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Stevens MA, Selders KJ, Jeckel O, Brownfield V, Nowell KP. An Evaluation of Parent and Teacher Discrepancies on an Adaptive Behavior Measure for Youth with Autism Spectrum Disorder, Intellectual Disability, and Global Developmental Delay. J Autism Dev Disord 2022:10.1007/s10803-022-05550-x. [PMID: 35445930 DOI: 10.1007/s10803-022-05550-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
Comprehensive evaluations include data from multiple informants, but discrepancies occur on adaptive skill measures of youth with autism spectrum disorder (ASD) and intellectual disabilities (ID). This study investigated discrepancies between parent-teacher ratings on a measure of adaptive behavior [Adaptive Behavior Assessment System, Third Edition (ABAS-3)] in a clinical sample of 115 youth. Agreement between informants was determined and then discrepancies were identified using paired-sample t-tests for the whole sample and subsamples. Factors associated with parent-teacher discrepancies were investigated including age, diagnoses, IQ, autism symptomology, and parent education. Parent-teacher scores were moderately correlated for the ABAS-3 composite and domains. Teachers rated youth with ASD and ID as having higher adaptive skills. Autism symptomology significantly predicted discrepancies between informants on the ABAS-3.
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Affiliation(s)
- Mallory A Stevens
- Department of Educational, School, and Counseling Psychology, University of Missouri, 16 Hill Hall, Columbia, MO, 65211, USA.
| | - Kimberly J Selders
- Department of Special Education, University of Missouri, Columbia, MO, USA
| | - Olivia Jeckel
- Department of Psychological Services, University of Missouri, Columbia, MO, USA
| | | | - Kerri P Nowell
- Department of Health Psychology, Thompson Center for Autism and Neurodevelopmental Disorder, University of Missouri, Columbia, MO, USA
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Overgaard KR, Oerbeck B, Aase H, Torgersen S, Reichborn-Kjennerud T, Zeiner P. Emotional Lability in Preschoolers With Symptoms of ADHD. J Atten Disord 2018; 22:787-795. [PMID: 25804545 DOI: 10.1177/1087054715576342] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine occurrence of emotional lability (EL) in preschoolers with ADHD symptoms versus controls. METHOD The study was part of the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. In the present study, 495 preschoolers were clinically examined. Symptoms of ADHD, anxiety, and oppositional defiant disorder (ODD) were measured with the Preschool Age Psychiatric Assessment Interview. An EL measure was obtained from the Emotional Control subscale of the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P), which parents and teachers completed. RESULTS EL was significantly more frequent in the ADHD group compared with controls (25% vs. 7%, p < .001). By parent report, EL correlated significantly with ADHD-, anxiety-, and ODD symptoms. By teacher report, EL was significantly correlated only with hyperactivity-impulsivity. CONCLUSION EL appears identifiable in young preschoolers and was particularly associated with ODD in children with ADHD symptoms.
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Affiliation(s)
| | | | - Heidi Aase
- 2 Norwegian Institute of Public Health, Oslo, Norway
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Youngstrom EA, Van Meter A, Frazier TW, Hunsley J, Prinstein MJ, Ong M, Youngstrom JK. Evidence‐based assessment as an integrative model for applying psychological science to guide the voyage of treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cpsp.12207] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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Cole DA, Martin JM, Jacquez FM, Tram JM, Zelkowitz R, Nick EA, Rights JD. Time-varying and time-invariant dimensions of depression in children and adolescents: Implications for cross-informant agreement. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:635-651. [PMID: 28425737 PMCID: PMC5503770 DOI: 10.1037/abn0000267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The longitudinal structure of depression in children and adolescents was examined by applying a Trait-State-Occasion structural equation model to 4 waves of self, teacher, peer, and parent reports in 2 age groups (9 to 13 and 13 to 16 years old). Analyses revealed that the depression latent variable consisted of 2 longitudinal factors: a time-invariant dimension that was completely stable over time and a time-varying dimension that was not perfectly stable over time. Different sources of information were differentially sensitive to these 2 dimensions. Among adolescents, self- and parent reports better reflected the time-invariant aspects. For children and adolescents, peer and teacher reports better reflected the time-varying aspects. Relatively high cross-informant agreement emerged for the time-invariant dimension in both children and adolescents. Cross-informant agreement for the time-varying dimension was high for adolescents but very low for children. Implications emerge for theoretical models of depression and for its measurement, especially when attempting to predict changes in depression in the context of longitudinal studies. (PsycINFO Database Record
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Affiliation(s)
- David A Cole
- Psychology and Human Development, Vanderbilt University
| | | | | | - Jane M Tram
- Department of Psychology, Pacific University
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5
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Ong ML, Youngstrom EA, Chua JJX, Halverson TF, Horwitz SM, Storfer-Isser A, Frazier TW, Fristad MA, Arnold LE, Phillips ML, Birmaher B, Kowatch RA, Findling RL. Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:611-623. [PMID: 27364346 PMCID: PMC5685560 DOI: 10.1007/s10802-016-0182-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10 M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively. Logistic regressions tested for incremental validity in the CASI-4R mania subscale and PGBI-10 M in predicting youth BPSD status above and beyond demographic and common diagnostic comorbidities. Both CASI-4R and PGBI-10 M scales significantly distinguished BPSD (N = 160) from other disorders (CASI-4R: Area under curve (AUC) = .80, p < 0.0005; PGBI-10 M: AUC = 0.79, p < 0.0005) even though scale items differed. Both scales performed equally well in differentiating BPSDs (Venkatraman test p > 0.05). Diagnostic likelihood ratios indicated low scores on either scale (CASI: 0-5; PGBI-10 M: 0-6) cut BPSD odds to 1/5 of those with high scores (CASI DLR- = 0.17; PGBI-10 M DLR- = 0.18). High scores on either scale (CASI: 14+; PGBI-10 M: 20+) increased BPSD odds about fourfold (CASI DLR+ = 4.53; PGBI-10 M DLR+ = 3.97). Logistic regressions indicated the CASI-4R mania subscale and PGBI-10 M each provided incremental validity in predicting youth BPSD status. The CASI-4R is at least as valid as the PGBI-10 M to help identify BPSDs, and can be considered as part of an assessment battery to screen for pediatric BPSDs.
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Affiliation(s)
- Mian-Li Ong
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA.
| | - Jesselyn Jia-Xin Chua
- Department of Psychology, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore
| | - Tate F Halverson
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC, 27599-3270, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | | | - Thomas W Frazier
- Cleveland Clinic Foundation, 2049 E 100th St, Cleveland, OH, 44195, USA
| | - Mary A Fristad
- Department of Psychology, Ohio State University, Columbus, OH, 43210, USA
| | - L Eugene Arnold
- Research Unit on Pediatric Psychopharmacology, Ohio State University, Columbus, OH, 43210, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Robert A Kowatch
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Robert L Findling
- Department of Psychiatry, Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, 21218, USA
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De Los Reyes A, Augenstein TM, Wang M, Thomas SA, Drabick DAG, Burgers DE, Rabinowitz J. The validity of the multi-informant approach to assessing child and adolescent mental health. Psychol Bull 2015; 141:858-900. [PMID: 25915035 DOI: 10.1037/a0038498n] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Child and adolescent patients may display mental health concerns within some contexts and not others (e.g., home vs. school). Thus, understanding the specific contexts in which patients display concerns may assist mental health professionals in tailoring treatments to patients' needs. Consequently, clinical assessments often include reports from multiple informants who vary in the contexts in which they observe patients' behavior (e.g., patients, parents, teachers). Previous meta-analyses indicate that informants' reports correlate at low-to-moderate magnitudes. However, is it valid to interpret low correspondence among reports as indicating that patients display concerns in some contexts and not others? We meta-analyzed 341 studies published between 1989 and 2014 that reported cross-informant correspondence estimates, and observed low-to-moderate correspondence (mean internalizing: r = .25; mean externalizing: r = .30; mean overall: r = .28). Informant pair, mental health domain, and measurement method moderated magnitudes of correspondence. These robust findings have informed the development of concepts for interpreting multi-informant assessments, allowing researchers to draw specific predictions about the incremental and construct validity of these assessments. In turn, we critically evaluated research on the incremental and construct validity of the multi-informant approach to clinical child and adolescent assessment. In so doing, we identify crucial gaps in knowledge for future research, and provide recommendations for "best practices" in using and interpreting multi-informant assessments in clinical work and research. This article has important implications for developing personalized approaches to clinical assessment, with the goal of informing techniques for tailoring treatments to target the specific contexts where patients display concerns. (PsycINFO Database Record
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Affiliation(s)
- Andres De Los Reyes
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland
| | - Tara M Augenstein
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland
| | - Mo Wang
- Department of Management, University of Florida
| | - Sarah A Thomas
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland
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De Los Reyes A, Augenstein TM, Wang M, Thomas SA, Drabick DA, Burgers DE, Rabinowitz J. The validity of the multi-informant approach to assessing child and adolescent mental health. Psychol Bull 2015; 141:858-900. [PMID: 25915035 PMCID: PMC4486608 DOI: 10.1037/a0038498] [Citation(s) in RCA: 813] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Child and adolescent patients may display mental health concerns within some contexts and not others (e.g., home vs. school). Thus, understanding the specific contexts in which patients display concerns may assist mental health professionals in tailoring treatments to patients' needs. Consequently, clinical assessments often include reports from multiple informants who vary in the contexts in which they observe patients' behavior (e.g., patients, parents, teachers). Previous meta-analyses indicate that informants' reports correlate at low-to-moderate magnitudes. However, is it valid to interpret low correspondence among reports as indicating that patients display concerns in some contexts and not others? We meta-analyzed 341 studies published between 1989 and 2014 that reported cross-informant correspondence estimates, and observed low-to-moderate correspondence (mean internalizing: r = .25; mean externalizing: r = .30; mean overall: r = .28). Informant pair, mental health domain, and measurement method moderated magnitudes of correspondence. These robust findings have informed the development of concepts for interpreting multi-informant assessments, allowing researchers to draw specific predictions about the incremental and construct validity of these assessments. In turn, we critically evaluated research on the incremental and construct validity of the multi-informant approach to clinical child and adolescent assessment. In so doing, we identify crucial gaps in knowledge for future research, and provide recommendations for "best practices" in using and interpreting multi-informant assessments in clinical work and research. This article has important implications for developing personalized approaches to clinical assessment, with the goal of informing techniques for tailoring treatments to target the specific contexts where patients display concerns. (PsycINFO Database Record
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Affiliation(s)
- Andres De Los Reyes
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland at College Park, 20742, USA
| | - Tara M. Augenstein
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland at College Park, 20742, USA
| | - Mo Wang
- Department of Management, Warrington College of Business Administration, University of Florida, Gainesville, FL, 32611, USA
| | - Sarah A. Thomas
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland at College Park, 20742, USA
| | | | - Darcy E. Burgers
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA
| | - Jill Rabinowitz
- Department of Psychology, Temple University, Philadelphia, PA, 19122, USA
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Da Fonseca D, Adida M, Belzeaux R, Azorin JM. Trouble déficitaire de l’attention et/ou trouble bipolaire ? Encephale 2014; 40 Suppl 3:S23-6. [DOI: 10.1016/s0013-7006(14)70127-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Horwitz SM, Storfer-Isser A, Demeter C, Youngstrom EA, Frazier TW, Fristad MA, Arnold LE, Axelson D, Birmaher B, Kowatch RA, Findling RL. Use of outpatient mental health services among children of different ages: are younger children more seriously ill? Psychiatr Serv 2014; 65:1026-33. [PMID: 24789735 PMCID: PMC4121963 DOI: 10.1176/appi.ps.201300209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study compared use of specialty outpatient mental services among children ages six and seven and children ages eight through 12 and investigated predictors of differences in the patterns of service use by age. METHODS Eligible children were first-time patients of clinics participating in the Longitudinal Assessment of Manic Symptoms who were between ages six and 12 and who were English speaking. Children who screened positive for symptoms of mania (N=1,124) were invited to participate, and families of 621 (55%) children consented. A matched sample of 86 children without a positive screen for mania also participated. Baseline interviews assessed sociodemographic characteristics of the child and family and the child's functioning, diagnoses, and use of services. RESULTS Of the 707 children, 30% were younger, and 50% used multiple types of specialty outpatient services. Younger children were more likely to be male, have Medicaid insurance, and have two parents with mental health problems. Use of multiple types of services was related to study site, high depression scores, fewer minor health issues, and fewer stressful life events among younger children and with parental stress, primary diagnosis, poor functioning, and not living with both parents among older children. Younger children were much more likely than older children to have used services before age six. CONCLUSIONS Younger children showed very early use of multiple types of services for mental health problems and a pattern of persistent impairment despite long-standing use of services. These data argue strongly for focusing on emotional and behavioral issues among young children.
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Findling RL, Jo B, Frazier TW, Youngstrom EA, Demeter CA, Fristad MA, Birmaher B, Kowatch RA, Arnold E, Axelson DA, Ryan N, Hauser JC, Brace DJ, Marsh LE, Gill MK, Depew J, Rowles BM, Horwitz SM. The 24-month course of manic symptoms in children. Bipolar Disord 2013; 15:669-79. [PMID: 23799945 PMCID: PMC3762908 DOI: 10.1111/bdi.12100] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 03/28/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Longitudinal Assessment of Manic Symptoms (LAMS) study was designed to investigate phenomenology and establish predictors of functional outcomes in children with elevated manic symptoms. The purpose of this series of analyses was to determine whether the participants demonstrated different trajectories of parent-reported manic and biphasic symptoms over the first 24 months of follow-up and to describe the clinical characteristics of the trajectories. METHODS The 707 participants were initially aged 6-12 years and ascertained from outpatient clinics associated with the four university-affiliated LAMS sites. There were 621 children whose parents/guardians' ratings scored ≥ 12 on the Parent General Behavior Inventory-10-item Mania Form (PGBI-10M) and a matched random sample of 86 children whose parents/guardians' ratings scored ≤ 11 on the PGBI-10M. Participants were seen every six months after the baseline and their parents completed the PGBI-10M at each visit. RESULTS For the whole sample, manic symptoms decreased over 24 months (linear effect B = -1.15, standard error = 0.32, t = -3.66, p < 0.001). Growth mixture modeling revealed four unique trajectories of manic symptoms. Approximately 85% of the cohort belonged to two classes in which manic symptoms decreased. The remaining ~15% formed two classes (high and rising and unstable) characterized by the highest rates of diagnostic conversion to a bipolar disorder (all p-values < 0.001). CONCLUSIONS Outcomes are not uniform among children with symptoms of mania or at high risk for mania. A substantial minority of clinically referred children shows unstable or steadily increasing manic symptoms, and these patterns have distinct clinical correlates.
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Affiliation(s)
- Robert L Findling
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, CA
| | - Thomas W Frazier
- Center for Autism, Pediatric Institute, Cleveland Clinic, Cleveland, OH
| | - Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Mary A Fristad
- Department of Psychiatry, The Ohio State University, Columbus, OH
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert A Kowatch
- Department of Psychiatry, Ohio State Medical Center, Columbus, OH
| | - Eugene Arnold
- Department of Psychiatry, The Ohio State University, Columbus, OH
| | - David A Axelson
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Neal Ryan
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jessica C Hauser
- Department of Psychiatry, The Ohio State University, Columbus, OH
| | - Daniel J Brace
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Linda E Marsh
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Mary Kay Gill
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Judith Depew
- Division of Psychiatry Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Brieana M Rowles
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
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Waxmonsky JG, Wymbs FA, Pariseau ME, Belin PJ, Waschbusch DA, Babocsai L, Fabiano GA, Akinnusi OO, Haak JL, Pelham WE. A novel group therapy for children with ADHD and severe mood dysregulation. J Atten Disord 2013; 17:527-41. [PMID: 22373865 PMCID: PMC4074910 DOI: 10.1177/1087054711433423] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE No psychosocial treatments have been developed for children with ADHD and severe mood dysregulation (SMD) despite the significant prevalence and morbidity of this combination. Therefore, the authors developed a novel treatment program for children with ADHD and SMD. METHOD The novel therapy program integrates components of cognitive-behavioral therapies for affect regulation with a parent-training intervention for managing recurrent defiant behaviors. It consists of nine 105-min child and parent groups run in unison. A pilot trial was conducted with seven participants with ADHD and SMD ages 7 to 12 who were on a stable stimulant regimen. RESULTS Six of the seven (86%) families completed the program. Participants showed large improvements in depressive symptoms, mood lability, and global functioning. Milder improvements in externalizing behaviors were observed. CONCLUSION Results suggest the feasibility and potential efficacy of the therapy program for children with ADHD and SMD and warrant a larger controlled trial.
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Consoli A, Cohen D. Symptomatologie d’allure maniaque chez l’enfant : problèmes diagnostiques et controverse actuelle. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.neurenf.2012.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Carlson GA. The dramatic rise in neuroleptic use in children: why do we do it and what does it buy us? Theories from inpatient data 1988-2010. J Child Adolesc Psychopharmacol 2013; 23:144-7. [PMID: 23607407 DOI: 10.1089/cap.2013.2331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gabrielle A. Carlson
- Department of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
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Youngstrom E, Zhao J, Mankoski R, Forbes RA, Marcus RM, Carson W, McQuade R, Findling RL. Clinical significance of treatment effects with aripiprazole versus placebo in a study of manic or mixed episodes associated with pediatric bipolar I disorder. J Child Adolesc Psychopharmacol 2013; 23:72-9. [PMID: 23480324 PMCID: PMC3696952 DOI: 10.1089/cap.2012.0024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Published studies in adult and pediatric bipolar disorder have used different definitions of treatment response. This analysis aimed to compare different definitions of response in a large sample of children and adolescents. METHODS Anexploratory analysis of a 4-week, multicenter, placebo-controlled study assessed patients (n=296; ages, 10-17 years) with an acute manic/mixed episode associated with BIPOLAR I disorder who were randomized to aripiprazole (10 or 30 mg/day) or placebo. The primary efficacy endpoint was mean change from baseline to week 4 in young mania rating scale (YMRS) total score. Additional assessments included: clinical global impressions-bipolar disorder (CGI-BP) Overall and mania scales, child global assessment scale (CGAS), and parent and subject general behavior inventory. Response was compared across seven operational definitions. Cohen's κ and Spearman's correlation tested relationships between various response definitions or changes in outcome measures and clinically meaningful improvement (defined as a CGI-BP overall improvement score of 1 or 2). RESULTS Response rates varied depending upon the operational definition, but were highest for 95% reliable change (statistical method used to determine individual change from previous assessment) and ≥33% reduction in YMRS total score. Response rate definitions with the highest validity in terms of predicting clinically meaningful improvement were: ≥50% reduction on YMRS (κ=0.64), a composite definition of response (YMRS <12.5, children's depression rating scale-revised (CDRS-R) ≤40, and CGAS ≥51; κ=0.59), and 95% reliable change on the CGAS or 33% reduction on YMRS (κ=0.56). Parent ratings of symptoms were generally better at detecting symptom improvement than were subject ratings (κ=∼0.4-0.5 vs. ∼0.2 when compared with CGI-BP overall improvement score). CONCLUSIONS Clinically meaningful definitions of response in acute treatment of a manic/mixed episode in pediatric subjects include a 50% change in YMRS and a composite measure of response. Parent-reported measures of symptom improvement appear reliable for assessing symptom change.
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Affiliation(s)
- Eric Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Margulies DM, Weintraub S, Basile J, Grover PJ, Carlson GA. Will disruptive mood dysregulation disorder reduce false diagnosis of bipolar disorder in children? Bipolar Disord 2012; 14:488-96. [PMID: 22713098 DOI: 10.1111/j.1399-5618.2012.01029.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The frequency of diagnosis of bipolar disorder has risen dramatically in children and adolescents. The DSM-V Work Group has suggested a new diagnosis termed disruptive mood dysregulation disorder (DMDD) (formerly temper dysregulation disorder with dysphoria) to reduce the rate of false diagnosis of bipolar disorder in young people. We sought to determine if the application of the proposed diagnostic criteria for DMDD would reduce the rate of diagnosis of bipolar disorder in children. PATIENTS AND METHODS Eighty-two consecutively hospitalized children, ages 5 to 12 years, on a children's inpatient unit were rigorously diagnosed using admission interviews of the parents and the child, rating scales, and observation over the course of hospitalization. RESULTS Overall, 30.5% of inpatient children met criteria for DMDD by parent report, and 15.9% by inpatient unit observation. Fifty-six percent of inpatient children had parent-reported manic symptoms. Of those, 45.7% met criteria for DMDD by parent-report, though only 17.4% did when observed on the inpatient unit. CONCLUSION Although DMDD does decrease the rate of diagnosis of bipolar disorder in children, how much depends on whether history or observation is used.
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Affiliation(s)
- David M Margulies
- Department of Psychiatry and Behavioral Science, School of Medicine, State University of New York at Stony Brook, NY, USA
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Carlson GA, Blader JC. Diagnostic implications of informant disagreement for manic symptoms. J Child Adolesc Psychopharmacol 2011; 21:399-405. [PMID: 22040185 DOI: 10.1089/cap.2011.0007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study examines diagnoses that occur in an outpatient sample when both parent and teacher endorse significant manic symptoms and when only a parent observes them. We hypothesized that the diagnosis of mania/bipolar (BP) disorder would occur when there is parent/teacher concordance on high mania symptom scores. METHODS Subjects were 911 5-18-year-old psychiatrically diagnosed youths with caregiver and teacher completed Child Mania Rating Scales (CMRSs) and Achenbach parent and teacher forms. Parent-teacher concordance on the CMRS was defined as both informants ≥75 percentile on the CMRS; discordance on the CMRS was defined as parent ≥75 percentile and teacher ≤25 percentile. Logistic regression examined factors associated with a child's parent and teacher ratings concordant for high CMRS total scores. RESULTS Correlation between parent CMRS (CMRS-P) and teacher CMRS (CMRS-T) scores was r=0.27 (p<0.000). Correlation between the CMRS-P and the Child Behavior Checklist "bipolar/dysregulation" phenotype was r=0.757 and between the CMRS-T and Teacher Report Form "bipolar/dysregulation" phenotype was r=0.786. A total of 66 (7.3%) of the 911 children were diagnosed with BP I (n=20) or II (n=3) or BP disorder not otherwise specified (BPNOS, n=43). If the CMRS-P score was ≥15, 14.7% (vs. 4.4%) had any BP (odds ratio: 3.6; 95% confidence interval: 2.1, 6.2). Teacher agreement or disagreement did not add to diagnostic accuracy for students with BP I or II. BPNOS was more common in children with concordant high CMRS-P and CMRS-T ratings (10.5% vs. 4.8%) but the difference was not statistically significant. However, logistic regression indicated 10-fold greater odds of both parents and teachers, providing high CMRS ratings among children who were diagnosed with externalizing disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, or any combination of these). Children with internalizing disorders (anxiety and depressive disorders) were 3.7 times more likely to have discordant CMRS-P/CMRS-T ratings. CONCLUSION Parent and teacher concordance on high mania rating scale scores was most associated with externalizing disorders, and discordance was most associated with internalizing disorders.
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Affiliation(s)
- Gabrielle A Carlson
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, Putnam Hall-South Campus, Stony Brook, New York 11794-8790, USA.
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Youngstrom EA, Youngstrom JK, Freeman AJ, De Los Reyes A, Feeny NC, Findling RL. Informants are not all equal: predictors and correlates of clinician judgments about caregiver and youth credibility. J Child Adolesc Psychopharmacol 2011; 21:407-15. [PMID: 22040186 PMCID: PMC3205789 DOI: 10.1089/cap.2011.0032] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objectives of this study were to examine how often clinicians judged youths or caregivers to not be credible informants, to identify the associated features of youth or caregiver credibility, and to examine credibility's impact on the validity of mood and behavior checklists. BACKGROUND Clinicians often have the experience of talking to a parent or a youth and judging that the credibility of the information offered is unusually poor. Little is known about the correlates of poor credibility or about the extent to which credibility changes the validity of commonly used checklists. METHODS Interviewers rated the credibility of 646 youths aged 5-18 and their primary caregivers after completing a Kiddie Schedule for Affective Disorders and Schizophrenia. Ratings and diagnoses were blind to the behavior checklists completed by caregivers, youths, and teachers. A subset of youths also had intelligent quotient tests and behavioral observations available. RESULTS Caregivers were perceived as more credible on average than youths, though this dropped sharply with adolescents. Caregiver credibility was higher for better functioning families, more credible youths, younger youths, and more educated caregivers; it was unrelated to caregiver mood symptoms or being the mother. Youth credibility was strongly connected to age, cognitive ability, caregiver credibility, and independent observations of youth behavior. Credibility ratings markedly altered the validity of checklists compared with interview ratings, diagnoses, or cross-informant criteria. CONCLUSION Clinicians' judgments about informant credibility are associated with different characteristics for youths versus caregivers, though youth age is important to both. Credibility affects the validity of information from checklists measured against several different independent criteria.
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Affiliation(s)
- Eric A. Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Andrew J. Freeman
- Department of Psychology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Norah C. Feeny
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio
| | - Robert L. Findling
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Frazier TW, Youngstrom EA, Horwitz SM, Demeter CA, Fristad MA, Arnold LE, Birmaher B, Kowatch RA, Axelson D, Ryan N, Gill MK, Findling RL. Relationship of persistent manic symptoms to the diagnosis of pediatric bipolar spectrum disorders. J Clin Psychiatry 2011; 72:846-53. [PMID: 21457674 PMCID: PMC3242357 DOI: 10.4088/jcp.10m06081yel] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 08/11/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The diagnosis of bipolar spectrum disorders (BPSDs [bipolar I and II disorders, cyclothymic disorder, and bipolar disorder not otherwise specified]) in youth remains controversial. The present study evaluated the possibility that the presence of persistent manic symptoms over a relatively short interval may increase the probability of a BPSD DSM diagnosis. METHOD Data were obtained from the screening and baseline assessments collected from 2005 through 2008 of an ongoing prospective, longitudinal study (Longitudinal Assessment of Manic Symptoms) examining the diagnosis and phenomenology of youth (N = 692) presenting to outpatient centers at ages 6-12 years. Youth were assessed for elevated symptoms of mania (ESM) with the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M), the primary outcome measure. Screening and baseline scores separated individuals into those with ESM (ESM+; PGBI-10M score ≥ 12) and a control group of youth without ESM (ESM-; PGBI-10M score < 12). Youth were classified into 4 groups: persistent ESM+, remitted ESM+, persistent ESM-, and progressed to ESM+. RESULTS Individuals with persistent ESM+ were more likely to have a BPSD (relative risk = 3.04; 95% CI, 2.15-4.30). Using 2 administrations of the PGBI-10M spaced over a relatively brief interval (median = 4.0, mean = 6.1, SD = 5.9 weeks) improved the prediction of BPSD over using only the first administration (ΔR(2) = 0.10, Δχ(2)(1) = 50.06, P < .001). Likelihood ratios indicated that persistent ESM- substantially decreased the probability of BPSD. While high levels of persistent ESM+ increased the probability of a BPSD diagnosis, the final positive predictive value was only sufficient to signify the need for more thorough clinical evaluation. CONCLUSIONS In many cases, obtaining repeated parent report of mania symptoms substantially altered the probability of a BPSD diagnosis and may be a useful adjunct to a careful clinical evaluation. Future waves of data collection from this longitudinal study will be crucial for devising clinically useful methods for identifying or ruling out pediatric BPSD.
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Affiliation(s)
- Thomas W. Frazier
- Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, Cleveland, OH
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sarah McCue Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, Stanford, CA
| | - Christine A. Demeter
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Mary A. Fristad
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - L. Eugene Arnold
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Robert A. Kowatch
- Division of Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Robert L. Findling
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
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Abstract
Early onset (pediatric) bipolar disorders are still an issue of much controversy due to several clinical particularities of the thymic episodes at this age. To date, there is indeed no consensus regarding the prevalence of bipolar disorders before puberty. Diagnosis criteria in children and young adolescents remain thus elusive. The purpose of this review is to provide an overview of this issue. The idea of continuity, from childhood to adulthood, in bipolar disorders also raises important questions regarding predictive factors of bipolar disorders in adults. Studies on the childhood of bipolar adults, as well as studies on the children of bipolar parents will be reviewed, in an attempt to identify the psychopathological substrates of bipolar disorders.
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Beaujean AA, Freeman MJ, Youngstrom E, Carlson G. The structure of cognitive abilities in youths with manic symptoms: a factorial invariance study. Assessment 2011; 19:462-71. [PMID: 21343151 DOI: 10.1177/1073191111399037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study compared the structure of cognitive ability (specifically, verbal/crystallized [Gc] and visual-spatial ability [Gv]), as measured in the Wechsler Intelligence Scale for Children, in youth with manic symptoms with a nationally representative group of similarly aged youth. Multigroup confirmatory factor analysis found the majority of the estimated parameters were invariant between the groups, although there was a difference in the intercepts for the Similarities subtest and difference in unique variances for the Picture Completion, Comprehension, and Picture Arrangement subtests. Thus, although there are many neurological changes associated with manic symptoms, the structure of verbal/crystallized and visual-spatial abilities appear relatively robust and invariant. As Gc and Gv are the primary domains on all the Wechsler Intelligence Scales for Children, results also indicate that clinical interpretation of the Wechsler scales may be appropriate to measure cognitive performance in youths with manic symptoms.
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21
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Findling RL, Youngstrom EA, Fristad MA, Birmaher B, Kowatch RA, Arnold LE, Frazier TW, Axelson D, Ryan N, Demeter C, Gill MK, Fields B, Depew J, Kennedy SM, Marsh L, Rowles BM, Horwitz SM. Characteristics of children with elevated symptoms of mania: the Longitudinal Assessment of Manic Symptoms (LAMS) study. J Clin Psychiatry 2010; 71:1664-72. [PMID: 21034685 PMCID: PMC3057622 DOI: 10.4088/jcp.09m05859yel] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 05/28/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the Longitudinal Assessment of Manic Symptoms (LAMS) study is to examine differences in psychiatric symptomatology, diagnoses, demographics, functioning, and psychotropic medication exposure in children with elevated symptoms of mania (ESM) compared to youth without ESM. This article describes the initial demographic information, diagnostic and symptom prevalence, and medication exposure for the LAMS cohort that will be followed longitudinally. METHOD Guardians of consecutively ascertained new outpatients 6 to 12 years of age presenting for treatment at one of 10 university-affiliated mental health centers were asked to complete the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M). Patients with scores ≥ 12 on the PGBI-10M (ESM+) and a matched sample of patients who screened negative (ESM-) were invited to participate. Patients were enrolled from December 13, 2005, to December 18, 2008. RESULTS 707 children (621 ESM+, 86 ESM-; mean [SD] age = 9.4 [2.0] years) were evaluated. The ESM+ group, compared to the ESM- group, more frequently met DSM-IV criteria for a mood disorder (P < .001), bipolar spectrum disorders (BPSD; P < .001), and disruptive behavior disorders (P < .01). Furthermore, they showed poorer overall functioning and more severe manic, depressive, attention-deficit/hyperactivity, disruptive behavioral, and anxiety symptoms. Nevertheless, rates of BPSD were relatively low in the ESM+ group (25%), with almost half of these BPSD patients (12.1% of ESM+ patients) meeting DSM-IV criteria for bipolar disorder not otherwise specified. ESM+ children with BPSD had significantly more of the following: current prescriptions for antipsychotics, mood stabilizers, and anticonvulsants (P < .001 for each); psychiatric hospitalizations (P < .001); and biological parents with elevated mood (P = .001 for mothers, P < .013 for fathers). ESM+ children with BPSD were also lower functioning compared to ESM+ children without BPSD. CONCLUSIONS Although ESM+ was associated with higher rates of BPSD than ESM-, 75% of ESM+ children did not meet criteria for BPSD. Results suggest that longitudinal assessment is needed to examine which factors are associated with diagnostic evolution to BPSD in children with elevated symptoms of mania.
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Affiliation(s)
- Robert L. Findling
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Eric A. Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary A. Fristad
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Robert A. Kowatch
- Division of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - L. Eugene Arnold
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - Thomas W. Frazier
- Center for Pediatric Behavioral Health and Center for Autism, Cleveland Clinic, Cleveland, OH
| | - David Axelson
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Christine Demeter
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA
| | - Benjamin Fields
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH
| | - Judith Depew
- Division of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shawn M. Kennedy
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Linda Marsh
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Brieana M. Rowles
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, OH
| | - Sarah McCue Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, Stanford, CA
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Horwitz SM, Demeter CA, Pagano ME, Youngstrom EA, Fristad MA, Arnold LE, Birmaher B, Gill MK, Axelson D, Kowatch RA, Frazier TW, Findling RL. Longitudinal Assessment of Manic Symptoms (LAMS) study: background, design, and initial screening results. J Clin Psychiatry 2010; 71:1511-7. [PMID: 21034684 PMCID: PMC3051351 DOI: 10.4088/jcp.09m05835yel] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the design of a longitudinal study of youth with elevated symptoms of mania (ESM), as well as the prevalence and correlates of manic symptoms. Bipolar disorder in youth is serious and is surrounded by controversy about its phenomenology, course, and treatment. Yet, there are no longitudinal studies of youth selected only for ESM, the phenomenological hallmark. The study's objective is to document the rate and sociodemographic correlates of ESM in children attending outpatient psychiatric clinics. METHOD Parents of 3,329 children aged 6-12 years visiting 10 outpatient clinics were asked to complete the Parent General Behavior Inventory 10-Item Mania Scale (PGBI-10M). Children with PGBI-10M scores ≥ 12 (ESM positive-screen [ESM+]) and a matched sample of ESM screen-negative (ESM-) children were invited to enroll in the longitudinal study. The sample was accrued from November 14, 2005, to November 28, 2008. RESULTS Most of the children whose parents filled out the PGBI-10M (N = 2,622, 78.8%) participated in the study. Nonparticipants were slightly younger (mean age = 9.1 years [SD = 2.0 years] versus 9.4 years [SD = 2.0 years] for participants; t3327 = 4.42, P < .001). Nearly half of the participants (43%) were ESM+; these were more likely to be Latino (4.2% versus 2.5% for ESM-; χ(2)1 = 5.45, P = .02), younger (mean age = 9.3 years [SD = 2.0 years] versus 9.6 years [SD = 1.9 years] for ESM-; t2620 = 3.8, P < .001), and insured by Medicaid (48.4% versus 35.4% for ESM-; χ(2)1 = 45.00, P < .001). There were no sociodemographic differences between those who did versus did not agree to enroll in the longitudinal portion (yes to enrollment: n = 621, 55.2%; no to enrollment: n = 503, 44.8%). Four items best discriminated ESM+ children from ESM- children. Three of the 4 items were not the most commonly endorsed items, but all were indicative of behavioral extremes. CONCLUSIONS Data suggest that ESM+ is not rare in 6- to 12-year-olds. Children who are ESM+ show behavioral extremes, including rapid mood shifts, compared to ESM- children.
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Affiliation(s)
- Sarah McCue Horwitz
- Department of Pediatrics and Stanford Health Policy, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305-6019, USA.
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Rages or temper tantrums? The behavioral organization, temporal characteristics, and clinical significance of angry-agitated outbursts in child psychiatry inpatients. Child Psychiatry Hum Dev 2009; 40:621-36. [PMID: 19568928 PMCID: PMC2941872 DOI: 10.1007/s10578-009-0148-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 06/17/2009] [Indexed: 10/20/2022]
Abstract
Angry, agitated outbursts (AAOs) are a common precipitant of children's psychiatric hospitalization. In the hospital, AAOs present both management and diagnostic challenges, e.g., while they have recently been described as manic "rages", older studies suggest that they may be exacerbated temper tantrums. Factor analyses of 109 AAOs had by 46 hospitalized 4-12 year olds yielded 3 subsets of behaviors expressing different intensities of anger and 2 subsets expressing different intensities of distress (sadness). Cluster analysis of behavior time course supported the anger-distress distinction; the former behaviors are most probable at AAO onset and then decline while the latter are more evenly distributed across the outburst. Age trends, factor structure, and temporal organization of AAOs all indicate that they are exacerbated tantrums. The AAOs of children with anxiety or PDD diagnoses showed significantly more distress relative to anger. AAOs have clinical implications; their particular characteristics may have diagnostic significance.
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Danner S, Fristad MA, Arnold LE, Youngstrom EA, Birmaher B, Horwitz SM, Demeter C, Findling RL, Kowatch RA. Early-onset bipolar spectrum disorders: diagnostic issues. Clin Child Fam Psychol Rev 2009; 12:271-93. [PMID: 19466543 PMCID: PMC3575107 DOI: 10.1007/s10567-009-0055-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child's developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians' assessment of children with early-onset BPSD are highlighted.
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Carlson GA, Potegal M, Margulies D, Gutkovich Z, Basile J. Rages--what are they and who has them? J Child Adolesc Psychopharmacol 2009; 19:281-8. [PMID: 19519263 PMCID: PMC2856921 DOI: 10.1089/cap.2008.0108] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to examine rages and define their associated clinical and diagnostic conditions systematically. Children's severe anger outbursts, sometimes called "rages," have been associated with many disorders, including mania, "severe mood dysregulation," and oppositional defiant/conduct disorder. Although reactive aggression has been studied extensively, there are almost no data on this important and disabling clinical phenomenon. METHOD A total of 130 different 5-12 year olds were hospitalized over 151 consecutive admissions were evaluated diagnostically with information from parents, children, doctors, nursing staff, and teachers. Rages were operationally defined as agitated/angry behaviors requiring seclusion or medication because the child could not be verbally redirected to "time out." Rage behaviors were categorized as they occurred with the specially designed Children's Agitation Inventory. Hypotheses were that rages would be associated with prior treatment failure, and that children with rages would have the most co-morbidities, including learning/language disorders. We did not expect narrow-phenotype bipolar disorder to be specifically associated with rages. RESULTS Of 130 children, 71 (54.6%) were admitted for rages. Preadmission rages and admission taking an atypical antipsychotic significantly predicted the subsequent number of in-hospital rages. Attention-deficit/hyperactivity disorder with learning/language disorder significantly predicted the occurrence and number of rages. Bipolar disorder was the referring diagnosis in 17/49 (34.7%) admissions with rages and 15/102 (14.7%) of admissions without rages (odds ratio [OR] 3.05, confidence interval [CI] 1.36, 6.80). However, a consensus diagnosis of bipolar disorder occurred in 5 (9.1%) of the sample with rages and 5 (5.8%) in the rest of admissions. CONCLUSIONS Psychiatrically hospitalized children with multiple rages have complex, chronic neuropsychiatric disorders and have failed prior conventional treatment. One third of children with rages had been given a bipolar diagnosis prior to admission. However, only 9% of children with rages were given that diagnosis after careful observation.
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Affiliation(s)
| | - Michael Potegal
- University of Minnesota, School of Medicine, Minneapolis, Minnesota
| | - David Margulies
- Stony Brook University School of Medicine, Stony Brook, New York
| | | | - Joann Basile
- Stony Brook University School of Medicine, Stony Brook, New York
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Youngstrom EA, Freeman AJ, Jenkins MM. The assessment of children and adolescents with bipolar disorder. Child Adolesc Psychiatr Clin N Am 2009; 18:353-90, viii-ix. [PMID: 19264268 PMCID: PMC2915577 DOI: 10.1016/j.chc.2008.12.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The overarching goal of this article is to examine the current best evidence for assessing bipolar disorder (BPD) in children and adolescents and provide a comprehensive, evidence-based approach to diagnosis. Evidence- based assessment strategies are organized around the "3 Ps" of clinical assessment: Predict important criteria or developmental trajectories, Prescribe a change in treatment choice, and inform Process of treating the youth and his/her family. The review characterizes BPD in youths-specifically addressing bipolar diagnoses and clinical subtypes; it then provides an actuarial approach to assessment using prevalence of disorder, risk factors, and questionnaires; discusses treatment thresholds; and identifies practical measures of process and outcomes. The clinical tools and risk factors selected for inclusion in this review represent the best empirical evidence in the literature. By the end of the article, clinicians will have a framework and set of clinically useful tools with which to effectively make evidence-based decisions regarding the diagnosis of BPD in children and adolescents.
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Affiliation(s)
- Eric A Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, NC 27599-3270, USA.
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Waxmonsky J, Pelham WE, Gnagy E, Cummings MR, O'Connor B, Majumdar A, Verley J, Hoffman MT, Massetti GA, Burrows-MacLean L, Fabiano GA, Waschbusch DA, Chacko A, Arnold FW, Walker KS, Garefino AC, Robb JA. The efficacy and tolerability of methylphenidate and behavior modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation. J Child Adolesc Psychopharmacol 2008; 18:573-88. [PMID: 19108662 PMCID: PMC2680095 DOI: 10.1089/cap.2008.065] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study examines the tolerability and efficacy of methylphenidate (MPH) and behavior modification therapy (BMOD) in children with attention-deficity/hyperactivity disorder (ADHD) and severe mood dysregulation (SMD). METHODS Children (ages 5-12) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessments and direct clinical interview with the Young Mania Rating Scale (YMRS). The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores (mean = 23.7). They underwent weekly mood assessments plus the daily ADHD measures that are part of the program. The comparison group (n = 68) was comprised of the rest of the program participants. Using a crossover design, all subjects in both groups were treated with three varying intensities of BMOD (no, low, high) each lasting 3 weeks, with MPH dose (placebo, 0.15 mg/kg t.i.d., 0.3mg/kg t.i.d., and 0.6 mg/kg t.i.d.) varying daily within each behavioral treatment. RESULTS Groups had comparable ADHD symptoms at baseline, with the SMD group manifesting more oppositional defiant disorder/conduct disorder (ODD/CD) symptoms (p < 0.001). Both groups showed robust improvement in externalizing symptoms (p < 0.001). There was no evidence of differential treatment efficacy or tolerability. Treatment produced a 34% reduction in YMRS ratings in SMD subjects (p - 0.001). However, they still exhibited elevated YMRS ratings, more ODD/CD symptoms (p < 0.001), and were more likely to remain significantly impaired at home than non-SMD subjects (p < 0.05). CONCLUSIONS MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD, but additional treatments may be needed to optimize their functioning.
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Affiliation(s)
- James Waxmonsky
- Department of Psychiatry, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York, USA.
| | - William E. Pelham
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Elizabeth Gnagy
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Michael R. Cummings
- Department of Psychiatry, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Briannon O'Connor
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Antara Majumdar
- Department of Biostatistics, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Jessica Verley
- Department of Psychiatry, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Martin T. Hoffman
- Department of Pediatrics, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Greta A. Massetti
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Lisa Burrows-MacLean
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Gregory A. Fabiano
- Department of Counseling, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Daniel A. Waschbusch
- Department of Pediatrics, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Anil Chacko
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Frances W. Arnold
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Kathryn S. Walker
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Allison C. Garefino
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
| | - Jessica A. Robb
- Department of Psychology, School and Educations Psychology, State University of New York at Buffalo, Buffalo, New York
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Johnson SL, McMurrich S. Life events and juvenile bipolar disorder: conceptual issues and early findings. Dev Psychopathol 2007; 18:1169-79. [PMID: 17064433 DOI: 10.1017/s0954579406060561] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is increasing interest in the psychosocial variables that might predict the course of child and adolescent bipolar disorder. In the literature on adult bipolar disorder, life events have been shown to be a major predictor of symptoms. In this review, we focus on studies of how life events influence the course of child and adolescent bipolar disorder. To begin, we review methodological considerations in life events research, and briefly summarize the findings regarding life events in adult bipolar disorder. Then, we discuss available studies on life events as a predictor of the course of juvenile bipolar disorder. We conclude with suggested directions for future research.
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Carlson GA, Meyer SE. Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: complexities and developmental issues. Dev Psychopathol 2007; 18:939-69. [PMID: 17064424 DOI: 10.1017/s0954579406060470] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review addresses the phenomenology of mania/bipolar disorder from a developmental psychopathology perspective and uses cases with longitudinal information to illustrate major points. Beginning with a summary of the phenomenology of bipolar illness as it occurs in adults, the authors identify diagnostic complexities unique to children and adolescents. These include the challenges of characterizing elation and grandiosity; differentiating mania from comorbid symptoms, rages, sequelae of maltreatment, and typical developmental phenomena; and the unique manifestations of psychosis. We conclude with the observation that a significant difference between early and later onset bipolar disorder is that, in the former, there appears to be a global delay or arrest in the development of appropriate affect regulation; whereas in adult-onset bipolar illness, emotion dysregulation generally presents as an intermittent phenomenon. At this juncture, the study of childhood bipolar illness would benefit from a developmental psychopathology perspective to move beyond the level of cross-sectional symptom description to begin to study individuals over time, focusing on developmental, environmental, genetic, and neurobiological influences on manifest behavior.
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McClellan J, Kowatch R, Findling RL. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:107-125. [PMID: 17195735 DOI: 10.1097/01.chi.0000242240.69678.c4] [Citation(s) in RCA: 272] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This practice parameter reviews the literature on the assessment and treatment of children and adolescents with bipolar disorder. The parameter focuses primarily on bipolar 1 disorder because that is the type most often studied in juveniles. The presentation of bipolar disorder in youth, especially children, is often considered atypical compared with that of the classic adult disorder, which is characterized by distinct phases of mania and depression. Children who receive a diagnosis of bipolar disorder in community settings typically present with rapid fluctuations in mood and behavior, often associated with comorbid attention-deficit/hyperactivity disorder and disruptive behavior disorders. Thus, at this time it is not clear whether the atypical forms of juvenile mania and the classic adult form of the disorder represent the same illness. The question of diagnostic continuity has important treatment and prognostic implications. Although more controlled trials are needed, mood stabilizers and atypical antipsychotic agents are generally considered the first line of treatment. Although patients may respond to monotherapy, combination pharmacotherapy is necessary for some youth. Behavioral and psychosocial therapies are also generally indicated for juvenile mania to address disruptive behavior problems and the impact of the illness on family and community functioning.
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Youngstrom E, Meyers O, Youngstrom JK, Calabrese JR, Findling RL. Diagnostic and measurement issues in the assessment of pediatric bipolar disorder: Implications for understanding mood disorder across the life cycle. Dev Psychopathol 2006; 18:989-1021. [PMID: 17064426 DOI: 10.1017/s0954579406060494] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The goal of this paper is to review assessment research of bipolar disorder in children and adolescents. The review addresses numerous themes: the benefits and costs of involving clinical judgment in the diagnostic process, particularly with regard to diagnosis and mood severity ratings; the validity of parent, teacher, and youth self-report of manic symptoms; how much cross-situational consistency is typically shown in mood and behavior; the extent to which a parent's mental health status influences their report of child behavior; how different measures compare in terms of detecting bipolar disorder, the challenges in comparing the performance of measures across research groups, and the leading candidates for research or clinical use; evidence-based strategies for interpreting measures as diagnostic aids; how test performance changes when a test is used in a new setting and what implications this has for research samples as well as clinical practice; the role of family history of mood disorder within an assessment framework; and the implications of assessment research for the understanding of phenomenology of bipolar disorder from a developmental framework.
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Affiliation(s)
- Eric Youngstrom
- Department of Psychology, University of North Carolina, Chapel Hill, NC 27599, USA.
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Waxmonsky J, Wood BL, Stern T, Ballow M, Lillis K, Cramer-Benjamin D, Mador J, Miller BD. Association of depressive symptoms and disease activity in children with asthma: methodological and clinical implications. J Am Acad Child Adolesc Psychiatry 2006; 45:945-954. [PMID: 16865037 DOI: 10.1097/01.chi.0000222789.34229.21] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was designed to assess the prevalence of depressive symptoms in children with asthma and the association between depression and asthma activity. METHOD Children ages 7 to 17 (n = 129) were recruited from a hospital emergency department after presenting for asthma symptoms. The majority of subjects were from disadvantaged, inner city families. Subjects' asthma disease activity was assessed using the revised National Heart, Lung, and Blood Institute guidelines, and subjects' emotional status was assessed by a combination of self-, parent-, and clinician-reported measures. Parental emotional status was assessed by self-report. RESULTS Depressive symptoms within the clinical range were reported in 26% of subjects and 43% of mothers, although symptom severity varied across scales. Self-reported depressive symptoms were more strongly correlated with asthma activity (r = 0.25) than clinician-reported (r = 0.14) or parent-reported symptoms (r = 0.12/0.18). Depressive symptoms in parents were correlated with child's depression scores but not with their asthma activity. CONCLUSIONS Depressive symptoms were common and associated with asthma activity in this inner city population of asthmatic children. Self-reported depressive symptoms were more strongly associated with child's asthma activity than either parental depression or parental/clinician ratings of the child's depression.
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Affiliation(s)
- James Waxmonsky
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo..
| | - Beatrice L Wood
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Trudy Stern
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Mark Ballow
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Kathleen Lillis
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Darci Cramer-Benjamin
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Jeffrey Mador
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
| | - Bruce D Miller
- Drs. Waxmonsky, Wood, Cramer-Benjamin, and Miller and Ms. Stern are with the Department of Psychiatry, Dr. Ballow is with the Department of Pediatrics, Dr. Lillis is with the Departments of Pediatrics and Emergency Medicine, and Dr. Mador is with the Departments of Medicine, State University of New York at Buffalo
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Carlson GA. Trouble bipolaire à début précoce : considérations cliniques et de recherche. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.neurenf.2006.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Meyer SE, Carlson GA, Wiggs EA, Ronsaville DS, Martinez PE, Klimes-Dougan B, Gold PW, Radke-Yarrow M. A prospective high-risk study of the association among maternal negativity, apparent frontal lobe dysfunction, and the development of bipolar disorder. Dev Psychopathol 2006; 18:573-89. [PMID: 16600068 DOI: 10.1017/s0954579406060299] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In a previous paper, the authors found that impairment on the Wisconsin Card Sorting Test (WCST) in adolescence was predictive of bipolar disorder in young adulthood among offspring of mothers with bipolar illness. In the present study, the authors explore the contribution of maternal characteristics, beyond maternal mood disorder, to the prediction of offspring dysfunction on the WCST. Results showed that maternal bipolar disorder and maternal negativity were both predictive of impaired performance on the WCST during adolescence. The contribution of maternal negativity to offspring WCST impairment was not better explained by maternal personality disorder, mother's functional impairment, family loading for bipolar disorder, or offspring disruptive behavioral disturbance. Findings did not support a moderator model. However, support was found for a mediation model in which maternal negativity contributed to risk for offspring bipolar disorder through its negative association with apparent frontal lobe functioning, as measured by the WCST. Findings are discussed from the perspective of a vulnerability-stress model. In addition, the authors consider the possibility that maternal negativity and offspring impairment on the WCST may be reflective of a common heritable trait.
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Youngstrom E, Meyers O, Demeter C, Youngstrom J, Morello L, Piiparinen R, Feeny N, Calabrese JR, Findling RL. Comparing diagnostic checklists for pediatric bipolar disorder in academic and community mental health settings. Bipolar Disord 2005; 7:507-17. [PMID: 16403176 DOI: 10.1111/j.1399-5618.2005.00269.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare six promising mania measures, the Parent Mood Disorder Questionnaire (P-MDQ), the Adolescent self-report MDQ, the 10-item short form of the Parent General Behavior Inventory (PGBI-SF10), the 28-item Adolescent General Behavior Inventory (AGBI), the Parent Young Mania Rating Scale (P-YMRS), and the adolescent YMRS, in a demographically diverse outpatient sample. METHODS Participants were 262 outpatients (including 164 males and 131 African-Americans) presenting to either an academic medical center (n = 153) or a community mental health center (n = 109). Diagnoses were based on semi-structured interviews with the parent and then youth sequentially. RESULTS Ninety youths (34%) met criteria for a bipolar spectrum disorder. Parent measures yielded Areas Under the Receiver Operating Curve (AUROC) values of 0.81 for the PGBI-SF10 to 0.66 for the P-YMRS. Adolescent report measures performed significantly less well, with AUROCs ranging from 0.65 to 0.50. There were no significant differences in the diagnostic performance of the measures across the sites or by racial groups, although the reliability of measures tended to be lower in the urban community mental health site. The PGBI-SF10 made a significant contribution to logistic regression models examining all combinations of the instruments. The P-MDQ added information in the younger age group, and no measure improved classification of bipolar cases after controlling for the PGBI-SF10 in the older age group. DISCUSSION Results replicate previous findings that, in decreasing order of efficiency, the PGBI-SF10, P-MDQ, and P-YMRS significantly discriminate bipolar from non-bipolar cases in youths aged 5-18; and they appear robust in a demographically diverse community setting. Adolescent self-report measures are significantly less efficient, sometimes performing no better than chance at detecting bipolar cases.
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Affiliation(s)
- Eric Youngstrom
- Department of Psychology, Case Western Reserve University, Cleveland, OH 44106, USA.
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Youngstrom EA, Findling RL, Youngstrom JK, Calabrese JR. Toward an Evidence-Based Assessment of Pediatric Bipolar Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2005; 34:433-48. [PMID: 16026213 DOI: 10.1207/s15374424jccp3403_4] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This article outlines a provisional evidence-based approach to the assessment of pediatric bipolar disorder (PBD). Public attention to PBD and the rate of diagnosis have both increased substantially in the past decade. Accurate diagnosis is crucial to avoid harm due to mislabeling or unnecessary medication exposure. Because there are no proven efficacious or effective treatments for PBD, the role of assessment is heightened to demonstrate efficacy in individual cases as well as to identify cases for participation in clinical trials. This review discusses (a) the state of psychopathology research regarding PBD; (b) the likely base rate of PBD in multiple clinical settings; (c) the diagnostic value of family history; (d) challenges to differential diagnosis, including comorbidity and symptom overlap with other diagnoses, shortcomings in contemporary assessment methods, and the cyclical nature of PBD; (e) practical methods for improving diagnosis, focusing on the most discriminative symptoms, extending the temporal window of assessment to capture mood changes, and using screening tools within an actuarial framework; and (f) monitoring response to treatment using a variety of assessment methods. Twelve recommendations are offered to move toward an evidence-based assessment model for PBD.
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Affiliation(s)
- Eric A Youngstrom
- Department of Psychology, Case Western Reserve University, Cleveland, OH 44106-7123, USA.
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Youngstrom EA, Duax J. Evidence-based assessment of pediatric bipolar disorder, part I: base rate and family history. J Am Acad Child Adolesc Psychiatry 2005; 44:712-7. [PMID: 15968241 DOI: 10.1097/01.chi.0000162581.87710.bd] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eric A Youngstrom
- Department of Psychology, Case Western Reserve University, Cleveland, OH 44106-7123, USA.
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Carlson GA. Early Onset Bipolar Disorder: Clinical and Research Considerations. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2005; 34:333-43. [PMID: 15901234 DOI: 10.1207/s15374424jccp3402_13] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This article examined some of the reasons for confusion and controversy surrounding the frequency of diagnosis of bipolar disorder, especially in prepubertal children. Four case vignettes are used to articulate questions surrounding manifestations of euphoria and grandiosity, informant variance, diagnostic implications of medication-induced behavioral toxicity, and treatment implications of family history. Although extant literature cited addresses some of the issues, specific research is needed for definitive answers.
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Affiliation(s)
- Gabrielle A Carlson
- Department of Psychiatry and Behavioral Sciences, Stony Brook University School of Medicine, NY 11794, USA.
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Kowatch RA, Fristad M, Birmaher B, Wagner KD, Findling RL, Hellander M. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry 2005; 44:213-35. [PMID: 15725966 DOI: 10.1097/00004583-200503000-00006] [Citation(s) in RCA: 280] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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.
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Affiliation(s)
- Robert A Kowatch
- Department of Psychiatry, Cincinnati Children's Hospital Medical, OH 45267-0559, USA.
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Youngstrom EA, Findling RL, Calabrese JR. Effects of adolescent manic symptoms on agreement between youth, parent, and teacher ratings of behavior problems. J Affect Disord 2004; 82 Suppl 1:S5-S16. [PMID: 15571790 DOI: 10.1016/j.jad.2004.05.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2003] [Accepted: 05/17/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is known about the extent to which manic symptoms might influence the self-report ratings of adolescents as compared to parent and teacher ratings, although there are clinical reasons to believe that mania would increase disagreement. METHODS Parents and youths between the ages of 11 and 17 years were evaluated with the Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS), Young Mania Rating Scale, and Child Depression Rating Scale-Revised. Based on the KSADS results, subjects were assigned to either a bipolar spectrum group (e.g., meeting criteria for a diagnosis of bipolar I, II, cyclothymia, or NOS) or a "nonbipolar" group (including depressive disorders, disruptive behaviors disorders, and other axis I diagnoses). Parents and youths both completed the Achenbach rating scales and the General Behavior Inventory (GBI). Teachers also completed the Achenbach scales. RESULTS Youth self-report of manic symptoms showed lower correlations with clinician ratings than did parent ratings. Youths with a bipolar diagnosis also show poorer agreement about their depressive symptoms. There was some evidence that bipolar youths underreported symptoms, even after controlling for parent history of mood disorder. The youth's own manic symptoms partially mediated the effect of a bipolar diagnosis on rater disagreement. LIMITATIONS Diagnoses and mood ratings were based on both parent and youth interviews. CONCLUSIONS Findings strongly suggest that cross-informant agreement can be substantially affected by the youth's own psychopathology. Youths with a bipolar diagnosis tend to underreport their manic symptoms compared to parental report. Results emphasize the importance of gathering collateral sources of information in evaluating juvenile mania, and also suggest that parent reported problems should not be discounted out of hand.
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Affiliation(s)
- Eric A Youngstrom
- Department of Psychiatry, Case Western Reserve University (CWRU) and University Hospitals of Cleveland, Cleveland, OH 441106-7123, USA.
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Abstract
Early onset bipolar spectrum disorder (EOBPSD) is difficult to diagnose because of symptom overlap with other disorders and nearly ubiquitous comorbidity. A thorough assessment of EOBPSD should include the following: 1) a timeline of the child's development, from birth to present, showing the episodic nature of EOBPSD; 2) a structured clinical interview determining comorbidity and differential diagnosis; 3) a family history genogram to ascertain familial loading and environmental stressors, which informs case conceptualization; 4) depression and mania rating scales to assess symptom severity and track treatment outcome; 5) global rating scales to obtain cross-informant data and inform broad-based treatments; and 6) a current mood log to document baseline functioning and track treatment outcome. Examples of a timeline, family history genogram, and current mood log are presented. This comprehensive approach to assessing EOBPSD, a severe and possibly lifelong disorder, is strongly advocated. No scale, instrument, or technique alone is adequate to diagnose EOBPSD.
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Affiliation(s)
- Colleen A Quinn
- Departments of Psychiatry and Psychology, The Ohio State University, Columbus, OH 43210, USA
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