioral inhibition system (BIS), children with both CD and anxiety disorder had higher levels of salivary cortisol than children with CD without comorbid anxiety disorder. In the absence of CD, however, anxiety disorder was not clearly associated with higher cortisol. This result suggests that cortisol may be a useful biological marker of arousal associated with BIS activity in children with CD.

Differences and similarities between children, mothers, and teachers as informants on disruptive child behavior

Prevalence rates of disruptive child behaviors, based on structured psychiatric interviews, are presented for samples of clinic-referred prepubertal boys at two sites to investigate differences and similarities among reports of the behaviors from children, parents, and teachers. Children reported significantly less hyperactive/inattentive and oppositional behaviors than either parents or teachers. In contrast, children did not differ from parents or teachers in their report on the prevalence of more serious conduct problems. These results were well replicated across two sites, despite the fact that there were significant differences between the sites in the level of hyperactive/inattentive child behaviors and conduct problems. The ranking of parents' and teachers' reported prevalence of specific child behavior problems in each of the three domains of disruptive behavior was strikingly similar. With one exception, the concordance between the prevalence ranking based on the children's reports was lower than that based on adults' reports, Children's reports on their own behavior did not predict various child handicaps 1 year later as well as did adults' reports. The results are discussed in relation to the usefulness of certain child behaviors in symptom lists for diagnostic purposes; the reliability of children's reports on their own behavior; and the possible reasons why prevalence rankings, as perceived by adults, are so similar.

Stability of mothers' recall of the age of onset of their child's attention and hyperactivity problems

The stability of mothers' recall of age of onset of attention deficit and hyperactive behaviors was assessed over a 1-year interval. The paper reports on which behaviors have the highest stability and the stability of a psychiatric diagnosis of attention deficit hyperactive disorder using different age cut-offs. The data showed a moderate degree of stability over a 1-year period, with school-related symptoms showing the least amount of change. An argument is made for keeping the current DSM-III-R diagnostic cut-off at age 6.

Attention deficit disorder without hyperactivity: a distinct behavioral and neurocognitive syndrome

This study examined the issue as to whether or not children carefully diagnosed as having either attention deficit disorder with hyperactivity (ADDH) or without hyperactivity (ADDnoH) could be distinguished on selected cognitive, academic, rapid naming, and behavioral measures. Employing a previously validated multimodal, multi-informant diagnostic process that results in reliable clinical diagnoses, 10 ADDH and 10 ADDnoH children were examined. While no significant differences in cognitive ability were noted between groups, significant underachievement was found in the children diagnosed as ADDnoH, particularly in mathematics achievement. The ADDnoH children were also significantly slower on rapid naming tasks than the ADDH children. Further, 60% of the ADDnoH children had a codiagnosis of a developmental reading or arithmetic disorder while none of the ADDH children received such a codiagnosis. Conversely, 40% of the ADDH children had a codiagnosis of conduct disorder and were rated by their parent as significantly more motorically active, impulsive, and deviant in the demonstration of age-appropriate social skills. These findings are discussed as they relate to the notion that children with attention deficit disorder may suffer from a right hemispheric syndrome.

Diagnostic conundrum of oppositional defiant disorder and conduct disorder

Evidence for a diagnostic distinction of oppositional defiant disorder (ODD) and conduct disorder (CD) is reviewed, and alternative conceptualizations and definitions for the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders are considered. Studies suggest that CD and ODD are strongly and developmentally related but clearly different. Factor analyses indicate that distinct covarying groups of ODD and CD symptoms can be identified, but certain symptoms relate to both (particularly mild aggression and lying). Age of onset for ODD is earlier than for most CD symptoms. Nearly all youths with CD have a history of ODD, but not all ODD cases progress to CD. The disorders demonstrate the same forms of parental psychopathology and family adversity but to a greater degree for CD than for ODD. Alternative conceptualizations for the disorders are presented for further study before the introduction of the DSM-IV.

Serious conduct problems in the children of adolescent mothers: disentangling confounded correlations

Early motherhood (less than 20 years of age) was found to be significantly correlated (r = .33) with the number of DSM-III symptoms of conduct disorder in a sample of 253 boys aged 6-13 years who had been referred to outpatient clinics. The following models were compared using path analysis: (a) Teenage motherhood, parental antisocial personality, and SES each contribute uniquely to the prediction of childhood conduct problems; (b) teenage motherhood mediates the association of SES and parental antisocial personality with child conduct problems; and (c) teenage motherhood is spuriously related with child conduct problems because of common associations with SES and parental antisocial personality. Model (c) best fit our data. Similar results were obtained whether maternal age at the birth of the firstborn child or the proband child was used to define maternal age and when teenage motherhood was defined as giving birth at less than 18 years.

Comparison of DSM-III and DSM-III-R diagnoses for prepubertal children: changes in prevalence and validity

A structured and reliable diagnostic procedure based on a revised version of the Diagnostic Interview Schedule for Children for children, parents, and teachers was used to assign both DSM-III and DSM-III-R diagnoses to 177 outpatient boys aged 7 to 12 years. Compared to their DSM-III counterparts, DSM-III-R oppositional defiant disorder was 25.5% less prevalent, DSM-III-R dysthymia was 37.8% less prevalent, and DSM-III-R conduct disorder (CD) was 44.3% less prevalent. However, DSM-III-R attention deficit hyperactivity disorder was 14.4% more prevalent than DSM-III attention deficit disorder with hyperactivity. The two definitions of CD were compared to exemplify an empirical approach to diagnostic validation. The DSM-III-R diagnosis of CD appears to be more valid as it is more strongly associated with police contacts, school suspensions, and history of antisocial personality disorder in the biological father, but both CD diagnoses are associated with family histories of criminal convictions.

Serious conduct problems in the children of adolescent mothers: Disentangling confounded correlations

Early motherhood (less than 20 years of age) was found to be significantly correlated (r = .33) with the number of DSM-III symptoms of conduct disorder in a sample of 253 boys aged 6-13 years who had been referred to outpatient clinics. The following models were compared using path analysis: (a) Teenage motherhood, parental antisocial personality, and SES each contribute uniquely to the prediction of childhood conduct problems; (b) teenage motherhood mediates the association of SES and parental antisocial personality with child conduct problems; and (c) teenage motherhood is spuriously related with child conduct problems because of common associations with SES and parental antisocial personality. Model (c) best fit our data. Similar results were obtained whether maternal age at the birth of the firstborn child or the proband child was used to define maternal age and when teenage motherhood was defined as giving birth at less than 18 years.

Do neurocognitive measures differentiate Attention Deficit Disorder (ADD) with and without hyperactivity?

Recent behavioral and neuropharmacological evidence suggests that the differentiation of children with Attention Deficit Disorder with (ADD/H) and without hyperactivity (ADD/WO) may reflect an appropriate nosological distinction. There is also evidence that attention-regulatory mechanisms possibly associated with anterior-posterior processes may be independently implicated in these children. To test this hypothesis, 100 clinic-referred children were reliably diagnosed as ADD/H (n = 48). ADD/WO (n = 26) and as having an internalizing disorder (n = 26) for inclusion as a clinic-control (CC) group. An analysis of covariance using Full-Scale IQ, chronological age, and the number of conduct-disorder symptoms provided little support for such a behavioral distinction using selected WISC-R, Luria-Nebraska-Children's Revision, and reaction-time variables. Alternative conceptualizations, possibly reflecting deficient right-hemispheric processes in ADD/H, may provide more productive avenues for research in distinguishing deficient neurocognitive processes in subtypes of ADD.

Personality characteristics of the mothers of children with disruptive behavior disorders

The biological mothers of 100 outpatient children aged 6-13 years completed the Minnesota Multiphasic Personality Inventory (MMPI). Mothers of children given DSM-III diagnoses of conduct disorder (CD; n = 13) had significantly higher scores on MMPI scales associated with antisocial behavior (Pd and Ma), histrionic behavior (Hs and Hy), and disturbed adjustment (Sc). In contrast, the children's diagnosis of attention deficit disorder with hyperactivity (ADD/H; n = 22) was not significantly associated with any maternal MMPI elevations, and the CD x ADD/H interactions were not significant for any MMPI scale. These results indicate that CD is linked to maternal personality disorder, but ADD/H is not.

Personality characteristics of the mothers of children with disruptive behavior disorders

The biological mothers of 100 outpatient children aged 6-13 years completed the Minnesota Multiphasic Personality Inventory (MMPI). Mothers of children given DSM-III diagnoses of conduct disorder (CD; n = 13) had significantly higher scores on MMPI scales associated with antisocial behavior (Pd and Ma), histrionic behavior (Hs and Hy), and disturbed adjustment (Sc). In contrast, the children's diagnosis of attention deficit disorder with hyperactivity (ADD/H; n = 22) was not significantly associated with any maternal MMPI elevations, and the CD x ADD/H interactions were not significant for any MMPI scale. These results indicate that CD is linked to maternal personality disorder, but ADD/H is not.

Cardiovascular reactivity with caffeine and stress in black and white normotensive females

Forty-eight healthy, young, normotensive black and white women, half with and half without a parental history of hypertension, were studied using a double-blind, randomized design. Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) were recorded in response to 250 mg of caffeine vs placebo (3 mg) during rest and during a stressful mental arithmetic task. Results indicated no racial or parental history differences in response to caffeine or to stress. Surprisingly, our female subjects evidenced a small drop in SBP (1 mm Hg) and a decline in HR (5 bpm), and, as expected, they demonstrated a rise in DBP of 6 mm Hg in response to caffeine. The effects of caffeine on SBP and HR were contingent on the experimental condition such that the difference in SBP and HR between the high vs low dose of caffeine was significant only under the caffeine plus psychological stress condition. These effects were only partially consistent with those previously observed in males. Previous evidence of significantly greater DBP pressor effects when caffeine is consumed under stressful conditions was confirmed. However, in this study, the caffeine alone condition had little effect on SBP reactivity and promoted a decrease in HR reactivity. The results are discussed in relation to previous research on males, and recommendations for future research are offered.

Neuropsychological test performance and the attention deficit disorders: Clinical utility of the Luria-Nebraska Neuropsychological Battery—Children's Revision

The Luria-Nebraska Neuropsychological Battery-Children's Revision (LNNB-CR) was administered to 54 clinic-referred children aged 8-12 years. Children reliably diagnosed as attention deficit disorder with hyperactivity were compared with children diagnosed as attention deficit disorder without hyperactivity and with a clinic control group diagnosed with internalizing disorders. Both attention deficit disorder groups were lower than the control group in verbal and Full Scale IQ scores but did not differ from one another. The groups did not differ significantly on any of the LNNB-CR clinical scales, on the right or left hemisphere scores, or on the pathognomonic score using analyses of variance or analyses of covariance with both Full Scale IQ and age as covariates. These findings failed to support the hypothesis that attention deficit disorder, either with or without hyperactivity, is associated with neuropsychological dysfunction as measured by the LNNB-CR.

Sociometric status of clinic-referred children with attention deficit disorders with and without hyperactivity

Peer sociometric nominations of clinic-referred children given the diagnosis of Attention) Deficit Disorder with Hyperactivity (ADD/H) or Attention Deficit Disorder without Hyperactivity (ADD/WO) were compared to one another and to those of normal control children. Only children with ADD diagnoses in the absence of other major diagnoses were included. Both children with ADD/H (n = 16) and ADD/WO (n = 11) received significantly fewer "liked most" nominations, more "liked least" nominations, and lower social preference scores than normal control (n = 45) children. These results confirm previous findings of social deficits in children with ADD/H, even when codiagnoses are excluded. In addition, they support the validity of the diagnostic category of ADD/WO by demonstrating that the ADD/WO behavior pattern is apparently "psychopathological" in being associated with peer unpopularity after codiagnoses are excluded. When larger groups including all codiagnoses (primarily Conduct Disorder) of children with ADD/H (n = 36) and ADD/WO (n = 20) were compared, identical patterns of peer unpopularity were found, except that children with ADD/H also were significantly more likely to be nominated as a child who "fights most."

Perception of child, child-rearing values, and emotional distress as mediating links between environmental stressors and observed maternal behavior

This observational study of 74 families investigated 3 areas of maternal psychological functioning (emotional distress, authoritarian child-rearing values, negative perceptions of children) that might mediate the relationship between 3 separate dimensions of family demographic characteristics, conceptualized as chronic environmental stressors (i.e., financial, structural, and historical circumstances), and the emotionally affective behavior of mothers. Demographic conditions accounted for 52.9% of the variance in mothers' psychological characteristics and as much as 36.6% of the variance in positive and negative behaviors to children. The psychological characteristics explained as much as 15.1% of the variance in maternal behavior. Both chronic stress and the psychological variables had an independent influence on the general emotional tone of maternal behavior. The findings provide tentative support for the conclusion that the psychological characteristics examined here partially mediate the influence of some demographic or stressful life conditions on the positive and negative behaviors of mothers.

Peer assessment of the social behavior of accepted, rejected, and neglected children

Positive and negative sociometric nominations were used with second and fifth-grade children to select 26 socially accepted, 32 rejected, and 28 neglected children. A total of 358 of their classmates evaluated these children by indicating whether each of 19 descriptions of social behavior was characteristic of each child. Rejected children were perceived by their peers as being more aggressive, disruptive, irritable, domineering , dishonest , and selfish than accepted and/or neglected children. Neglected children, in contrast, differed from accepted children only in being less likely to brag about physical prowess . While the low sociometric status of rejected children appears to be related to the negative impact of their behavior on peers, this does not appear to be the case for neglected children. Females were generally perceived as behaving more positively with peers, but no interactions were found between sex and sociometric status. In general, the test-retest reliability of peer evaluation items was higher for fifth- than for second-grade children, but significant grade by sociometric status interactions were found for only two items.

Correlates of depressed mood in normal children

Two instruments which have been proposed as measures of clinical depression in children and an ad hoc teacher rating were given to a group of 109 normal children. The Children's Depression Inventory (CDI), the Peer Nomination Inventory for Depression (PNID), and a teacher rating of depression were given along with the Conners Teacher Rating Scale (TRS), teacher ratings of somatic complaints, peer popularity, and absenteeism, and peer ratings of popularity to examine the behavioral correlates of depressed mood in normal children. While few sex differences were found on mean depression scores, different patterns of correlations were found for the two sexes. For males, there were no significant correlations among the three depression measures, but all three depression measures were correlated with unpopularity and conduct problem ratings on the TRS. For females, the three depression measures were adequately intercorrelated. The teacher rating of depression was correlated with general deviance as measured by the TRS, but the CDI and PNID were correlated with TRS ratings of conduct problems, with peer ratings of unpopularity, and with teacher ratings of somatic complaints. Implications for the issue of the possible existence of a clinical syndrome of depression in children were discussed.

Physiological correlates of conduct problems and anxiety in hyperactive and learning-disabled children

Thirty-six learning disabled children (21 of whom were also classified as hyperactive) were subgrouped according to teacher ratings of tension-anxiety and conduct problems and then compared on measures of tonic and phasic autonomic arousal. The results indicated that children rated high on the conduct problem dimension evidenced smaller amplitude specific skin conductance responses, and that anxiety appeared to exert a moderating effect on physiological responses. When the hyperactive sample was considered separately, lower skin conductance levels were observed in children rated high on conduct problems than in hyperactive children rated low in conduct problems. These findings support the notion that hyperactive and learning-disabled children are heterogeneous at a physiological level and suggest that physiological differences previously attributed to hyperactivity may actually be correlates of the conduct problem dimension.

Toward a behavioral model of academic remediation with learning disabled children

One of the more rapidly developing approaches to the remediation of academic deficiencies in learning disabled children involves the use of behavioral technology in the direct instruction of academic skills. In this topical review, Treiber and Lahey discuss the essential characteristics of a behavioral approach to intervention and then examine some of the evidence that supports use of the approach with learning disabled children. Although the review is essentially positive, the authors do point out that we need much more research on the long-term effectiveness of behavioral approaches to remediation. A final contribution of this paper is the presentation of a model for developing new interventions that may serve as a useful guide to teachers and researchers alike.—JKT

Do learning-disabled children exhibit peripheral deficits in selective attention? An analysis of eye movements during reading

It has been suggested that deficits in selective attention play a functional role in the learning and behavior problems of children diagnosed as learning-disabled. In the present study, peripheral and central aspects of selective attention were distinguished and peripheral aspects were examined. The attending eye movements during reading of 12 fifth-grade learning-disabled children who read at the third-grade level were compared with 12 fifth-grade children who read at the fifth-grade level (grade placement controls) and 12 third-grade children who read at the third-grade level (reading level controls). The learning-disabled children did not differ from their reading level controls on any of 10 measures but showed a pattern of eye movements that was generally slower and less smooth than their grade placement controls. While these patterns might be considered to be "immature" relative to normal readers of the same age, they are not indicative of peripheral deficits in selective attention. Males, however, did exhibit more variability in duration of fixations and made more regressive eye movements than did females.

ties"ties"

The diagnostic category of learning disabilities is a heterogeneous one, but few empirical attempts have been made to distinguish subgroups. Recent research, however, suggests that it may be meaningful to discriminate between "hyperactive" and "nonhyperactive" learning-disabled children. In the present study, 21 learning-disabled children identified as "hyperactive" through teacher nominations and ratings were compared to 15 learning-disabled children identified as "nonhyperactive" in the same manner. The two groups differed on rated behavior, birth order, amount of prescribed stimulant medication, amount of psychosocial stress, and Verbal, Performance, and Full Scale WISC-R IQ scores. They did not differ, however, on several demographic variables, the number of perinatal complications, reading achievement, and a number of tonic and phasic measures of autonomic activity. These findings support the distinction between "hyperactive" and "nonhyperactive" subgroups of learning-disabled children, but suggest that the two subgroups may have a similar biological substrate.