Assessing ADHD and comorbid disorders in children: the Child Behavior Checklist and the Devereux Scales of Mental Disorders

Evaluated discriminant validity and clinical utility of selected subscales of the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) and the Child Behavior Checklist (CBCL; Achenbach, 1991a) in 228 children referred to a clinic for the evaluation and treatment of attention deficit hyperactivity disorder (ADHD). The DSMD is a multiaxial behavior rating scale that measures symptomatology for a broad range of child psychopathology as described in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-R-III] and 4th ed. [DSM-IV]; American Psychiatric Association, 1987, 1994). Discriminant function analyses as well as sensitivity, specificity, and predictive power analyses were computed to evaluate the discriminant validity and clinical utility of selected DSMD and CBCL subscales for assessing ADHD, oppositional defiant disorder (ODD), and anxiety disorders. Results indicated that the DSMD compared very favorably with the CBCL in the ability to discriminate between children with ADHD and those without ADHD and between children with comorbid ODD and anxiety disorders and children who did not meet criteria for these disorders. The DSMD Attention subscale may be somewhat better at ruling in ADHD combined subtype (ADHD-C) and ADHD inattentive subtype (ADHD-I) than the CBCL Attention Problems subscale, but the CBCL Attention Problems subscale may have slightly better utility than the DSMD Attention subscale in ruling out these subtypes. Both the CBCL and DSMD were more useful for ruling out than for ruling in ODD and anxiety disorders.

Global negative self-evaluations, weight and eating concerns and depressive symptoms: a prospective study of adolescents

A longitudinal study with four sequential cohorts of girls and boys in early to mid-adolescence (n = 607) was used to assess adolescent changes in global negative self-evaluation, depressive symptoms and weight and eating concerns. The effects of these areas on one another over time were also assessed. Over the six months between the two data collection times, both the girls and the boys experienced an improvement in depressive symptoms, while the boys also experienced a decrease in weight concerns. The results indicated that global negative self-evaluations could predict weight and eating concerns in boys and girls, while weight concerns could predict depressive symptoms in girls. These results are of particular interest, since these relationships have not been previously examined in a longitudinal study.

Impact of development on children's mourning

PURPOSE

A qualitative approach was used to analyze the impact of development on the grief responses of 157 children from 88 families to the death of a parent from cancer.

DESCRIPTION OF STUDY

Children from age 3 to 17 years were divided by developmental characteristics, derived from interview data, into five development-derived age categories.

RESULTS

The responses of children in different categories clarified the impact of development on their distinct expressions of grief, attributes of the parent they mourned, and the parent's tasks in enhancing the reconstitution of the child and the family.

CLINICAL IMPLICATIONS

This first attempt to find a way to segregate children into developmentally more homogenous subgroups led to the clarification of patterns of mourning behaviors that are clinically useful. The increased precision of findings, such as the way development affects the child's mourning and the related parental support they need, may help clinicians develop more specific interventions to help children cope with the death of a parent and guide parents in understanding their children's differing responses. The pivotal role of the surviving parent and the tasks required of that parent are important for healthcare professionals to understand and support.

Attention and joint attention in preschool children with autism

Three experiments examined the role of attention in explaining dyadic (child-adult) and triadic (child-adult-object) joint attention difficulties in autism. Experiments 1 and 2 investigated children's ability to orient to an adult's attention bid and to follow the direction of a human or nonhuman cue. Experiment 3 tested ability to disengage and shift attention to objects. Results showed autism-specific difficulties at both dyadic and triadic levels. Children with autism were less responsive than developmentally delayed controls in orienting to attention bids and in following a human head-turn cue yet had no difficulty in shifting attention and were faster overall in orienting to targets. Results suggest a specific developmental delay in which children with autism rely on the presence of objects in the visual field to guide action. The relation between this problem and autistic children's difficulties with human communicative signals is discussed.

Parental perspectives of the health status and health-related quality of life of teen-aged children who were extremely low birth weight and term controls

OBJECTIVES

To compare the health status and health-related quality of life of teen-aged children who were extremely low birth weight (ELBW) with matched controls from the perspective of their parents.

STUDY DESIGN

Geographically defined cohort; longitudinal follow-up; cross-sectional interviews.

PARTICIPANTS

parents of 149/169 (88%) ELBW children between 12 and 16 years of age (including 41 children with neurosensory impairments) and 126/145 (87%) parents of term controls. Health status of the teenagers was classified according to the 6 attributes of the Health Utilities Index Mark 2, based on information obtained during parent interviews. Parents were asked to imagine themselves living in their own child's health state and 4 preselected hypothetical health states when providing directly measured standard gamble utility scores.

RESULTS

Parents of ELBW children reported a higher frequency and more complex functional limitations than parents of controls for their own children's health status. Also, the mean utilities were lower (ELBW =.91 vs controls =. 97) and the variability in their scores was greater. There were no differences in the valuation of the hypothetical health states provided by parents of ELBW and control children.

CONCLUSIONS

ELBW children were reported to have a greater burden of disability than were control children based on parental descriptions. Nonetheless, parents of ELBW children, on average, rated the health-related quality of life of their children fairly high. Thus, differences in reported functional status are not necessarily associated with lower utility scores.

Role of the working alliance in the treatment of delinquent boys in community-based programs

Examined the role of the working alliance in the treatment of delinquent boys in community-based residential programs, clarifying the relation between therapeutic process and behavioral change. Horvath and Greenberg's (1989) Working Alliance Inventory was used to assess the therapeutic alliance between youth and staff after 3 weeks in treatment and again after 3 months. Achenbach's (1991) Child Behavior Checklist (CBCL; Youth Self-Report [YSR] and Teacher Report Form [TRF]) and recidivism scores were used to assess treatment progress and outcome. Results indicated that a positive working alliance assessed after 3 months in treatment related to positive psychological changes and predicted lower rates of recidivism. Unexpectedly, a positive working alliance assessed early in treatment was associated with negative outcomes (increased internalizing and externalizing symptoms and higher rates of recidivism). This finding suggests that for some delinquent youth initially optimistic assessments may be prognostic of slow progress or treatment failure.

The role of proactive and reactive aggression in the formation and development of boys' friendships

This study tested the hypothesis that friends are more similar in proactive aggression than in reactive aggression. Interpersonal processes that may account for this similarity (i.e., selection and mutual influence) were also examined. In the fall and spring of the school year, the friendships of 185 4th-, 5th-, and 6th-grade boys were identified. Proactive and reactive aggressive behavior were assessed with a teacher-rating instrument for each boy. The results support the general hypothesis and suggest that proactively aggressive boys tend to select proactively aggressive peers as friends; however, mutual influence between stable friends does not appear to account for similarity. These findings are discussed within the framework of G. R. Patterson, J. B. Reid, and T. J. Dishion's (1992) theory of antisocial behavior.

Effects of prenatal alcohol exposure on social behavior in humans and other species

Alcohol exposure during development causes central nervous system alterations in both humans and animals. Although the most common behavioral manifestation of these alterations is a reduction in cognitive abilities, it is becoming increasingly apparent that deficits in social behavior may be very prevalent sequelae of developmental alcohol exposure. In infancy and early childhood, deficits in attachment behavior and state regulation are seen in both alcohol-exposed people and animals, suggesting that these changes are largely the result of the alcohol exposure rather than maternal behavior. In the periadolescent period, people exposed to alcohol during development show a variety of difficulties in the social domain as measured by checklists filled out by either a parent or teacher. Rats exposed to alcohol during development show changes in play and parenting behaviors. In adulthood, prenatal alcohol exposure is related to high rates of trouble with the law, inappropriate sexual behavior, depression, suicide, and failure to care for children. These high rates all suggest that there may be fundamental problems in the social domain. In other animals, perinatal alcohol exposure alters aggression, active social interactions, social communication and recognition, maternal behavior, and sexual behavior in adults. In conclusion, research suggests that people exposed to alcohol during development may exhibit striking changes in social behavior; the animal research suggests that these changes may be largely the result of the alcohol insult and not the environment.

Attachment and borderline personality disorder. A theory and some evidence

An attachment theory approach to severe personality disorder is described. Evidence is presented that suggests that representations of attachment relationships and attachment behaviors of patients with this diagnosis are commonly disorganized in character. It is argued that the capacity to develop mental representations of mental states in self and other (reflective function) develops in the context of attachment relationships and that disorganization of attachment undermines this process. Such disorganization can be associated with trauma but may also be linked to other biological and psychosocial deficits. Many of the clinical characteristics of patients with borderline personality disorder may be seen as consequences of disordered self-organization and a limited rudimentary capacity to think about behavior in mental state terms. The relevance of this model for the practice of psychotherapy with this group of patients is discussed.

Marital behavior and the security of preschooler-parent attachment relationships

Longitudinal and concurrent relations among positive and negative marital behaviors in 2 contexts and preschoolers' security of attachment were examined for 53 families. At 6 months postpartum, couples were observed in their homes during couple discussion and family play. At 3 years, parents completed the Attachment Q-Set (E. Waters, 1987); marital and parenting behavior was also observed. Interparental hostility during family play at 6 months predicted less secure preschooler-mother attachment. Greater marital conflict at 3 years was associated with less security with mother and father, whereas positive marital engagement at 3 years was associated with more secure child-father attachment. Mothers' parenting partially explained the linkages between marital behavior and child-mother attachment. These results highlight the impact of positive and negative marital behaviors on children's abilities to use their parents as a secure base.

Comorbidity of reading disability and attention-deficit/hyperactivity disorder: differences by gender and subtype

This study used a community sample of 494 twins with a reading disability (223 girls, 271 boys) and 373 twins without a reading disability (189 girls, 184 boys) to assess the relation between reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD). Symptoms of DSM-III and DSM-IV ADHD were classified into symptoms of inattention and symptoms of hyperactivity-impulsivity (H/I). Results indicated that individuals with RD were more likely than individuals without RD to meet criteria for ADHD and that the association between RD and ADHD was stronger for symptoms of inattention than for symptoms of H/I. Parents and teachers reported similar rates of ADHD, suggesting that ADHD symptoms were pervasive across settings and were not solely attributable to academic frustration. Analyses of possible gender differences revealed that RD was significantly associated with inattention in both girls and boys but associated with H/I only in boys. This difference may provide a partial explanation for the discrepancy between the gender ratio obtained in referred (approximately 4 boys to 1 girl) and nonreferred (1.2 to 1.5 boys to 1 girl) samples of individuals with RD. Specifically, the hyperactive and impulsive behaviors exhibited by boys with RD may be more disruptive than the inattentive behaviors exhibited by girls and may therefore precipitate more frequent referrals for clinical attention.

Assessing peer network and dyadic loneliness

Describes the Peer Network and Dyadic Loneliness Scale (PNDLS), a new scale designed to assess simultaneously children's loneliness at multiple levels of peer relationships. Specifically, this scale measures loneliness associated with (a) lack of involvement in a social network and (b) the absence of a close dyadic friendship. Employing a sample of 209 5th-, 6th-, and 7th-grade boys and girls, the psychometric properties, interscale correlations, and preliminary validity data for the new scale are examined. Analyses revealed good internal consistency and a pattern of relationships with other loneliness, friendship quality, mutual best friendship, and sociometric social preference variables supporting the validity of the new scale.

Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes

Compared 16 children with attention deficit hyperactivity disorder (ADHD) combined type (ADHD-C), 14 children with ADHD predominantly inattentive type (ADHD-I), and 17 controls on parent and teacher ratings of social status and performance, self-report of social knowledge and performance, and observations of behavior on an emotional regulation task. Analyses revealed distinct patterns of social dysfunction between ADHD subgroups. Children with ADHD-C were rated as showing more aggressive behavior; furthermore, they displayed emotional dysregulation characterized by high intensity and high levels of both positive and negative behavior. In contrast, children with ADHD-I were perceived as displaying social passivity and showed deficits in social knowledge on the self-report measure but did not evidence problems in emotional regulation. Regression analyses revealed that social performance, emotional regulation, and, to a lesser degree, social knowledge, were predictive of social status. The application of these findings to understanding the nature of the social deficits in the ADHD subtypes and directions for future research are discussed.

Adolescent growth in new forms of problem behavior: macro- and micro-peer dynamics

Longitudinal data from an at-risk sample were used to analyze individual linear trend scores for each of three new forms of problem behavior that emerges during the interval from age 10 through 18 years. Growth in substance use, health-risking sexual behavior and police arrests defined a latent construct for growth in adolescent problem behavior. A structural equation model (SEM) showed a significant path from early involvement with deviant peers to a latent construct for growth in new forms of antisocial behavior. A second SEM showed that the contribution of early involvement to later growth was mediated by a latent construct for deviancy training assessed at age 14 years. The relative rates of reinforcement for deviancy, amount of time spent with deviant peers, and deviancy level of the peer network defined a deviancy training construct that accounted for 53% of the variance in later growth in new forms.

Resilient and stress-affected adolescents in an urban setting

Studied 185 seventh- and eighth-grade inner-city adolescents. Participants were categorized as low and high in exposure to stressors (stressful events or neighborhood disadvantage) and externally exhibited competence (self-, teacher, and school reports). We predicted that resilient (high-stress/high-competence) and stress-affected (high-stress/low-competence) youth would differ across three domains of hypothesized protective resources: internal resources (i.e., coping skills, perceived competence), familial support, and extrafamilial support. We also predicted that there would be an emotional cost to resilient youth in terms of experiencing internalizing problems (depression, anxiety). There were direct effects for stressor level on several protective resources; however, the hypothesized protective resources did not discriminate resilient from stress-affected youth. Both Resilient and stress-affected youth experienced equivalent levels of internalizing symptoms, and these groups' scores were higher than those of low-stress participants. These results are possibly reflective of the effects of chronic stressors.

Parent-teacher concordance for DSM-IV attention-deficit/hyperactivity disorder in a clinic-referred sample

OBJECTIVE

To examine concordance between parent and teacher reports of DSM-IV attention-deficit/hyperactivity disorder (ADHD) and its symptoms.

METHOD

Parents and teachers of 74 clinically referred children were interviewed using the ADHD module of the Diagnostic Interview Schedule for Children. Parent-teacher agreement for the diagnosis of ADHD and its subtypes, as defined in DSM-IV, as well as parent-teacher concordance of in-school ADHD symptoms, was examined.

RESULTS

Agreement between parents and teachers was found to be relatively poor, with virtually no agreement for individual ADHD subtypes. Diagnoses based on either parent or teacher report frequently yielded a diagnosis of either inattentive or hyperactive-impulsive subtype of ADHD. However, when cross-informant data were used to form diagnoses, these subtypes became relatively rare, with most cases meeting criteria for ADHD combined type. In addition, parent reports of in-school behavior were more highly correlated with their own reports of their child's behavior at home than with teacher reports of their child's behavior in school.

CONCLUSIONS

These data suggest that the diagnosis of ADHD inattentive or hyperactive-impulsive subtype based on data from a single informant may be of questionable validity, and they point to the importance of using multiple informants when diagnosing this disorder in clinically referred samples.

Parenting practices and child disruptive behavior problems in early elementary school. Conduct Problems Prevention Research Group

Examined the hypothesis that distinct parenting practices may be associated with type and profile of a child's disruptive behavior problems (e.g., oppositional, aggressive, hyperactive). Parents of 631 behaviorally disruptive children described the extent to which they experienced warm and involved interactions with their children and the extent to which their discipline strategies were inconsistent and punitive and involved spanking and physical aggression. As expected from a developmental perspective, parenting practices that included punitive interactions were associated with elevated rates of all child disruptive behavior problems. Low levels of warm involvement were particularly characteristic of parents of children who showed elevated levels of oppositional behaviors. Physically aggressive parenting was linked more specifically with child aggression. In general, parenting practices contributed more to the prediction of oppositional and aggressive behavior problems than to hyperactive behavior problems, and parenting influences were fairly consistent across ethnic groups and sex.

Disentangling the impact of low cognitive ability and inattention on social behavior and peer relationships. Conduct Problems Prevention Re search Group

Examined the shared and unique contributions of low cognitive ability and inattention to the development of social behavior problems and peer relationships of children at the time of school entry. Kindergarten and first-grade assessments of cognitive ability, inattention and prosocial and aggressive behavior were collected for a multisite, normative sample. Sociometric assessments of peer relationships were collected at the end of first grade. Cognitive ability and inattention both contributed to the prediction of social behavior and peer relationships. Low cognitive ability was particularly predictive of prosocial skill deficits, and social behavior mediated the relation between cognitive ability and social preference. Inattention predicted both prosocial skill deficits and elevated aggressive-disruptive behavior problems. Behavior problems partially mediated the relation between inattention and social preference. Identified subgroups of children with elevated levels of inattention or low cognitive ability showed different patterns of peer problems, with low acceptance characteristic of the low cognitive ability (only) group and high dislike ratings characteristic of the inattentive and inattentive/low-ability group. Implications are discussed for the design of early intervention and prevention programs.

Developmental risk factors for youth violence

PURPOSE

To replicate earlier research findings on risk factors for youth violence and to explore the effects on violent behavior of constructs shown to increase risk for other problem behaviors, within a developmental frame.

METHODS

Data were from the Seattle Social Development Project (SSDP), a prospective study involving a panel of youths followed since 1985. Potential risk factors for violence at age 18 years were measured at ages 10, 14, and 16 years. Bivariate relationships involving risk factor constructs in the individual, family, school, peer and community domains and violence were examined at each age to assess changes in their strength of prediction over time. Attention was also given to the additive strength of increasing numbers of risk factors in the prediction of violence at age 18 years. A final set of analyses explored the extent to which youths were correctly classified as having committed a violent act (or not) at age 18 years on the basis of their overall level of risk at ages 10, 14, and 16 years.

RESULTS

At each age, risk factors strongly related to later violence were distributed among the five domains. Ten of 15 risk factors constructs measured at age 10 years were significantly predictive of violence at age 18 years. Twenty of 25 constructs measured at age 14 years and 19 of 21 constructs measured at age 16 years were significantly predictive of later violence. Many constructs predicted violence from more than one developmental point. Hyperactivity (parent rating), low academic performance, peer delinquency, and availability of drugs in the neighborhood predicted violence from ages 10, 14, and 16 years. Analyses of the additive effects of risk factors revealed that youths exposed to multiple risks were notably more likely than others to engage in later violence. The odds for violence of youths exposed to more than five risk factors compared to the odds for violence of youths exposed to fewer than two risk factors at each age were seven times greater at age 10 years, 10 times greater at age 14 years, and nearly 11 times greater at age 16 years. However, despite information gained from all significant risk factors, the overall accuracy in predicting youths who would go on to commit violent acts was limited.

CONCLUSIONS

Findings from the study have important implications for preventive intervention programs. Prevention efforts must be comprehensive and developmentally sensitive, responding to large groups or populations exposed to multiple risks.

Q-sort assessment of attachment security during the preschool years: links from home to school

This study investigated relations among preschoolers' secure-base behavior with mother at home, stressful family conditions, and qualities of developing relationships with peers and teachers in preschool. Preschool-age children (N = 94; 51 boys and 43 girls) and their mothers were observed during multiple home visits, and their security of attachment was assessed with the Attachment Q-Set. Children in families with lower levels of stress had more secure attachment relationships with mothers. Both boys and girls who were less securely attached to their mothers expressed significantly more anger-aggression in preschool. For boys, higher levels of family stress were also significantly related to anger-aggression and to social competence in preschool. In addition, boys who were more securely attached to their mothers were more securely attached to their preschool teachers and were more popular with peers in preschool.

The relationship of maternal personality characteristics to birth outcomes and infant development

BACKGROUND

Previous studies reported an association between maternal psychological factors and adverse pregnancy outcomes. The objective of this study was to evaluate the relationships between maternal personality characteristics, as determined by the Minnesota Multiphasic Personality Inventory (MMPI), and infant birth outcomes and development.

METHOD

The inventory was administered during pregnancy to 638 pregnant women enrolled in a staff model health maintenance organization. MMPI validity as well as clinical and research scales were evaluated in relationship to infant birth outcomes (low birthweight, preterm birth) and 15-month-old infant development as assessed by the Bayley Scales of Infant Development.

RESULTS

Mothers of low birthweight infants scored significantly lower on the hypochondriasis scale, a relationship which was no longer significant after controlling for ethnicity. No other relationships were observed between infant birth outcomes and maternal MMPI scale scores. A higher infant Mental Developmental Index (MDI) was related to higher maternal masculinity-femininity and ego-strength scale scores and lower lie and hypochondriasis scale scores. Only the relationship between infant MDI and maternal masculinity-femininity scale score remained significant after controlling for ethnicity and socioeconomic index (beta = 0.104, p = 0.036).

CONCLUSIONS

Maternal personality characteristics, as determined by the MMPI, did not appear to be significantly related to the occurrence of preterm birth or low birthweight in this healthy, general population. Maternal personality characteristics reflected in the MMPI masculinity-femininity scale appeared to be related to infant mental development, above and beyond the effects of socioeconomic status and ethnicity.

Identification of neuropsychological subtypes in a sample of delinquent adolescents

Although research has long recognized a relationship between neurological dysfunction and delinquency, the nature of this relationship is unclear. Based on the theory that there may be clusters of delinquents with different types of neurological dysfunction which contribute to the delinquency in different ways, the present research attempted to identify these subtypes using neuropsychological testing. Seventy-seven such adolescents were administered the full Luria-Nebraska Neuropsychological Battery-III (LNNB-III) and a battery of assessments measuring behavioral functioning and substance use. A Hierarchical Cluster Analysis yielded four identifiable neuropsychological clusters: Verbal/Left-Hemispheric Deficits, Subcortical-Frontal Deficits, Mild-Verbal Deficits, and Normals. The distinctiveness of these subtypes was confirmed by univariate analyses. Results further indicated that the number of LNNB scales that were in the abnormal range differed per subtype, with each subtype differing significantly from one another. These neuropsychological subtypes were found to be associated with specific psychological and behavioral problems.

The development of infant intersensory perception: advantages of a comparative convergent-operations approach

Despite impressive demonstrations of human infants' intersensory capabilities over the past several decades, there has been little focus on the contributions of prenatal and postnatal experience or the specific developmental processes underlying the emergence of intersensory functioning. Research with nonhuman animals has, however, provided a number of advances in understanding early intersensory perception. The authors explore the value of a comparative, convergent-operations approach to the study of early intersensory perception and examine how this approach has highlighted the study of (a) prenatal factors, (b) brain-behavior relations, and (c) context and experience variables contributing to infants' intersensory responsiveness. Examples of how human and animal research programs can cross-fertilize one another in their attempts to understand developmental processes underlying intersensory perception are considered.

Determinants of psychological well-being in Irish immigrants

Immigration accounts for nearly half of the U.S. population growth in the past 20 years, and this trend is expected to continue. The purpose of this study is to examine the relationship between demographics, resilience, life satisfaction, and psychological well-being among Irish immigrants. Employing a cross-sectional design, a sample of 100 Irish immigrants completed the Demographic and Migration Questionnaire, the Resilience Scale, the Migration Quality of Life Scale, and the General Well-Being Schedule. Hierarchical regression analyses were used to test the association of psychological well-being with demographics, resilience, and life satisfaction. Findings revealed that number of annual health care appointments, higher resilience, and greater life satisfaction were the strongest predictors of psychological well-being.

Findings on disruptive behavior disorders from the first decade of the Developmental Trends Study

The paper summarizes the first decade of the Developmental Trends Study, a prospective longitudinal study of 177 boys. Initially, they were referred to mental health clinics in Pennsylvania (Pittsburgh), and Georgia (Athens and Atlanta). Since 1987, the boys, their parents, and their teachers have been followed up almost annually. The study is unique because the cooperation rate of participants has remained very high over the years, psychiatric diagnoses were derived from structured interviews (especially disruptive behavior disorders), and many risk factors were measured over the years. The present paper summarizes key findings on the development of disruptive behavior, especially Oppositional Defiant Disorder, Conduct Disorder, and Attention Deficit-Hyperactivity Disorder. The paper also highlights results on risk factors and comorbid conditions of disruptive behaviors.

Psychological consequences of child maltreatment in homeless adolescents: untangling the unique effects of maltreatment and family environment

OBJECTIVE

This study examined the differential effects of various forms of abuse, as well as their combined effects. The study also sought to separate the factors uniquely associated with abuse from those associated with the more general problems present in an abusive family environment.

METHODOLOGY

Data were collected from 329 homeless adolescents. Preliminary analyses indicated some degree of matching for family background variables. Any differences in demographic or family characteristics were controlled for statistically.

RESULTS

Chi-square analyses revealed significant differences across groups for rates of assault, rape, depression/dysthymia, and attempted suicide. Multivariate analyses (MANOVAs) indicated significant differences in severity of internalizing problems and cognitive problems. Without exception, the group with histories of both physical and sexual abuse exhibited the most severe symptomatology and was at greatest risk for revictimization. Multiple regression analyses suggested that abuse histories were predictive of internalizing problems while family characteristics were more predictive of externalizing problems.

CONCLUSIONS

The findings indicate that both abuse type and family characteristics contribute to the development of symptomatology. Future prospective and longitudinal studies are needed to clarify the sequelae of abuse, as well as the possible cause and effect relations between abuse, family characteristics, and psychological outcome.

Emotion regulation as a mediator of associations between mother-child attachment and peer relationships in middle childhood

Although a link between attachment and peer relationships has been established, the mechanisms that account for this link have not been identified. The 1st goal of this study was to test emotion regulation as a mediator of this link in middle childhood. The 2nd goal was to examine how different aspects of emotion regulation relate to peer competence. Fifth graders completed self-report and semiprojective measures to index mother-child attachment, mothers reported on children's emotionality and coping strategies, and teachers reported on children's peer competence. Constructive coping was related to both attachment and peer competence, and mediated the association between attachment and peer competence, suggesting that emotion regulation is one of the mechanisms accounting for attachment-peer links. Constructive coping was more strongly associated with peer competence for children high on negative emotionality than for children low on negative emotionality.

On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy

Disinhibition is a common focus in psychopathology research. However, use of inhibition models often is piecemeal, lacking an overarching taxonomy of inhibitory processes. The author organizes key concepts and models pertaining to different kinds of inhibitory control from the cognitive and temperament/personality literatures. Within the rubrics of executive inhibitory processes, motivational inhibitory processes, and automatic attentional inhibition processes, 8 kinds of inhibition are distinguished. Three basic temperament traits may address key executive and motivational inhibitory processes. Future developmental psychopathology research should be based on a systematic conceptual taxonomy of the kinds of inhibitory function relevant to a given disorder. Such an approach can clarify which inhibition distinctions are correct and which inhibition deficits go with which disorders.

Ultradian rhythms and temporal coherence in sleep EEG in depressed children and adolescents

BACKGROUND

It has been suggested that a primary ultradian (80-120 minute) rhythm disturbance in EEG underlies sleep abnormalities in adults with depression. The present study evaluated ultradian rhythm disturbances in childhood and adolescent depression.

METHODS

Sleep macroarchitecture and temporal coherence in quantitative EEG rhythms were investigated in 50 medication-free outpatients with major depression (25 children and 25 adolescents) and 15 healthy normal controls (5 children and 10 adolescents).

RESULTS

Few of the macroarchitectural measures showed significant group effects. In fact, age and sex effects were stronger than disease-dependent components. Temporal coherence of EEG rhythms during sleep did differentiate those with MDD from controls. Both depressed children and adolescents had lower intrahemispheric coherence, whereas interhemispheric was only lower in depressed adolescents in comparison with controls. Gender differences were evident in adolescents, but not children, with MDD with lowest interhemispheric coherence in adolescent girls.

CONCLUSIONS

These findings are in keeping with increased risk for depression in females beginning at adolescence and extending throughout adulthood. It was suggested that low temporal coherence in depression reflects a disruption in the fundamental basic rest-activity cycle of arousal and organization in the brain that is strongly influenced by gender.

Treatment and prevention implications of antisocial personality disorder

Recent research efforts have focused on understanding the developmental nature of antisocial personality disorder (APD) in order to better develop intervention strategies. This article reviews what is known about biologic and environmental risk factors for the development of APD as well as issues surrounding treatment. Insights into how these factors may work together, and issues involving approaches to researching them, are discussed. Given the impact of this disorder on the lives of the affected individuals as well as society, prevention of this disorder may be a more important focus than intervention.

The relation of perceived neighborhood danger to childhood aggression: a test of mediating mechanisms

In the current study, two mediational mechanisms, parenting practices and children's beliefs about aggression, were hypothesized to account for the relationship between perceived neighborhood danger and childhood aggression. Using structural equation modeling, data were analyzed from an inner-city school-based sample of 732 predominantly African American 5th graders. Results suggested that perceived neighborhood danger was associated with strong positive beliefs about aggression, which in turn was associated high levels of aggression. The hypothesized mediating role of parenting practices (restrictive discipline, parental monitoring, and parental involvement) on the relation between perceived neighborhood danger and child aggression was not supported. However, the current findings suggest that children's positive beliefs about aggression mediated the relationship between restrictive discipline and aggression. Directions for future research are discussed.

School difficulties at adolescence in a regional cohort of children who were extremely low birth weight

OBJECTIVES

To compare measures of psychometric assessment and school difficulties in a cohort of extremely low birth weight (ELBW) teenagers and term controls, and to determine whether there is stability in psychometric measures between age 8 and the teen years.

STUDY DESIGN

Longitudinal follow-up; geographically defined region.

PARTICIPANTS

150 of 169 (89%) ELBW survivors born between 1977 and 1982 and 124 of 145 (86%) sociodemographically matched term controls between 12 and 16 years of age. Psychometric measures: Wechsler Intelligence Scale for Children-Revised, Wide Range Achievement Test-Revised, and a validated parent questionnaire.

RESULTS

Neurosensory impairments were present in 28% of ELBW and 1% of controls. The mean Wechsler Intelligence Scale for Children-Revised scores were ELBW: 89 +/- 19 and controls: 102 +/- 13. ELBW children did less well on Wide Range Achievement Test-Revised Reading, Spelling, and Arithmetic measures with mean scores in the range from 75 to 85. ELBW children <750 g were more disadvantaged, compared with those >/=750 g. A significantly higher proportion of ELBW children were receiving special educational assistance and/or had repeated a grade (ELBW: 58%; controls: 13%; odds ratio: 9.0). Paired analysis of within-cohort data at age 8 and teen years showed that for both cohorts Arithmetic scores declined, but there were small improvements in other measures, predominantly in the term children.

CONCLUSIONS

Differences of 13 to 18 points in psychometric measures in ELBW teens compared with controls are both statistically significant and clinically relevant. Decreasing birth weight was associated with increased risk on all measures. The high utilization of special educational resources has economic implications, and the incremental cost attributable to being extremely premature needs to be determined.

Sociocultural differences in the developmental consequences of the use of physical discipline during childhood for African Americans

Given the diverse cultures that can shape parenting behavior, some basic assumptions regarding the links between parenting styles and developmental outcomes may not be universal. Although a positive correlation between the use of physical discipline (i.e., spanking) and disruptive disorders in children is found in studies of European American families, research on African American families has found a negative association or none at all. Moreover, a review of the literature indicates that the positive association between spanking and child behavior problems is bidirectional for White families, whereas it is the product of reverse causation (i.e., negative child behaviors result in spanking) in Black families. The implications of these sociocultural differences for parent training programs and the family study of disruptive behaviors are discussed.

Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking

CONTEXT

Although studies of clinical samples have identified links between childhood abuse, especially sexual abuse, and adult health-risk behaviors, the generalizability of these findings to the population and the relative importance of different types of abuse in men and women are not known.

OBJECTIVE

To estimate the risk of self-reported adult HIV-risk behaviors and heavy drinking that is associated with self-reported childhood histories of physical and/or sexual abuse for men and women in a general-population sample, after controlling for age and education. A second objective is to determine whether, among women, early and chronic sexual abuse is associated with heightened risk compared to later or less extensive abuse.

DESIGN

A population-based telephone survey, the 1997 Washington State Behavioral Risk Factor Surveillance System (BRFSS), asked a representative sample of adults whether they had ever been physically or sexually abused in childhood, and if so, the age at first occurrence and number of occurrences. The survey also asked about levels of alcohol use and, for those under 50 years, about HIV-risk behaviors.

PARTICIPANTS

Three thousand four hundred seventy-three English-speaking non-institutionalized civilian adults in Washington State.

MAIN OUTCOME MEASURES

Self-reported HIV-risk behaviors in the past year and heavy drinking in the past month.

RESULTS

We identified associations between reported abuse history and each health-risk behavior that we examined. For women, early and chronic sexual abuse (occurring without nonsexual physical abuse) was associated with more than a 7-fold increase in HIV-risk behaviors (odds ratio [OR], 7.4; 95% confidence intervals [CI] 2.4 to 23.5); and any sexual abuse, combined with physical abuse, was associated with a 5-fold increase in these risk behaviors (OR, 5.0; 95% CI, 2.2 to 11.5). For women, only combined sexual and physical abuse was associated with heavy drinking (OR, 6.2; 95% CI, 2.2 to 16.9). Physical abuse alone was not associated with either health-risk behavior for women. For men, any sexual abuse was associated with an 8-fold increase in HIV-risk behaviors (OR, 7.9; 95% CI, 1.8 to 35.1). Physical abuse alone was associated with a 3-fold increase in risk of HIV-risk behaviors (OR, 3.2; 95% CI, 1.3 to 7.9) and a similar increase in risk of heavy drinking (OR, 3.2; 95% CI, 1.8 to 5.5). Although only 29% of the women and 19% of the men who were asked about HIV-risk behaviors reported any history of childhood abuse, these accounted for 51% and 50% of those reporting HIV-risk behaviors, respectively. For heavy drinking the corresponding figures were 25% of the women and 23% of the men reporting any abuse, who accounted for 45% and 33% of those reporting heavy drinking, respectively.

CONCLUSIONS

Efforts to prevent or remediate adult health-risk behaviors should consider the possibility of a history of childhood abuse, as one third to one half of those reporting HIV-risk behaviors or heavy drinking in a general-population survey also reported childhood abuse.

Behavior and autonomic nervous system function assessed via heart period measures: the case of hyperarousal in boys with fragile X syndrome

Physiological responses may inform us about and help us to interpret behavioral responses. For example, hyperarousal may be a source of behavior problems in children with fragile X syndrome (FXS). To evaluate this approach, we examined heart period data in specific contexts in boys with FXS and in normally developing chronological-age-matched boys. Spectral analysis was used to evaluate the parasympathetic and sympathetic nervous systems' contributions to heart period. Boys with FXS had shorter interbeat intervals, lower parasympathetic activity, and similar sympathetic activity. Also, the groups were differentially responsive to experimental challenge. These results have important implications for our understanding of the basic nervous system dysfunction in FXS and for the strategies likely to be effective in terms of pharmacological intervention with these children. These methods can be applied to a variety of contexts and populations, including children who are sensory defensive, socially avoidant, inattentive, or hyperactive.