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Loh HW, Ooi CP, Oh SL, Barua PD, Tan YR, Acharya UR, Fung DSS. ADHD/CD-NET: automated EEG-based characterization of ADHD and CD using explainable deep neural network technique. Cogn Neurodyn 2024; 18:1609-1625. [PMID: 39104684 PMCID: PMC11297883 DOI: 10.1007/s11571-023-10028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 08/07/2024] Open
Abstract
In this study, attention deficit hyperactivity disorder (ADHD), a childhood neurodevelopmental disorder, is being studied alongside its comorbidity, conduct disorder (CD), a behavioral disorder. Because ADHD and CD share commonalities, distinguishing them is difficult, thus increasing the risk of misdiagnosis. It is crucial that these two conditions are not mistakenly identified as the same because the treatment plan varies depending on whether the patient has CD or ADHD. Hence, this study proposes an electroencephalogram (EEG)-based deep learning system known as ADHD/CD-NET that is capable of objectively distinguishing ADHD, ADHD + CD, and CD. The 12-channel EEG signals were first segmented and converted into channel-wise continuous wavelet transform (CWT) correlation matrices. The resulting matrices were then used to train the convolutional neural network (CNN) model, and the model's performance was evaluated using 10-fold cross-validation. Gradient-weighted class activation mapping (Grad-CAM) was also used to provide explanations for the prediction result made by the 'black box' CNN model. Internal private dataset (45 ADHD, 62 ADHD + CD and 16 CD) and external public dataset (61 ADHD and 60 healthy controls) were used to evaluate ADHD/CD-NET. As a result, ADHD/CD-NET achieved classification accuracy, sensitivity, specificity, and precision of 93.70%, 90.83%, 95.35% and 91.85% for the internal evaluation, and 98.19%, 98.36%, 98.03% and 98.06% for the external evaluation. Grad-CAM also identified significant channels that contributed to the diagnosis outcome. Therefore, ADHD/CD-NET can perform temporal localization and choose significant EEG channels for diagnosis, thus providing objective analysis for mental health professionals and clinicians to consider when making a diagnosis. Supplementary Information The online version contains supplementary material available at 10.1007/s11571-023-10028-2.
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Affiliation(s)
- Hui Wen Loh
- School of Science and Technology, Singapore University of Social Sciences, Singapore, Singapore
| | - Chui Ping Ooi
- School of Science and Technology, Singapore University of Social Sciences, Singapore, Singapore
| | - Shu Lih Oh
- Cogninet Australia, Sydney, NSW 2010 Australia
| | - Prabal Datta Barua
- Cogninet Australia, Sydney, NSW 2010 Australia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007 Australia
- School of Business (Information System), University of Southern Queensland, Darling Heights, Australia
- Australian International Institute of Higher Education, Sydney, NSW 2000 Australia
- School of Science & Technology, University of New England, Armidale, Australia
- School of Biosciences, Taylor’s University, Selangor, Malaysia
- School of Computing, SRM Institute of Science and Technology, Kattankulathur, India
- School of Science and Technology, Kumamoto University, Kumamoto, Japan
- Sydney School of Education and Social work, University of Sydney, Camperdown, Australia
| | - Yi Ren Tan
- Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - U. Rajendra Acharya
- School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Darling Heights, Australia
- School of Mathematics, Physics and Computing, University of Southern Queensland, Springfield, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Australia
| | - Daniel Shuen Sheng Fung
- Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
- Lee Kong Chian School of Medicine, DUKE NUS Medical School, Yong Loo Lin School of Medicine, Nanyang Technological University, National University of Singapore, Singapore, Singapore
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Loh HW, Ooi CP, Oh SL, Barua PD, Tan YR, Molinari F, March S, Acharya UR, Fung DSS. Deep neural network technique for automated detection of ADHD and CD using ECG signal. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 241:107775. [PMID: 37651817 DOI: 10.1016/j.cmpb.2023.107775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Attention Deficit Hyperactivity problem (ADHD) is a common neurodevelopment problem in children and adolescents that can lead to long-term challenges in life outcomes if left untreated. Also, ADHD is frequently associated with Conduct Disorder (CD), and multiple research have found similarities in clinical signs and behavioral symptoms between both diseases, making differentiation between ADHD, ADHD comorbid with CD (ADHD+CD), and CD a subjective diagnosis. Therefore, the goal of this pilot study is to create the first explainable deep learning (DL) model for objective ECG-based ADHD/CD diagnosis as having an objective biomarker may improve diagnostic accuracy. METHODS The dataset used in this study consist of ECG data collected from 45 ADHD, 62 ADHD+CD, and 16 CD patients at the Child Guidance Clinic in Singapore. The ECG data were segmented into 2 s epochs and directly used to train our 1-dimensional (1D) convolutional neural network (CNN) model. RESULTS The proposed model yielded 96.04% classification accuracy, 96.26% precision, 95.99% sensitivity, and 96.11% F1-score. The Gradient-weighted class activation mapping (Grad-CAM) function was also used to highlight the important ECG characteristics at specific time points that most impact the classification score. CONCLUSION In addition to achieving model performance results with our suggested DL method, Grad-CAM's implementation also offers vital temporal data that clinicians and other mental healthcare professionals can use to make wise medical judgments. We hope that by conducting this pilot study, we will be able to encourage larger-scale research with a larger biosignal dataset. Hence allowing biosignal-based computer-aided diagnostic (CAD) tools to be implemented in healthcare and ambulatory settings, as ECG can be easily obtained via wearable devices such as smartwatches.
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Affiliation(s)
- Hui Wen Loh
- School of Science and Technology, Singapore University of Social Sciences, Singapore
| | - Chui Ping Ooi
- School of Science and Technology, Singapore University of Social Sciences, Singapore
| | - Shu Lih Oh
- Cogninet Australia, Sydney, NSW 2010, Australia
| | - Prabal Datta Barua
- Cogninet Australia, Sydney, NSW 2010, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW 2007, Australia; School of Business (Information System), University of Southern Queensland, Australia; Australian International Institute of Higher Education, Sydney, NSW 2000, Australia; School of Science & Technology, University of New England, Australia; School of Biosciences, Taylor's University, Malaysia; School of Computing, SRM Institute of Science and Technology, India; School of Science and Technology, Kumamoto University, Japan; Sydney School of Education and Social work, University of Sydney, Australia
| | - Yi Ren Tan
- Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Filippo Molinari
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
| | - Sonja March
- Centre for Health Research and School of Psychology and Wellbeing, University of Southern Queensland, Springfield, Australia
| | - U Rajendra Acharya
- School of Mathematics, Physics, and Computing, University of Southern Queensland, Springfield, Australia.
| | - Daniel Shuen Sheng Fung
- Developmental Psychiatry, Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, DUKE NUS Medical School, Yong Loo Lin School of Medicine, National University of Singapore
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Sapozhnikov Y, Mink JW, Augustine EF, Adams HR, Vierhile A, Lewin AB, Collins AT, McDermott MP, O'Connor T, Kurlan R, Murphy TK, Vermilion J. Teacher Knowledge of Tourette Syndrome and Associated Factors. Pediatr Neurol 2023; 145:80-87. [PMID: 37295059 DOI: 10.1016/j.pediatrneurol.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND TS is associated with learning disabilities and educational impairment. Teacher knowledge about TS may have a positive impact on students with TS, but factors associated with teacher knowledge of TS are not known. METHODS In this cross-sectional study, teachers of youth with TS and of a community control group completed a Teacher Understanding of Tourette Syndrome Survey (TUTS), a pilot questionnaire enquiring about self-perceived understanding, teacher knowledge, and sources of information. We compared TUTS scores between TS and control groups and between those who did and did not use specific sources of information about TS using Wilcoxon rank-sum tests. Bivariate correlation analyses were used to evaluate associations between teacher knowledge and potential contributing factors. RESULTS Data from 114 teachers of children with TS and 78 teachers of control subjects were included. Teachers of youth with TS had significantly more knowledge, had higher self-perceived understanding, and used more sources of information than teachers of the control group. Teachers who knew of the Tourette Association of America and who gathered information themselves had higher knowledge about TS than those who did not. CONCLUSION Teachers of children with TS know more about TS and use more sources to learn about TS than teachers of children without TS.
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Affiliation(s)
| | | | | | - Heather R Adams
- Department of Neurology, University of Rochester, Rochester, New York
| | - Amy Vierhile
- Department of Neurology, University of Rochester, Rochester, New York
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
| | - Alyssa T Collins
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Michael P McDermott
- Department of Neurology, University of Rochester, Rochester, New York; Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York
| | - Thomas O'Connor
- Department of Psychiatry, University of Rochester, Rochester, New York
| | - Roger Kurlan
- The Center for Neurological and Neurodevelopmental Health, Voorhees, New Jersey
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
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Lewin AB, Murphy TK, Mink JW, Small BJ, Adams HR, Brennan E, Augustine EF, Vermilion J, Vierhile A, Collins A, Kudryk K, Dickinson S, Danielson ML, Bitsko RH. Brief youth self-report screener for tics: Can a subscale of the Motor tic, Obsession and compulsion, and Vocal tic Evaluation Survey (MOVES) identify tic disorders in youth? EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 8:1-11. [PMID: 37323827 PMCID: PMC10267813 DOI: 10.1080/23794925.2023.2191354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Tics are unwanted, repetitive movements and sounds that frequently present during childhood. They are typically brief and purposeless, but can create significant distress for individuals, and often co-occur with other neuropsychiatric conditions. Thus, early identification of tics is warranted. Unfortunately, tics are often misdiagnosed, and because tics may wax and wane, identification can be difficult, especially in the context of routine clinical visits. There are limited tools that can be used to reliably identify tics in clinical practice, especially in non-specialty settings. The purpose of the current study was to evaluate the performance of the Motor tic, Obsession and compulsion, and Vocal tic Evaluation Survey (MOVES), a self-report scale with some support as a screening tool. In addition, the performance of a subset of questions (the MOVES-6) was evaluated for rapid screening. Participants were recruited across two study sites and included children and adolescents diagnosed with Tourette syndrome (n = 151) or another persistent tic disorder (n = 10) and community controls (n = 74). Results suggest both the MOVES and the MOVES-6 have high sensitivity (90% and 88%, respectively) and at least acceptable specificity (77% and 86%, respectively) compared with expert assessment of tic disorders, suggesting that both versions can identify tic disorders without high proportions of false negatives. Both versions were highly sensitive with acceptable specificity regardless of sex, race/ethnicity, and age. The MOVES and MOVES-6 show promise as a screener for tics or tic disorders, but additional research is needed, particularly in a general population setting.
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Bitsko RH, Holbrook JR, Fisher PW, Lipton C, van Wijngaarden E, Augustine EF, Mink JW, Vierhile A, Piacentini J, Walkup J, Firchow B, Ali AR, Badgley A, Adams HR. Validation of the Diagnostic Interview Schedule for Children (DISC-5) Tic Disorder and Attention-Deficit/Hyperactivity Disorder Modules. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:231-244. [PMID: 38883232 PMCID: PMC11177540 DOI: 10.1080/23794925.2023.2191352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Effective methods to assess mental disorders in children are necessary for accurate prevalence estimates and to monitor prevalence over time. This study assessed updates of the tic disorder and attention-deficit/hyperactivity disorder (ADHD) modules of the Diagnostic Interview Schedule for Children, Version 5 (DISC-5) that reflect changes in diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (Fifth edition, DSM-5). The DISC-5 tic disorder and ADHD parent- and child-report modules were compared to expert clinical assessment for 100 children aged 6-17 years (40 with tic disorder alone, 17 with tic disorder and ADHD, 9 with ADHD alone, and 34 with neither) for validation. For the tic disorder module, parent-report had high (>90%) sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, while the youth-report had high specificity and PPV, moderate accuracy (81.4%), and lower sensitivity (69.8%) and NPV (67.3%). The ADHD module performed less well: parent-report had high NPV (91.4%), moderate sensitivity (80.8%), and lower specificity (71.6%), PPV (50.0%), and accuracy (74.0%); youth-report had moderate specificity (82.8%) and NPV (88.3%), and lower sensitivity (65.0%), PPV (54.2%), and accuracy (78.6%). Adding teacher-report of ADHD symptoms to DISC-5 parent-report of ADHD increased sensitivity (94.7%) and NPV (97.1%), but decreased specificity (64.2%), PPV (48.7%), and accuracy (72.2%). These findings support using the parent-report tic disorder module alone or in combination with the child report module in future research and epidemiologic studies; additional validation studies are warranted for the ADHD module.
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Affiliation(s)
- Rebecca H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Prudence W Fisher
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute - Columbia University - Vagelos College of Physicians and Surgeons, New York, NY
| | - Corey Lipton
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center (URMC), Rochester, NY
| | - Erika F Augustine
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD; Adjunct Associate Professor, Department of Neurology, URMC, Rochester, NY
| | - Jonathan W Mink
- Departments of Neurology, Neuroscience, and Pediatrics, University of Rochester, Rochester, NY
| | - Amy Vierhile
- Departments of Neurology, Neuroscience, and Pediatrics, University of Rochester, Rochester, NY
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - John Walkup
- Pritzker Department of Psychiatry and Behavioral Health, Lurie Children's Hospital & Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley Firchow
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Akilah R Ali
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allison Badgley
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Heather R Adams
- Departments of Neurology, Neuroscience, and Pediatrics, University of Rochester, Rochester, NY
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Adams HR, Augustine EF, Bonifacio K, Collins AE, Danielson ML, Mink JW, Morrison P, van Wijngaarden E, Vermilion J, Vierhile A, Bitsko RH. Evaluation of new instruments for screening and diagnosis of tics and tic disorders in a well-characterized sample of youth with tics and recruited controls. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:216-230. [PMID: 38883231 PMCID: PMC11177539 DOI: 10.1080/23794925.2023.2178040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Tics and tic disorders can significantly impact children, but limited screening tools and diagnostic challenges may delay access to care. The current study attempted to address these gaps by evaluating sensitivity and specificity of the Motor or Vocal Inventory of Tics (MOVeIT), a tic symptom screener, and the Description of Tic Symptoms (DoTS), a brief diagnostic assessment for tic disorders. Children (n=100, age 6-17 years old) with tic disorders attending a Tourette specialty clinic and a community-recruited sample without tics completed a gold-standard assessment by a tic expert; these evaluations were compared to child self-report and parent and teacher report versions of the MOVeIT, and child and parent versions of the DoTS. The parent and child MOVeIT met or exceeded pre-specified 85% sensitivity and specificity criteria for detecting the presence of tics when compared to a gold-standard tic expert diagnosis. The Teacher MOVeIT had lower sensitivity (71.4%) but good specificity (95.7%) for identifying any tic symptoms compared to gold standard. For determination of the presence or absence of any tic disorder, sensitivity of both parent and child DoTS was 100%; specificity of the parent DoTS was 92.7% and child DoTS specificity was 75.9%. More work may be needed to refine the teacher MOVeIT, but it is also recognized that tic expression may vary by setting. While the MOVeIT and DoTS parent and child questionnaires demonstrated adequate sensitivity and specificity for determining the presence of tics and tic disorders in this well-defined sample, additional testing in a general population is warranted.
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Affiliation(s)
- H R Adams
- Department of Neurology, University of Rochester Medical Center (URMC), Rochester, NY
| | - E F Augustine
- Department of Neurology, University of Rochester Medical Center (URMC), Rochester, NY
- Clinical Trials Unit and Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
| | - K Bonifacio
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - A E Collins
- Child Life Program, Golisano Children's Hospital, URMC, Rochester, NY
| | - M L Danielson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - J W Mink
- Department of Neurology, University of Rochester Medical Center (URMC), Rochester, NY
| | - P Morrison
- Department of Neurology, University of Rochester Medical Center (URMC), Rochester, NY
| | | | - J Vermilion
- Department of Neurology, University of Rochester Medical Center (URMC), Rochester, NY
| | - A Vierhile
- Department of Neurology, University of Rochester Medical Center (URMC), Rochester, NY
| | - R H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Szejko N, Robinson S, Hartmann A, Ganos C, Debes NM, Skov L, Haas M, Rizzo R, Stern J, Münchau A, Czernecki V, Dietrich A, Murphy TL, Martino D, Tarnok Z, Hedderly T, Müller-Vahl KR, Cath DC. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment. Eur Child Adolesc Psychiatry 2022; 31:383-402. [PMID: 34661764 PMCID: PMC8521086 DOI: 10.1007/s00787-021-01842-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/30/2021] [Indexed: 11/03/2022]
Abstract
In 2011 a working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines for Tourette syndrome (TS). Now, we present an updated version 2.0 of these European clinical guidelines for Tourette syndrome and other tic disorders, part I: assessment. Therefore, the available literature has been thoroughly screened, supplemented with national guidelines across countries and discussions among ESSTS experts. Diagnostic changes between DSM-IV and DSM-5 classifications were taken into account and new information has been added regarding differential diagnoses, with an emphasis on functional movement disorders in both children and adults. Further, recommendations regarding rating scales to evaluate tics, comorbidities, and neuropsychological status are provided. Finally, results from a recently performed survey among ESSTS members on assessment in TS are described. We acknowledge that the Yale Global Tic Severity Scale (YGTSS) is still the gold standard for assessing tics. Recommendations are provided for scales for the assessment of tics and psychiatric comorbidities in patients with TS not only in routine clinical practice, but also in the context of clinical research. Furthermore, assessments supporting the differential diagnosis process are given as well as tests to analyse cognitive abilities, emotional functions and motor skills.
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Affiliation(s)
- Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, USA
| | - Sally Robinson
- Tic and Neurodevelopmental Movements Service (TANDeM), Children's Neurosciences Centre, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | | | - Christos Ganos
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nanette M Debes
- Paediatric Department, Herlev University Hospital, Herlev, Denmark
| | - Liselotte Skov
- Paediatric Department, Herlev University Hospital, Herlev, Denmark
| | - Martina Haas
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Renata Rizzo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Jeremy Stern
- Department of Neurology, St George's Hospital, St George's University of London, London, UK
| | | | | | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tara L Murphy
- Tic Disorder Clinic, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | | | - Tammy Hedderly
- Tic and Neurodevelopmental Movements Service (TANDeM), Children's Neurosciences Centre, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Kirsten R Müller-Vahl
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, GGZ Drenthe Mental Health Institution, Hanzeplein 1, Assen, 9713, Groningen, The Netherlands.
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Danielson ML, Bitsko RH, Holbrook JR, Charania SN, Claussen AH, McKeown RE, Cuffe SP, Owens JS, Evans SW, Kubicek L, Flory K. Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States. Child Psychiatry Hum Dev 2021; 52:500-514. [PMID: 32734339 PMCID: PMC8016018 DOI: 10.1007/s10578-020-01027-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The Project to Learn About Youth-Mental Health (PLAY-MH; 2014-2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%-17.8%) and higher in Ohio (33.3%). PLAY-MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.
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Affiliation(s)
- Melissa L. Danielson
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Joseph R. Holbrook
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Sana N. Charania
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Angelika H. Claussen
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-4, Atlanta, GA 30341-3717, USA
| | - Robert E. McKeown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Steven P. Cuffe
- Department of Psychiatry, University of Florida College of Medicine–Jacksonville, Jacksonville, FL, USA
| | | | | | - Lorraine Kubicek
- Department of Pediatrics and Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Tor HT, Ooi CP, Lim-Ashworth NS, Wei JKE, Jahmunah V, Oh SL, Acharya UR, Fung DSS. Automated detection of conduct disorder and attention deficit hyperactivity disorder using decomposition and nonlinear techniques with EEG signals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105941. [PMID: 33486340 DOI: 10.1016/j.cmpb.2021.105941] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/10/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Attention deficit hyperactivity disorder (ADHD) is often presented with conduct disorder (CD). There is currently no objective laboratory test or diagnostic method to discern between ADHD and CD, and diagnosis is further made difficult as ADHD is a common neuro-developmental disorder often presenting with other co-morbid difficulties; and in particular with conduct disorder which has a high degree of associated behavioural challenges. A novel automated system (AS) is proposed as a convenient supplementary tool to support clinicians in their diagnostic decisions. To the best of our knowledge, we are the first group to develop an automated classification system to classify ADHD, CD and ADHD+CD classes using brain signals. METHODS The empirical mode decomposition (EMD) and discrete wavelet transform (DWT) methods were employed to decompose the electroencephalogram (EEG) signals. Autoregressive modelling coefficients and relative wavelet energy were then computed on the signals. Various nonlinear features were extracted from the decomposed coefficients. Adaptive synthetic sampling (ADASYN) was then employed to balance the dataset. The significant features were selected using sequential forward selection method. The highly discriminatory features were subsequently fed to an array of classifiers. RESULTS The highest accuracy of 97.88% was achieved with the K-Nearest Neighbour (KNN) classifier. The proposed system was developed using ten-fold validation strategy on EEG data from 123 children. To the best of our knowledge this is the first study to develop an AS for the classification of ADHD, CD and ADHD+CD classes using EEG signals. POTENTIAL APPLICATION Our AS can potentially be used as a web-based application with cloud system to aid the clinical diagnosis of ADHD and/or CD, thus supporting faster and accurate treatment for the children. It is important to note that testing with larger data is required before the AS can be employed for clinical applications.
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Affiliation(s)
- Hui Tian Tor
- School of Science and Technology, Singapore University of Social Sciences, Singapore
| | - Chui Ping Ooi
- School of Science and Technology, Singapore University of Social Sciences, Singapore
| | | | | | - V Jahmunah
- School of Engineering, Ngee Ann Polytechnic, Singapore
| | - Shu Lih Oh
- School of Engineering, Ngee Ann Polytechnic, Singapore
| | - U Rajendra Acharya
- School of Engineering, Ngee Ann Polytechnic, Singapore; Department of Bioinformatics and Medical Engineering, Asia University, Taiwan, ROC; School of Management and Enterprise University of Southern Queensland, Springfield, Australia.
| | - Daniel Shuen Sheng Fung
- Developmental Psychiatry, Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University; DUKE NUS Medical School, National University of Singapore; Yong Loo Lin School of Medicine, National University of Singapore
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10
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Singer HS, McDermott S, Ferenc L, Specht M, Mahone EM. Efficacy of Parent-Delivered, Home-Based Therapy for Tics. Pediatr Neurol 2020; 106:17-23. [PMID: 32165032 DOI: 10.1016/j.pediatrneurol.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although behavioral therapy is an effective approach to reduce tics in children and adults, there is an insufficient availability and accessibility of behavioral therapy in the community. OBJECTIVE The goal of the study was to test the clinical efficacy of home-based, parent-provided behavioral therapy in children with Tourette syndrome aged seven to 13 years. METHOD An instructional habit reversal training-based video and guide was developed for use by parents. Eligible families, in this 10-week study, were enrolled in either a home-based therapy (DVD) group (received disk and written instructions) or an in-person therapist group (had scheduled visits with the therapist). Outcome scales included the Yale Global Tic Severity Scale, both the total Tic Severity Score and total Global Severity Score, and the parent report of Clinical Global Impressions of Improvement. RESULTS Forty-four children (mean age = 10.21 ± 1.69 years) were enrolled into either the DVD (n = 33) or in-person therapist (n = 11) groups. Eighteen completed the study-eight in the DVD and 10 in the in-person therapist group. Outcome measures showed significant reductions in Yale Global Tic Severity Scale change ratios: mean improvement on the Tic Severity Score was DVD 32.4% (P < 0.001) and in-person therapist 26.6% (P = 0.01); and for the Global Severity Score, DVD 33.7% (P < 0.001) and in-person therapist 26.7% (P < 0.001). CONCLUSIONS Home-based, parent-administered habit reversal training behavioral therapy is efficacious for reducing tics in children. Telephone contacts early in the DVD treatment course might reduce the number of dropouts.
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Affiliation(s)
- Harvey S Singer
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Baltimore, Maryland.
| | | | - Lisa Ferenc
- Kennedy Krieger Institute, Baltimore, Maryland
| | | | - E Mark Mahone
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Baltimore, Maryland
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11
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Augustine EF, Adams HR, Bitsko RH, van Wijngaarden E, Claussen AH, Thatcher A, Hanks CE, Lewin AB, O'Connor TG, Vierhile A, Danielson ML, Kurlan R, Murphy TK, Mink JW. Design of a Multisite Study Assessing the Impact of Tic Disorders on Individuals, Families, and Communities. Pediatr Neurol 2017; 68:49-58.e3. [PMID: 28254245 PMCID: PMC5440614 DOI: 10.1016/j.pediatrneurol.2016.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tic disorders, including Tourette syndrome, are complex, multisymptom diseases, yet the impact of these disorders on affected children, families, and communities is not well understood. METHODS To improve the understanding of the impacts of Tourette syndrome, two research groups conducted independent cross-sectional studies using qualitative and quantitative measures. They focused on similar themes, but distinct scientific objectives, and the sites collaborated to align methods of independent research proposals with the aim of increasing the analyzable sample size. RESULTS Site 1 (University of Rochester) was a Pediatric Neurology referral center. Site 2 (University of South Florida) was a Child Psychiatry referral center. A total of 205 children with tic disorders were enrolled from both studies. The University of Rochester also enrolled 100 control children in order to clearly isolate impacts of Tourette syndrome distinct from those occurring in the general population. The majority of children with tic disorders (n = 191, 93.1%) had Tourette syndrome, the primary population targeted for these studies. Children with Tourette syndrome were similar across sites in terms of tic severity and the occurrence of comorbid conditions. The occurrence of psychiatric comorbidities in the control group was comparable with that in the general pediatric population of the United States, making this a well-justified comparison group. CONCLUSIONS Through collaboration, two sites conducting independent research developed convergent research methods to enable pooling of data, and by extension increased power, for future analyses. This method of collaboration is a novel model for future epidemiological research of tic disorders.
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Affiliation(s)
- E F Augustine
- Department of Neurology, University of Rochester Medical Center, Rochester, New York.
| | - H R Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - R H Bitsko
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - E van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - A H Claussen
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A Thatcher
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - C E Hanks
- Department of Pediatrics, University of South Florida, Rothman Center for Neuropsychiatry, St. Petersburg, Florida
| | - A B Lewin
- Department of Pediatrics, University of South Florida, Rothman Center for Neuropsychiatry, St. Petersburg, Florida
| | - T G O'Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - A Vierhile
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - M L Danielson
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R Kurlan
- Atlantic Neuroscience Institute, Overlook Medical Center, Summit, New Jersey
| | - T K Murphy
- Department of Pediatrics, University of South Florida, Rothman Center for Neuropsychiatry, St. Petersburg, Florida
| | - J W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
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12
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Hamblin RJ, Salloum A, Andel R, Nadeau JM, McBride NM, Lewin AB, Storch EA. Predictors of parent-child agreement on child anxiety diagnoses on the ADIS-IV-C/P. Psychiatry Res 2016; 245:303-310. [PMID: 27567193 DOI: 10.1016/j.psychres.2016.07.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/22/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
Diagnostic agreement between parents' and children's reports on children's anxiety problems is notoriously poor; however, very few investigations have examined specific predictors of inter-rater agreement on child anxiety diagnoses. This study examined predictors of categories of parent and child diagnostic endorsement on the Anxiety Disorders Interview Schedule for Children-IV. One hundred eight children (ages 7-13) and their parents completed structured diagnostic interviews for non-OCD/PTSD anxiety diagnoses and paper and pencil measures of functioning and impairment in a variety of domains. Parent-child agreement was statistically significant for social phobia and separation anxiety disorder, but was overall poor for all anxiety diagnoses. Externalizing disorder status, family accommodation frequency, and child rated impairment in various domains differentially predicted informant discrepancies for different anxiety disorders. These data are among the first to suggest variables that may explain parent-child concordance.
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Affiliation(s)
- Rebecca J Hamblin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA.
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Joshua M Nadeau
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA
| | - Nicole M McBride
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; Department of Health Policy and Management, University of South Florida, Tampa, FL, USA; All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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13
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Vachon MJ, Striley CW, Gordon MR, Schroeder ML, Bihun EC, Koller JM, Black KJ. VISIT-TS: A multimedia tool for population studies on tic disorders. F1000Res 2016; 5:1518. [PMID: 27853509 PMCID: PMC5089139 DOI: 10.12688/f1000research.7196.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 01/06/2023] Open
Abstract
Population-based assessment of Tourette syndrome (TS) and other tic disorders produces a paradox. On one hand, ideally diagnosis of tic disorders requires expert observation. In fact, diagnostic criteria for TS explicitly require expert assessment of tics for a definite diagnosis. On the other hand, large-scale population surveys with expert assessment of every subject are impracticable. True, several published studies have successfully used expert assessment to find tic prevalence in a representative population (e.g. all students in a school district). However, extending these studies to larger populations is daunting. We created a multimedia tool to demonstrate tics to a lay audience, discuss their defining and common attributes, and address features that differentiate tics from other movements and vocalizations. A first version was modified to improve clarity and to include a more diverse group in terms of age and ethnicity. The result is a tool intended for epidemiological research. It may also provide additional benefits, such as more representative minority recruitment for other TS studies and increased community awareness of TS.
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Affiliation(s)
- M Jonathan Vachon
- College of Arts and Sciences, Washington University in St. Louis, University City, USA
| | - Catherine W Striley
- Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, USA
| | - Mollie R Gordon
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
| | | | - Emily C Bihun
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Jonathan M Koller
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, USA
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