The syndrome of minimal brain dysfunction: psychological aspects

Effect of Adolescent Cigarette Smoking on Adulthood Substance Use and Abuse: The Mediating Role of Educational Attainment

BACKGROUND

Even though the association between cigarette smoking and later substance use has been shown, there is still no compelling evidence that demonstrates the long-term effects in a high drug using community in African Americans. Few studies have examined the mediating mechanisms of the effect of adolescent cigarette smoking on the drug progression pathway.

OBJECTIVES

We examined the long-term influence of adolescent smoking on later illegal drug use in a cohort of urban African Americans, and the mediating role of educational attainment in the drug progression pathway.

METHODS

The study used a longitudinal dataset from the Woodlawn Project that followed 1,242 African Americans from 1966-1967 (at age 6-7) through 2002-2003 (at age 42-43). We used the propensity score matching method to find a regular and a nonregular adolescent smoking group that had similar childhood characteristics; we used the matched sample to assess the association between adolescent smoking and drug progression, and the mediating role of educational attainment.

RESULTS

Adolescent regular smokers showed significantly higher odds of using marijuana, cocaine, and heroin, having alcohol abuse problems and any drug dependence, and abuse problems in adulthood. We found that educational attainment mediated most of the drug progression pathway, including cigarette smoking, marijuana, cocaine and heroin use, and drug dependence or abuse problems in adulthood, but not alcohol abuse.

CONCLUSIONS

More focus needs to be put on high school dropout and development of interventions in community settings for African Americans to alter the pathway for drug progression for adolescents who use cigarettes regularly.

Taking a life course approach to studying substance use treatment among a community cohort of African American substance users

BACKGROUND

Life course theory emphasizes the need to examine a wide variety of distal factors along with proximal factors, longitudinally. Yet research on who obtains substance use treatment is generally cross-sectional and limited to examining developmentally proximal factors (e.g., substance use severity) and demographic factors.

METHODS

To investigate treatment within a life-course framework, we studied 522 drug and/or alcohol users from a community cohort of African Americans followed prospectively from age 6. Developmentally distal factors of childhood and adolescent social behavior, family environment, academic achievement, mental health, and substance use along with the key proximal factors of substance use severity and socioeconomic status were examined using regression analyses to assess their impact on obtaining adult substance use treatment.

RESULTS

One-fifth of the study population obtained treatment for substance use by age 32 (20.5%). Although adult socioeconomic status was not associated with substance use treatment in adulthood in the multivariable model, the proximal factor of substance use severity was a strong predictor of obtaining substance use treatment, as expected. After including several developmentally distal factors in the model, childhood aggression also had an independent effect on adult substance use treatment, above and beyond substance use severity.

CONCLUSIONS

These findings emphasize the importance of using a life course framework when exploring predictors of treatment; early life characteristics are important influences beyond the more proximal factors in adulthood. Research should continue to take a life course approach to better understand pathways to substance use treatment.

Early life conditions of overall and cause-specific mortality among inner-city African Americans

OBJECTIVES

We examined how early life conditions influence midlife overall and cause-specific mortality in a community cohort of disadvantaged African Americans.

METHODS

Using a prospective design, we assessed first-grade children and their teachers and families when children were 6 years old, with follow-up at ages 16, 32, and 42 years. We obtained information on death from family members, neighbors, and the National Death Index (NDI). We conducted a survival analysis and competing risk analysis to examine early life predictors of mortality.

RESULTS

Of 1242 participants, 87 (7%) had died by 2004. In multivariate Cox proportional hazards regression, males who lived in foster care and females with lower math grades in first grade were more likely to die by age 42 years. In multivariate competing risks analysis, hospitalization by the time of first grade was related to mortality from acute and chronic illness. Male gender, being in foster care, and aggressive behavior in first grade were related to mortality from drug use, violence, or suicide.

CONCLUSIONS

Early classroom, environmental, and family-level interventions are potentially beneficial in reducing later overall and cause-specific mortality.

Interrelationship of substance use and psychological distress over the life course among a cohort of urban African Americans

BACKGROUND

Substance use and psychological problems are major public health issues because of their high prevalence, co-occurrence, clustering in socio-economically disadvantaged groups, and serious consequences. However, their interrelationship over time is not well understood.

METHODS

This study identifies and compares the developmental epidemiology from age 6 to 42 of substance use and psychological distress in a population of African American men and women. Data come from the Woodlawn study, a longitudinal study of an urban community cohort followed since 1966. We use structural equation modeling to examine pathways between substance use (i.e., alcohol, marijuana, and cocaine) and psychological distress over time by gender.

RESULTS

We find significant continuity from adolescence to midlife for substance use and for psychological distress, as well as significant correlations within time periods between substance use and psychological distress, particularly among women. We also find greater adolescent substance use predicts psychological distress in young adulthood for men, but no cross-lag associations for women. Women's adolescent psychological distress and substance use are linked uniquely to that of their mothers. Findings show additional gender differences in the developmental etiology of substance use and psychological distress.

CONCLUSIONS

Findings demonstrate the continuity of substance use and psychological distress over time; the contemporaneous relationships between psychological distress and substance use within time periods, and minimal cross-lagged relationships. Findings also show that adolescent substance use may set boys on a pathway of long-term psychological distress, thus adding to evidence of negative consequences of frequent use.

Emotional dysregulation in adult ADHD and response to atomoxetine

BACKGROUND

Before 1980, attention-deficit/hyperactivity disorder (ADHD) was called minimal brain dysfunction and included emotional symptoms now listed as "associated features" in DSM-IV. Data from two multicenter, placebo-controlled studies with 536 patients were reexamined to assess: 1) the pervasiveness of these symptoms in samples of adults with ADHD; 2) the response of these symptoms to atomoxetine; and 3) their association with depressive/anxiety symptoms.

METHODS

The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) was used to assess temper, affective lability, and emotional overreactivity, thus identifying patients exhibiting "emotional dysregulation." Other DSM-IV Axis I diagnoses were exclusionary. Outcome measures were the Conners' Adult ADHD Rating Scale (CAARS) and the WRAADDS.

RESULTS

Thirty-two percent of the sample met post hoc criteria for emotional dysregulation and had higher baseline scores on ADHD measures, a lower response to placebo, and greater response to atomoxetine (p = .048). Symptoms of emotional dysregulation had a treatment effect (p < .001) at least as large as the CAARS (p = .002) and the total WRAADDS (p = .001). Emotional dysregulation was present in the absence of anxiety or depressive diagnosis.

CONCLUSIONS

Symptoms of emotional dysregulation were present in many patients with ADHD and showed a treatment response similar to other ADHD symptoms.

Childhood, adolescent, and young adult predictors of suicidal behaviors: a prospective study of African Americans

This study examined the lifetime prevalence of suicidal behaviors and their relation to social integration, depression, and aggression/substance use in a cohort of African Americans followed prospectively from first grade to age 32. Lifetime depressive moods in adulthood, lifetime use of cocaine, and frequent mobility were associated with suicidal behaviors for both males and females. For males, having been in a mother-alone or mother-absent family at age 6, childhood psychopathology, and not being married were related to suicidal behaviors. Females who reported high assault behavior in adolescence were more likely to report suicide attempts. The results suggest that social integration, depression, and aggression/drug use are important risk factors for suicidal behaviors in this African American population.

A practical approach to children failing in school

The most likely causes of failure in school in otherwise capable children who come from homes in which they are loved and cared for are learning disabilities, affective illness, primary disorder of vigilance and, on occasion, narcolepsy. The various learning disabilities are often accompanied by problems of attention, concentration, organization, mood and feelings, and social interaction. These latter problems are reflections of biochemical disorders that respond effectively to judicious pharmacologic intervention. When this type of medical management is combined with constructive counseling and suitable curriculum adjustments, the child can attain his or her maximum education potential and become a productive and contributing adult member of society.

An epidemiological investigation of minimal brain dysfunction in six elementary schools in Beijing

Six elementary schools from urban, suburban and mountain areas of Beijing (containing 2770 school children) were screened with a standardized questionnaire and each suspected case was interviewed to determine whether diagnostic criteria were met for attention deficit disorder with hyperactivity (DSM-III), with some cultural modification. The MBD prevalence rate was 3.1% in the urban, 7.8% in the suburban and 7.0% in the mountain area. Lower rates were found in the families of scientific and technical professionals or in those with higher education than others. The mean score or the severity of some clinical manifestations of MBD children showed differences in families with different occupations or educational levels. Social environmental factors were considered to play an important role in the development of MBD, which is possibly based on biological factors.

MBD: meanings and misconceptions

Few terms have generated as much debate and apprehension among those who render clinical services to children as has "MBD". The childhood disabilities to which this term has been applied are undeniable. However, neither the implication of the term itself nor the meaning of the concept behind it are well recognized. In order to foster more rational discussion of the topic, the present paper attempts to clarify major misconceptions regarding MBD, and reviews essential features of the concept. Because their term generates false impressions of the disorders to which it is applied and because the concept it represents is itself unsatisfactory, the continued use of the term is objectionable. Nevertheless, the emphasis that the MBD conceptor, more accurately, the tradition underlying it - has placed on biological factors as relevant to the understanding of learning and behavioral problems is worth retaining. Separating the sense from the nonsense behind this concept will, hopefully, foster the development of more appropriate terminology and, in the process, improve communication among those who work with disabled children.

Salicylate sensitivity in children reported to respond to salicylate exclusion

Twelve children, aged six to 13 years, whose parents reported an improvement in behavioural problems with use of the Feingold (K-P) diet for an average period of 12 months, were challenge-tested with 40 mg of acetylsalicylic acid in a double-blind, cross-over trial with ascorbic acid as a placebo. The children were tested within three hours of ingestion of either the experimental or placebo tablet with a battery of psychological and neurological tests, and were rated by a parent on an enlarged Conners' Parent-Teacher Questionnaire for four days after the ingestion of the tablet. It was found that significance was reached in tests of general cognitive capacity, line walking and the "finger-to-nose" tests, as well as increased disturbance in sleep patterns in these children.

Effects of positive and negative feedback on behavior control in hyperactive and normal boys

The hypothesis that hyperactive boys have relatively less response to negative feedback than to positive feedback was studied. Sixteen hyperactive boys and 16 controls were compared on two tasks under different feedback conditions. Feedback conditions were no feedback, positive feedback, and negative feedback. Tasks were symbol encoding and correcting spelling words. Hyperactives and controls were compared in amount of time on-task and amount of work correctly completed. Hyperactives were on-task significantly more under conditions of negative feedback than under positive feedback, but negative feedback significantly increased errors on the spelling correction task. Controls were equally responsive to positive, negative, or no feedback. Hyperactives accomplished significantly less than controls on the coding task, but performed as well as controls on the spelling correction task, which was administered to each boy at his own level of spelling ability. The results imply that while consistent negative feedback can reduce off-task behavior for hyperactives, it can also decrease the accuracy of the work they are doing.

Recognizing the precursors of failure in school

Most of the children who fail in school come from educationally high-risk groups which are identifiable in the preschool years. Early recognition allows for constructive planning and in some cases the interposition of specific therapy (Table 1). Aall physicians should be aware of the relationships between these high-rish categories and future educational failure. The physician needs to accept responsibility for properly ensuring that the child will experience a wholesome, enriching experience in the school years. If the above measures were applied widely, a substantial reduction in the incidence of school failure among American children would be realized.