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Gosling CJ, Caparos S, Pinabiaux C, Schwarzer G, Rücker G, Agha SS, Alrouh H, Ambler A, Anderson P, Andiarena A, Arnold LE, Arseneault L, Asherson P, Babinski L, Barbati V, Barkley R, Barros AJD, Barros F, Bates JE, Bell LJ, Berenguer C, van Bergen E, Biederman J, Birmaher B, B⊘e T, Boomsma DI, Brandt VC, Bressan RA, Brocki K, Broughton TR, Bufferd SJ, Bussing R, Cao M, Cartigny A, Casas AM, Caspi A, Castellanos FX, Caye A, Cederkvist L, Collishaw S, Copeland WE, Cote SM, Coventry WL, Debes NMM, Denyer H, Dodge KA, Dogru H, Efron D, Eller J, Abd Elmaksoud M, Ercan ES, Faraone SV, Fenesy M, Fernández MF, Fernández-Somoano A, Findling R, Fombonne E, Fossum IN, Freire C, Friedman NP, Fristad MA, Galera C, Garcia-Argibay M, Garvan CS, González-Safont L, Groenman AP, Guxens M, Halperin JM, Hamadeh RR, Hartman CA, Hill SY, Hinshaw SP, Hipwell A, Hokkanen L, Holz N, Íñiguez C, Jahrami HA, Jansen PW, Jónsdóttir LK, Julvez J, Kaiser A, Keenan K, Klein DN, Klein RG, Kuntsi J, Langfus J, Langley K, Lansford JE, Larsen SA, Larsson H, Law E, Lee SS, Lertxundi N, Li X, Li Y, Lichtenstein P, Liu J, Lundervold AJ, Lundström S, Marks DJ, Martin J, Masi G, Matijasevich A, Melchior M, Moffitt TE, Monninger M, Morrison CL, Mulraney M, Muratori P, Nguyen PT, Nicholson JM, Øie MG, O'Neill S, O'Connor C, Orri M, Pan PM, Pascoe L, Pettit GS, Price J, Rebagliato M, Riaño-Galán I, Rohde LA, Roisman GI, Rosa M, Rosenbaum JF, Salum GA, Sammallahti S, Santos IS, Schiavone NS, Schmid L, Sciberras E, Shaw P, Silk TJ, Simpson JA, Skogli EW, Stepp S, Strandberg-Larsen K, Sudre G, Sunyer J, Tandon M, Thapar A, Thomson P, Thorell LB, Tinchant H, Torrent M, Tovo-Rodrigues L, Tripp G, Ukoumunne O, Van Goozen SHM, Vos M, Wallez S, Wang Y, Westermaier FG, Whalen DJ, Yoncheva Y, Youngstrom EA, Sayal K, Solmi M, Delorme R, Cortese S. Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis. Lancet Psychiatry 2023; 10:922-933. [PMID: 37898142 DOI: 10.1016/s2215-0366(23)00272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The youngest children in a school class are more likely than the oldest to be diagnosed with ADHD, but this relative age effect is less frequent in older than in younger school-grade children. However, no study has explored the association between relative age and the persistence of ADHD diagnosis at older ages. We aimed to quantify the association between relative age and persistence of ADHD at older ages. METHODS For this meta-analysis, we searched MEDLINE, Embase, CINAHL, PsycINFO, and PubPsych up to April 1, 2022, with terms related to "cohort" and "ADHD" with no date, publication type, or language restrictions. We gathered individual participant data from prospective cohorts that included at least ten children identified with ADHD before age 10 years. ADHD was defined by either a clinical diagnosis or symptoms exceeding clinical cutoffs. Relative age was recorded as the month of birth in relation to the school-entry cutoff date. Study authors were invited to share raw data or to apply a script to analyse data locally and generate anonymised results. Our outcome was ADHD status at a diagnostic reassessment, conducted at least 4 years after the initial assessment and after age 10 years. No information on sex, gender, or ethnicity was collected. We did a two-stage random-effects individual participant data meta-analysis to assess the association of relative age with persistence of ADHD at follow-up. This study was registered with PROSPERO, CRD42020212650. FINDINGS Of 33 119 studies generated by our search, we identified 130 eligible unique studies and were able to gather individual participant data from 57 prospective studies following up 6504 children with ADHD. After exclusion of 16 studies in regions with a flexible school entry system that did not allow confident linkage of birthdate to relative age, the primary analysis included 41 studies in 15 countries following up 4708 children for a period of 4 to 33 years. We found that younger relative age was not statistically significantly associated with ADHD persistence at follow-up (odds ratio 1·02, 95% CI 0·99-1·06; p=0·19). We observed statistically significant heterogeneity in our model (Q=75·82, p=0·0011, I2=45%). Participant-level sensitivity analyses showed similar results in cohorts with a robust relative age effect at baseline and when restricting to cohorts involving children with a clinical diagnosis of ADHD or with a follow-up duration of more than 10 years. INTERPRETATION The diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. One interpretation is that the relative age effect decreases the likelihood of children of older relative age receiving a diagnosis of ADHD, and another is that assigning a diagnostic label of ADHD leads to unexplored carryover effects of the initial diagnosis that persist over time. Future studies should be conducted to explore these interpretations further. FUNDING None.
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García Murillo L, Ramos-Olazagasti MA, Klein RG, Mannuzza S, Castellanos FX. Correlates of nicotine dependence in men with childhood attention-deficit/hyperactivity disorder: a 33-year follow-up. ACTA ACUST UNITED AC 2018; 11:183-189. [PMID: 30171588 DOI: 10.1007/s12402-018-0263-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
Abstract
Identify correlates of nicotine dependence [lifetime (l) and ongoing (o)] in adults with attention-deficit/hyperactivity disorder (ADHD) in childhood. We conducted a 33-year prospective follow-up of boys (mean age 8) with combined type ADHD (n = 135/207, 65% original sample). Correlates of nicotine dependence in adulthood were selected from characteristics obtained in childhood and adolescence. Among selected childhood features, only immature behavior was significantly related to nicotine dependence (OR(o) = 0.29, p = 0.02), indexing decreased risk. In contrast, several adolescent variables significantly correlated (p < 0.01) with nicotine dependence at mean age 41, including alcohol substance use disorder (SUD, OR(l) = 4.97), non-alcohol SUD (OR(o) = 4.33/OR(l) = 10.93), parental antisocial personality disorder (OR(l) = 4.42), parental SUD (OR(l) = 3.58), dropped out of school (OR(l) = 2.29), impulsivity (OR(o) = 1.53/OR(l) = 1.59), hyperactivity (OR(o) = 1.38), and number of antisocial behaviors (OR(o) = 1.10/OR(l) = 1.14). Results highlight the role of adolescent psychopathology in the development of nicotine dependence, motivating prospective longitudinal efforts to better define the developmental trajectories of risk and protection.
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Affiliation(s)
- Lourdes García Murillo
- Department of Psychiatry, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Child Study Center, Hassenfeld Children's Hospital at NYU Langone, One Park Ave 7th Floor, New York, NY, 10016, USA
| | - María A Ramos-Olazagasti
- Reproductive Health and Family Formation and Hispanic Institute, Child Trends, Bethesda, MD, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Rachel G Klein
- Department of Child and Adolescent Psychiatry, Child Study Center, Hassenfeld Children's Hospital at NYU Langone, One Park Ave 7th Floor, New York, NY, 10016, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Salvatore Mannuzza
- Department of Child and Adolescent Psychiatry, Child Study Center, Hassenfeld Children's Hospital at NYU Langone, One Park Ave 7th Floor, New York, NY, 10016, USA
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, Child Study Center, Hassenfeld Children's Hospital at NYU Langone, One Park Ave 7th Floor, New York, NY, 10016, USA. .,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
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Ramos-Olazagasti MA, Castellanos FX, Mannuzza S, Klein RG. Predicting the Adult Functional Outcomes of Boys With ADHD 33 Years Later. J Am Acad Child Adolesc Psychiatry 2018; 57:571-582.e1. [PMID: 30071978 PMCID: PMC6126351 DOI: 10.1016/j.jaac.2018.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/02/2018] [Accepted: 06/11/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Little is known of the factors that influence the course of childhood attention-deficit/hyperactivity disorder (ADHD). Objectives were to identify early features predictive of the adult outcome of children with ADHD. In the longest prospective follow-up to date of children with ADHD, predictors of multiple functional domains were examined: social, occupational, and overall adjustment and educational and occupational attainment. METHOD White boys (6-12 years, mean age 8 years) with ADHD (N = 135), selected to be free of conduct disorder, were assessed longitudinally through adulthood (mean age 41) by clinicians blinded to all previous characteristics. Predictors had been recorded in childhood and adolescence (mean age 18). RESULTS Childhood IQ was positively associated with several outcomes: educational attainment, occupational rank, and social and occupational adjustment. Despite their low severity, conduct problems in childhood were negatively related to overall function, educational attainment, and occupational functioning. Two other childhood features that had positive associations with adult adjustment were socioeconomic status and reading ability, which predicted educational attainment. Of multiple adolescent characteristics, 4 were significant predictors: antisocial behaviors predicted poorer educational attainment; educational goals were related to better overall function; early job functioning had a positive relation with social functioning; and early social functioning was positively related to occupational functioning. CONCLUSION Other than childhood IQ, which predicted better outcomes in several domains, there were no consistent prognosticators of adult function among children with ADHD. Providing additional supports to children with relatively lower IQ might improve the adult functional outcome of children with ADHD. However, predicting the course of children with ADHD remains a challenge.
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Affiliation(s)
| | - Francisco Xavier Castellanos
- New York University Langone Medical Center, New York; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
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Gabbay V, Freed RD, Alonso CM, Senger S, Stadterman J, Davison BA, Klein RG. A Double-Blind Placebo-Controlled Trial of Omega-3 Fatty Acids as a Monotherapy for Adolescent Depression. J Clin Psychiatry 2018; 79:17m11596. [PMID: 29985566 PMCID: PMC6625364 DOI: 10.4088/jcp.17m11596] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/13/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Reports are mixed on the efficacy of omega-3 fatty acids (O3FA) for the treatment of major depressive disorder (MDD), with only limited data in adolescents. The present trial aimed to investigate systematically the efficacy of O3FA as a monotherapy, compared to a placebo, in adolescents with MDD. Secondarily, we explored O3FA effects on anhedonia, irritability, and suicidality-all key features of adolescent MDD. METHODS Fifty-one psychotropic medication-free adolescents with DSM-IV-TR diagnoses of MDD (aged 12-19 years; 57% female) were randomized to receive O3FA or a placebo for 10 weeks. Data were collected between January 2006 and June 2013. O3FA and a placebo were administered on a fixed-flexible dose titration schedule based on clinical response and side effects. The initial dose of 1.2 g/d was increased 0.6 g/d every 2 weeks, up to a maximum of 3.6 g/d. Clinician-rated and self-rated depression severity, along with treatment response, served as primary outcome measures. Additionally, we examined O3FA effects on depression-related symptoms, including anhedonia, irritability, and suicidality. Treatment differences were analyzed via intent-to-treat analyses. RESULTS O3FA were not superior to a placebo on any clinical feature, including depression severity and levels of anhedonia, irritability, or suicidality. Additionally, response rates were comparable between treatment groups. Within-treatment analyses indicated that both treatments were associated with significant improvement in depression severity on self- (O3FA: t = -4.38, P < .001; placebo: t = -3.52, P = .002) and clinician (O3FA: t = -6.47, P < .001; placebo: t = -8.10, P < .001) ratings. CONCLUSIONS In adolescents with MDD, O3FA do not appear to be superior to placebo. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00962598.
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Affiliation(s)
- Vilma Gabbay
- Pediatric Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029. .,Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | | | | | | | | | | | - Rachel G. Klein
- New York University Langone Medical Center, New York, New York
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Murillo LG, Ramos-Olazagasti MA, Mannuzza S, Castellanos FX, Klein RG. Childhood Attention-Deficit/Hyperactivity Disorder and Homelessness: A 33-Year Follow-Up Study. J Am Acad Child Adolesc Psychiatry 2016; 55:931-936. [PMID: 27806860 PMCID: PMC5533180 DOI: 10.1016/j.jaac.2016.07.772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/16/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether childhood attention-deficit/hyperactivity disorder (ADHD) predicts homelessness in adulthood, and whether the persistence of childhood ADHD through adolescence influences the likelihood of homelessness. METHOD A 33-year prospective, controlled, follow-up was performed of clinic-referred, 6- to 12-year-old boys of white ethnicity with ADHD (probands; mean = 8), at a mean age of 41 years (follow-up [FU] = 41). Comparisons, children without ADHD from the same medical center, were matched for age and socioeconomic status (SES). Both groups were evaluated at a mean age of 18 years (FU18). Homelessness was assessed at FU41 in 134 of 207 probands (65%) and 136 of 178 (76%) comparisons. We tested the following: the relationship between childhood ADHD and homelessness; whether adolescent dysfunctions (conduct disorder, non-alcohol substance use disorder, arrests, and school dropout) accounted for this relationship, if found; and whether ADHD that persisted through FU18 elevated probands' homelessness rate. RESULTS Probands had significantly higher rates of homelessness than comparisons (23.7% vs. 4.4%; χ21 = 21.15, df = 1, p < .001). In a multivariate analysis, including childhood ADHD and covariates, the probands' significant elevation of homelessness remained (odds ratio [OR] = 3.60, 95% CI = 1.32-9.76, p = .01). Probands with persistent ADHD through adolescence had significantly more homelessness than remitted probands (χ21 = 12.73, p < .001), but this relationship was no longer significant when conduct disorder at FU18 was controlled (OR = 1.97, 95% CI = 0.89-4.38, p = .09). CONCLUSION Among boys of white ethnicity who were followed into adulthood, childhood ADHD was associated with an elevated rate of homelessness. Findings point to the need for clinical monitoring of childhood ADHD through adolescence, even when ADHD does not persist, in hopes of mitigating a cascade of malfunction that includes homelessness.
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Affiliation(s)
| | | | | | - Francisco Xavier Castellanos
- The Child Study Center at New York University Langone Medical Center, New York. Nathan Kline Institute for Psychiatric Research, Orangeburg, NY
| | - Rachel G. Klein
- The Child Study Center at New York University Langone Medical Center, New York
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Masia Warner C, Colognori D, Brice C, Herzig K, Mufson L, Lynch C, Reiss PT, Petkova E, Fox J, Moceri DC, Ryan J, Klein RG. Can school counselors deliver cognitive-behavioral treatment for social anxiety effectively? A randomized controlled trial. J Child Psychol Psychiatry 2016; 57:1229-1238. [PMID: 27002215 DOI: 10.1111/jcpp.12550] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) typically onsets in adolescence and is associated with multiple impairments. Despite promising clinical interventions, most socially anxious adolescents remain untreated. To address this clinical neglect, we developed a school-based, 12-week group intervention for youth with SAD, Skills for Academic and Social Success (SASS). When implemented by psychologists, SASS has been found effective. To promote dissemination and optimize treatment access, we tested whether school counselors could be effective treatment providers. METHOD We randomized 138, ninth through 11th graders with SAD to one of three conditions: (a) SASS delivered by school counselors (C-SASS), (b) SASS delivered by psychologists (P-SASS), or (c) a control condition, Skills for Life (SFL), a nonspecific counseling program. Blind, independent, evaluations were conducted with parents and adolescents at baseline, post-intervention, and 5 months beyond treatment completion. We hypothesized that C-SASS and P-SASS would be superior to the control, immediately after treatment and at follow-up. No prediction was made about the relative efficacy of C-SASS and P-SASS. RESULTS Compared to controls, adolescents treated with C-SASS or P-SASS experienced significantly greater improvement and reductions of anxiety at the end of treatment and follow-up. There were no significant differences between SASS delivered by school counselors and psychologists. CONCLUSION With training, school counselors are effective treatment providers to adolescents with social anxiety, yielding benefits comparable to those obtained by specialized psychologists. Questions remain regarding means to maintain counselors' practice standards without external support.
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Affiliation(s)
- Carrie Masia Warner
- Department of Psychology, William Paterson University, Wayne, NJ, USA. .,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA. .,Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA.
| | - Daniela Colognori
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Chad Brice
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Kathleen Herzig
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Laura Mufson
- Department of Psychiatry, Columbia University College of Physicians and Surgeon and New York State Psychiatric Institute, New York, NY, USA
| | - Chelsea Lynch
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Philip T Reiss
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.,Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA.,Department of Population Health, NYU Langone Medical Center, New York, NY, USA
| | - Eva Petkova
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.,Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA.,Department of Population Health, NYU Langone Medical Center, New York, NY, USA
| | - Jeremy Fox
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Dominic C Moceri
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Julie Ryan
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Rachel G Klein
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
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Bruzzese JM, Reigada LC, Lamm A, Wang J, Li M, Zandieh SO, Klein RG. Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents. Acad Pediatr 2016; 16:792-798. [PMID: 27049680 PMCID: PMC5047850 DOI: 10.1016/j.acap.2016.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/16/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the association of adolescent asthma-related anxiety, social anxiety, separation anxiety, and caregiver asthma-related anxiety with asthma care by urban adolescents. METHODS Participants were 386 ethnic minority adolescents (mean age 12.8 years) with persistent asthma and their caregivers. Adolescents reported what they do to prevent asthma symptoms and to manage acute symptoms, and if they or their caregiver is responsible for their asthma care. Adolescents completed the Youth Asthma-Related Anxiety Scale, and the social and separation anxiety subscales of the Screen for Child Anxiety and Emotional Disorders (SCARED); caregivers completed the Parent Asthma-Related Anxiety Scale. Linearity of the associations was assessed by generalized additive models. When there was no evidence for nonlinearity, linear mixed effects models were used to evaluate the effects of the predictors. RESULTS Adolescent asthma-related anxiety had a strong curvilinear relationship with symptom prevention (P < .001). Adolescents took more prevention steps as their anxiety increased, with a plateau at moderate anxiety. There was a linear relationship of adolescent asthma-related anxiety to symptom management (β = 0.03, P = .021) and to asthma responsibility (β = 0.11, P = .015), and of caregiver asthma-related anxiety to adolescent symptom prevention (β = 0.04, P = .001). Adolescent social and separation anxiety had weak to no relationship with asthma care. Results remained consistent when controlling for each of the other anxieties. CONCLUSIONS Asthma-related anxiety plays an important, independent role in asthma care. When low, adolescents may benefit from increased support from caregivers and awareness of the consequences of uncontrolled asthma. When elevated, health providers should ensure the adolescents are not assuming responsibility for asthma care prematurely.
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Affiliation(s)
- Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Laura C. Reigada
- Department of Psychology, Brooklyn College of the City University of New York, 2900 Bedford Avenue, Brooklyn, NY 11210, USA
| | - Alexandra Lamm
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Jing Wang
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Meng Li
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
| | - Stephanie O. Zandieh
- Department of Pediatrics, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Rachel G. Klein
- Department of Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7 FL, New York, NY 10016, USA
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Roy AK, Lopes V, Klein RG. Disruptive Mood Dysregulation Disorder: A New Diagnostic Approach to Chronic Irritability in Youth. Focus (Am Psychiatr Publ) 2016; 14:145-151. [PMID: 31997949 PMCID: PMC6524431 DOI: 10.1176/appi.focus.140104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted from the American Journal of Psychiatry 2014; 171:918-924 with permission from American Psychiatric Association Publishing).
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Abikoff HB, Thompson M, Laver-Bradbury C, Long N, Forehand RL, Brotman LM, Klein RG, Reiss P, Huo L, Sonuga-Barke E. Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs. J Child Psychol Psychiatry 2015; 56:618-31. [PMID: 25318650 PMCID: PMC4400193 DOI: 10.1111/jcpp.12346] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The 'New Forest Parenting Package' (NFPP), an 8-week home-based intervention for parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD), fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control. Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short- and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior ['Helping the Noncompliant Child' (HNC)] in young children with ADHD. METHODS A randomized controlled trial with three parallel arms was the design for this study. A total of 164 3-4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N = 67), HNC (N = 63), or wait-list control (WL, N = 34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: http://www/clinicaltrials.gov/ct2/show/NCT01320098). RESULTS In both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC. CONCLUSIONS The results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across nontargeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects.
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Affiliation(s)
- Howard B. Abikoff
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, USA
| | - Margaret Thompson
- Child and Adolescent Mental Health Service, Southampton City PCT, UK,Orchard Centre, Southampton, UK,Department of Psychology, University of Southampton, UK
| | | | - Nicholas Long
- Department of Pediatrics, University of Arkansas for Medical Sciences, AR, USA
| | - Rex L. Forehand
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Laurie Miller Brotman
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, USA,Department of Population Health, New York University School of Medicine, NY, USA
| | - Rachel G. Klein
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, USA
| | - Philip Reiss
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, USA,Department of Population Health, New York University School of Medicine, NY, USA,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Lan Huo
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, USA
| | - Edmund Sonuga-Barke
- Department of Psychology, University of Southampton, UK,Department of Experimental Clinical and Health Psychology, Ghent University, Belgium,Department of Child Psychiatry, Aarhus University, Denmark
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Gabbay V, Johnson AR, Alonso CM, Evans LK, Babb JS, Klein RG. Anhedonia, but not irritability, is associated with illness severity outcomes in adolescent major depression. J Child Adolesc Psychopharmacol 2015; 25:194-200. [PMID: 25802984 PMCID: PMC4403015 DOI: 10.1089/cap.2014.0105] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Unlike adult major depressive disorder (MDD) which requires anhedonia or depressed mood for diagnosis, adolescent MDD can be sufficiently diagnosed with irritability in the absence of the former symptoms. In addition, the current Diagnostic and Statistical Manual of Mental Disorders (DSM) schema does not account for the interindividual variability of symptom severity among depressed adolescents. This practice has contributed to the high heterogeneity and diagnostic complexity of adolescent MDD. Here, we sought to examine relationships between two core symptoms of adolescent MDD - irritability and anhedonia, assessed both quantitatively and categorically - and other clinical correlates among depressed adolescents. METHODS Ninety adolescents with MDD (51 females), ages 12-20, were enrolled. Anhedonia and irritability scores were quantified by summing related items on the Children's Depression Rating Scale-Revised and the Beck Depression Inventory. Extremes of score distribution were defined as high or low irritability/anhedonia subgroups. A significance level of p=0.01 was set to adjust for the five comparisons. RESULTS Despite all subjects exhibiting moderate to severe MDD, both irritability and anhedonia scores manifested a full and normally distributed severity range including the lowest values possible. However, only anhedonia severity was associated with more severe clinical outcomes, including greater overall illness severity (p<0.001), suicidality scores (p<0.001), episode duration (p=0.006), and number of MDD episodes (p=0.01). Similarly, only the high-anhedonia subgroup manifested more severe outcomes; specifically, greater illness severity (p<0.0001), number of MDD episodes (p=0.01), episode duration (p=0.01), and suicidality scores (p=0.0001). CONCLUSIONS Our findings suggest the significance of anhedonia as a hallmark of adolescent MDD and the need to incorporate dimensional analyses. These data are preliminary, and future prospective studies are needed to better characterize the syndrome of adolescent MDD.
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Affiliation(s)
- Vilma Gabbay
- Icahn School of Medicine at Mount Sinai, New York, New York.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Amy R. Johnson
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Lori K. Evans
- New York University Langone Medical Center, New York, New York
| | - James S. Babb
- New York University Langone Medical Center, New York, New York
| | - Rachel G. Klein
- New York University Langone Medical Center, New York, New York
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Abstract
Disruptive mood dysregulation disorder (DMDD), a newcomer to psychiatric nosology, addresses the need for improved classification and treatment of children exhibiting chronic nonepisodic irritability and severe temper outbursts. In recent years, many of these children have been diagnosed with bipolar disorder, despite the lack of distinct mood episodes. This diagnostic practice has raised concerns, in part because of the escalating prescription of atypical antipsychotics. This article provides an overview of the limited literature on DMDD, including its history and relevant studies of assessment and treatment. A case study is included to illustrate key points, including diagnostic issues that clinicians may encounter when considering a diagnosis of DMDD.
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Roy AK, Klein RG, Angelosante A, Bar-Haim Y, Leibenluft E, Hulvershorn L, Dixon E, Dodds A, Spindel C. Clinical features of young children referred for impairing temper outbursts. J Child Adolesc Psychopharmacol 2013; 23:588-96. [PMID: 24168713 PMCID: PMC3842879 DOI: 10.1089/cap.2013.0005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. METHODS Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 non-referred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. RESULTS No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. CONCLUSIONS Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.
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Affiliation(s)
- Amy K. Roy
- Department of Psychology, Fordham University, Bronx, New York
| | | | | | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ellen Leibenluft
- Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Erica Dixon
- Department of Psychology, American University, Washington DC
| | - Alice Dodds
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Carrie Spindel
- New York University Child Study Center, New York, New York
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Cortese S, Imperati D, Zhou J, Proal E, Klein RG, Mannuzza S, Ramos-Olazagasti MA, Milham MP, Kelly C, Castellanos FX. White matter alterations at 33-year follow-up in adults with childhood attention-deficit/hyperactivity disorder. Biol Psychiatry 2013; 74:591-8. [PMID: 23566821 PMCID: PMC3720804 DOI: 10.1016/j.biopsych.2013.02.025] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 02/02/2013] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is increasingly conceived as reflecting altered functional and structural brain connectivity. The latter can be addressed with diffusion tensor imaging (DTI). We examined fractional anisotropy (FA), a DTI index related to white matter structural properties, in adult male subjects diagnosed with ADHD in childhood (probands) and matched control subjects without childhood ADHD. Additionally, we contrasted FA among probands with and without current ADHD in adulthood and control subjects. METHODS Participants were from an original cohort of 207 boys and 178 male control subjects. At 33-year follow-up, analyzable DTI scans were obtained in 51 probands (41.3 ± 2.8 yrs) and 66 control subjects (41.2 ± 3.1 yrs). Voxel-based FA was computed with tract-based spatial statistics, controlling for multiple comparisons. RESULTS Probands with childhood ADHD exhibited significantly lower FA than control subjects without childhood ADHD in the right superior and posterior corona radiata, right superior longitudinal fasciculus, and in a left cluster including the posterior thalamic radiation, the retrolenticular part of the internal capsule, and the sagittal stratum (p<.05, corrected). Fractional anisotropy was significantly decreased relative to control subjects in several tracts in both probands with current and remitted ADHD, who did not differ significantly from each other. Fractional anisotropy was not significantly increased in probands in any region. CONCLUSIONS Decreased FA in adults with childhood ADHD regardless of current ADHD might be an enduring trait of ADHD. White matter tracts with decreased FA connect regions involved in high-level as well as sensorimotor functions, suggesting that both types of processes are involved in the pathophysiology of ADHD.
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Affiliation(s)
- Samuele Cortese
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, New York University Langone School of Medicine, New York; Child Neuropsychiatry Unit, G. B. Rossi Hospital, Department of Life Science and Reproduction, Verona University, Verona, Italy; UMR_S INSERM U 930, CNRS ERL 3106, François-Rabelais University, Child Psychiatry Centre, University Hospital, Tours, France.
| | - Davide Imperati
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, NYU Langone School of Medicine, New York, NY, USA
| | - Juan Zhou
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, NYU Langone School of Medicine, New York, NY, USA,Duke-NUS Graduate Medical School, Neuroscience and Behavioral Disorders Program, & the Agency for Science, Technology and Research, Neuroscience Research Partnership, Singapore
| | - Erika Proal
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, NYU Langone School of Medicine, New York, NY, USA,Neuroingenia Clinical and Research Center, México, D.F., México
| | - Rachel G. Klein
- Anita Saltz Institute for Anxiety and Mood Disorders, Child Study Center, NYU Langone School of Medicine, New York, NY, USA
| | - Salvatore Mannuzza
- Anita Saltz Institute for Anxiety and Mood Disorders, Child Study Center, NYU Langone School of Medicine, New York, NY, USA
| | - Maria A. Ramos-Olazagasti
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, NYU Langone School of Medicine, New York, NY, USA
| | - Michael P. Milham
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA,Center for the Developing Brain, Child Mind Institute, New York, NY, USA
| | - Clare Kelly
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, NYU Langone School of Medicine, New York, NY, USA
| | - F. Xavier Castellanos
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, NYU Langone School of Medicine, New York, NY, USA,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Cortese S, Ramos Olazagasti MA, Klein RG, Castellanos FX, Proal E, Mannuzza S. Obesity in men with childhood ADHD: a 33-year controlled, prospective, follow-up study. Pediatrics 2013; 131:e1731-8. [PMID: 23690516 PMCID: PMC4074659 DOI: 10.1542/peds.2012-0540] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare BMI and obesity rates in fully grown men with and without childhood attention-deficit/hyperactivity disorder (ADHD). We predicted higher BMI and obesity rates in: (1) men with, versus men without, childhood ADHD; (2) men with persistent, versus men with remitted, ADHD; and (3) men with persistent or remitted ADHD versus those without childhood ADHD. METHODS Men with childhood ADHD were from a cohort of 207 white boys (referred at a mean age of 8.3 years), interviewed blindly at mean ages 18 (FU18), 25 (FU25), and 41 years (FU41). At FU18, 178 boys without ADHD were recruited. At FU41, 111 men with childhood ADHD and 111 men without childhood ADHD self-reported their weight and height. RESULTS Men with childhood ADHD had significantly higher BMI (30.1 ± 6.3 vs 27.6 ± 3.9; P = .001) and obesity rates (41.4% vs 21.6%; P = .001) than men without childhood ADHD. Group differences remained significant after adjustment for socioeconomic status and lifetime mental disorders. Men with persistent (n = 24) and remitted (n = 87) ADHD did not differ significantly in BMI or obesity rates. Even after adjustment, men with remitted (but not persistent) ADHD had significantly higher BMI (B: 2.86 [95% CI: 1.22 to 4.50]) and obesity rates (odds ratio: 2.99 [95% CI: 1.55 to 5.77]) than those without childhood ADHD. CONCLUSIONS Children with ADHD are at increased risk of obesity as adults. Findings of elevated BMI and obesity rates in men with remitted ADHD require replication.
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Affiliation(s)
- Samuele Cortese
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience
- Child Neuropsychiatry Unit, Department of Life Sciences and Reproduction, Verona University, Verona, Italy
| | | | - Rachel G. Klein
- Anita Saltz Institute for Anxiety and Mood Disorders, Child Study Center of the NYU Langone Medical Center, New York, New York
| | - F. Xavier Castellanos
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York; and
| | - Erika Proal
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience
- Neuroingenia Clinical and Research Center, México, D.F., Mexico
| | - Salvatore Mannuzza
- Anita Saltz Institute for Anxiety and Mood Disorders, Child Study Center of the NYU Langone Medical Center, New York, New York
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Ramos Olazagasti MA, Klein RG, Mannuzza S, Belsky ER, Hutchison JA, Lashua-Shriftman EC, Castellanos FX. Does childhood attention-deficit/hyperactivity disorder predict risk-taking and medical illnesses in adulthood? J Am Acad Child Adolesc Psychiatry 2013; 52:153-162.e4. [PMID: 23357442 PMCID: PMC3662801 DOI: 10.1016/j.jaac.2012.11.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/14/2012] [Accepted: 11/20/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test whether children with attention-deficit/hyperactivity disorder (ADHD), free of conduct disorder (CD) in childhood (mean = 8 years), have elevated risk-taking, accidents, and medical illnesses in adulthood (mean = 41 years); whether development of CD influences risk-taking during adulthood; and whether exposure to psychostimulants in childhood predicts cardiovascular disease. We hypothesized positive relationships between childhood ADHD and risky driving (in the past 5 years), risky sex (in the past year), and between risk-taking and medical conditions in adulthood; and that development of CD/antisocial personality (APD) would account for the link between ADHD and risk-taking. We report causes of death. METHOD Prospective 33-year follow-up of 135 boys of white ethnicity with ADHD in childhood and without CD (probands), and 136 matched male comparison subjects without ADHD (comparison subjects; mean = 41 years), blindly interviewed by clinicians. RESULTS In adulthood, probands had relatively more risky driving, sexually transmitted disease, head injury, and emergency department admissions (p< .05-.01). Groups did not differ on other medical outcomes. Lifetime risk-taking was associated with negative health outcomes (p = .01-.001). Development of CD/APD accounted for the relationship between ADHD and risk-taking. Probands without CD/APD did not differ from comparison subjects in lifetime risky behaviors. Psychostimulant treatment did not predict cardiac illness (p = .55). Probands had more deaths not related to specific medical conditions (p = .01). CONCLUSIONS Overall, among children with ADHD, it is those who develop CD/APD who have elevated risky behaviors as adults. Over their lifetime, those who did not develop CD/APD did not differ from comparison subjects in risk-taking behaviors. Findings also provide support for long-term safety of early psychostimulant treatment.
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Klein RG, Mannuzza S, Ramos Olazagasti MA, Roizen Belsky E, Hutchison JA, Lashua-Shriftman E, Castellanos FX. Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Arch Gen Psychiatry 2012; 69:1295-303. [PMID: 23070149 PMCID: PMC3597443 DOI: 10.1001/archgenpsychiatry.2012.271] [Citation(s) in RCA: 363] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Prospective studies of childhood attention-deficit/hyperactivity disorder (ADHD) have not extended beyond early adulthood. OBJECTIVE To examine whether children diagnosed as having ADHD at a mean age of 8 years (probands) have worse educational, occupational, economic, social, and marital outcomes and higher rates of ongoing ADHD, antisocial personality disorder (ASPD), substance use disorders (SUDs), adult-onset psychiatric disorders, psychiatric hospitalizations, and incarcerations than non-ADHD comparison participants at a mean age of 41 years. DESIGN Prospective, 33-year follow-up study, with masked clinical assessments. SETTING Research clinic. PARTICIPANTS A total of 135 white men with ADHD in childhood, free of conduct disorder, and 136 men without childhood ADHD (65.2% and 76.4% of original cohort, respectively). MAIN OUTCOME MEASURES Occupational, economic, and educational attainment; marital history; occupational and social functioning; ongoing and lifetime psychiatric disorders; psychiatric hospitalizations; and incarcerations. RESULTS Probands had significantly worse educational, occupational, economic, and social outcomes; more divorces; and higher rates of ongoing ADHD (22.2% vs 5.1%, P < .001), ASPD (16.3% vs 0%, P < .001), and SUDs (14.1% vs 5.1%, P = .01) but not more mood or anxiety disorders (P = .36 and .33) than did comparison participants. Ongoing ADHD was weakly related to ongoing SUDs (ϕ = 0.19, P = .04), as well as ASPD with SUDs (ϕ = 0.20, P = .04). During their lifetime, probands had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. Relative to comparisons, psychiatric disorders with onsets at 21 years or older were not significantly elevated in probands. Probands without ongoing psychiatric disorders had worse social, but not occupational, functioning. CONCLUSIONS The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD.
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Affiliation(s)
- Rachel G. Klein
- Anita Saltz Institute for Anxiety and Mood Disorders, NYU Child Study Center, New York, NY, USA
| | | | - María A. Ramos Olazagasti
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, NYU Child Study Center, New York, NY, USA
| | - Erica Roizen Belsky
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | | | | | - F. Xavier Castellanos
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, NYU Child Study Center, New York, NY, USA
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Gabbay V, Babb JS, Klein RG, Panzer AM, Katz Y, Alonso CM, Petkova E, Wang J, Coffey BJ. A double-blind, placebo-controlled trial of ω-3 fatty acids in Tourette's disorder. Pediatrics 2012; 129:e1493-500. [PMID: 22585765 PMCID: PMC3362909 DOI: 10.1542/peds.2011-3384] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Clinical observations have suggested therapeutic effects for ω-3 fatty acids (O3FA) in Tourette's disorder (TD), but no randomized, controlled trials have been reported. In a placebo-controlled trial, we examined the efficacy of O3FA in children and adolescents with TD. METHODS Thirty-three children and adolescents (ages 6-18) with TD were randomly assigned, double-blind, to O3FA or placebo for 20 weeks. O3FA consisted of combined eicosapentaenoic acid and docosahexaenoic acid. Placebo was olive oil. Groups were compared by using (1) intent-to-treat design, with the last-observation-carried-forward controlling for baseline measures and attention-deficit/hyperactivity disorder via (a) logistic regression, comparing percentage of responders on the primary Yale Global Tic Severity Scale (YGTSS)-Tic and secondary (YGTSS-Global and YGTSS-Impairment) outcome measures and (b) analysis of covariance; and (2) longitudinal mixed-effects models. RESULTS At end point, subjects treated with O3FA did not have significantly higher response rates or lower mean scores on the YGTSS-Tic (53% vs 38%; 15.6 ± 1.6 vs 17.1 ± 1.6, P > .1). However, significantly more subjects on O3FA were considered responders on the YGTSS-Global measure (53% vs 31%, P = .05) and YGTSS-Impairment measure (59% vs 25%, P < .05), and mean YGTSS-Global scores were significantly lower in the O3FA-treated group than in the placebo group (31.7 ± 2.9 vs 40.9 ± 3.0, P = .04). Obsessive-compulsive, anxiety, and depressive symptoms were not significantly affected by O3FA. Longitudinal analysis did not yield group differences on any of the measures. CONCLUSIONS O3FA did not reduce tic scores, but it may be beneficial in reduction of tic-related impairment for some children and adolescents with TD. Limitations include the small sample and the possible therapeutic effects of olive oil.
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Affiliation(s)
- Vilma Gabbay
- NYU Child Study Center, NYU School of Medicine, New York, New York, USA.
| | - James S. Babb
- Department of Radiology, NYU School of Medicine, New York, New York
| | - Rachel G. Klein
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Aviva M. Panzer
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Yisrael Katz
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Carmen M. Alonso
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Eva Petkova
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Jing Wang
- NYU Child Study Center, NYU School of Medicine, New York, New York
| | - Barbara J. Coffey
- NYU Child Study Center, NYU School of Medicine, New York, New York;,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York; and
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Proal E, Reiss PT, Klein RG, Mannuzza S, Gotimer K, Ramos-Olazagasti MA, Lerch JP, He Y, Zijdenbos A, Kelly C, Milham MP, Castellanos FX. Brain gray matter deficits at 33-year follow-up in adults with attention-deficit/hyperactivity disorder established in childhood. ACTA ACUST UNITED AC 2011; 68:1122-34. [PMID: 22065528 DOI: 10.1001/archgenpsychiatry.2011.117] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Volumetric studies have reported relatively decreased cortical thickness and gray matter volumes in adults with attention-deficit/hyperactivity disorder (ADHD) whose childhood status was retrospectively recalled. We present, to our knowledge, the first prospective study combining cortical thickness and voxel-based morphometry in adults diagnosed as having ADHD in childhood. OBJECTIVES To test whether adults with combined-type childhood ADHD exhibit cortical thinning and decreased gray matter in regions hypothesized to be related to ADHD and to test whether anatomic differences are associated with a current ADHD diagnosis, including persistent vs remitting ADHD. DESIGN Cross-sectional analysis embedded in a 33-year prospective follow-up at a mean age of 41.2 years. SETTING Research outpatient center. PARTICIPANTS We recruited probands with ADHD from a cohort of 207 white boys aged 6 to 12 years. Male comparison participants (n = 178) were free of ADHD in childhood. We obtained magnetic resonance images in 59 probands and 80 comparison participants (28.5% and 44.9% of the original samples, respectively). MAIN OUTCOME MEASURES Whole-brain voxel-based morphometry and vertexwise cortical thickness analyses. RESULTS The cortex was significantly thinner in ADHD probands than in comparison participants in the dorsal attentional network and limbic areas (false discovery rate < 0.05, corrected). In addition, gray matter was significantly decreased in probands in the right caudate, right thalamus, and bilateral cerebellar hemispheres. Probands with persistent ADHD (n = 17) did not differ significantly from those with remitting ADHD (n = 26) (false discovery rate < 0.05). At uncorrected P < .05, individuals with remitting ADHD had thicker cortex relative to those with persistent ADHD in the medial occipital cortex, insula, parahippocampus, and prefrontal regions. CONCLUSIONS Anatomic gray matter reductions are observable in adults with childhood ADHD, regardless of the current diagnosis. The most affected regions underpin top-down control of attention and regulation of emotion and motivation. Exploratory analyses suggest that diagnostic remission may result from compensatory maturation of prefrontal, cerebellar, and thalamic circuitry.
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Affiliation(s)
- Erika Proal
- Phyllis Green and Randolph Cowen Institute for Pediatric Neuroscience, Child Study Center, New York University Langone School of Medicine, USA
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Klein RG. Temperament: half a century in the Journal. J Am Acad Child Adolesc Psychiatry 2011; 50:1090-2. [PMID: 22023995 DOI: 10.1016/j.jaac.2010.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 07/22/2010] [Accepted: 07/26/2010] [Indexed: 11/28/2022]
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Klein RG. Severe conduct disorder and hyperkinetic conduct disorder in childhood is associated with criminality in later life. Evid Based Ment Health 2011; 14:94. [PMID: 22009233 DOI: 10.1136/ebmh.2011.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gabbay V, Mao X, Klein RG, Ely BA, Babb JS, Panzer AM, Alonso CM, Shungu DC. Anterior cingulate cortex γ-aminobutyric acid in depressed adolescents: relationship to anhedonia. ACTA ACUST UNITED AC 2011; 69:139-49. [PMID: 21969419 DOI: 10.1001/archgenpsychiatry.2011.131] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Anhedonia, a core symptom of major depressive disorder (MDD) and highly variable among adolescents with MDD, may involve alterations in the major inhibitory amino acid neurotransmitter system of γ-aminobutyric acid (GABA). OBJECTIVE To test whether anterior cingulate cortex (ACC) GABA levels, measured by proton magnetic resonance spectroscopy, are decreased in adolescents with MDD. The associations of GABA alterations with the presence and severity of anhedonia were explored. DESIGN Case-control, cross-sectional study using single-voxel proton magnetic resonance spectroscopy at 3 T. SETTING Two clinical research divisions at 2 teaching hospitals. PARTICIPANTS Twenty psychotropic medication-free adolescents with MDD (10 anhedonic, 12 female, aged 12-19 years) with episode duration of 8 weeks or more and 21 control subjects group matched for sex and age. MAIN OUTCOME MEASURES Anterior cingulate cortex GABA levels expressed as ratios relative to unsuppressed voxel tissue water (w) and anhedonia scores expressed as a continuous variable. RESULTS Compared with control subjects, adolescents with MDD had significantly decreased ACC GABA/w (t = 3.2; P < .003). When subjects with MDD were categorized based on the presence of anhedonia, only anhedonic patients had decreased GABA/w levels compared with control subjects (t = 4.08; P < .001; P(Tukey) < .001). Anterior cingulate cortex GABA/w levels were negatively correlated with anhedonia scores for the whole MDD group (r = -0.50; P = .02), as well as for the entire participant sample including the control subjects (r = -0.54; P < .001). Anterior cingulate cortex white matter was also significantly decreased in adolescents with MDD compared with controls (P = .04). CONCLUSIONS These findings suggest that GABA, the major inhibitory neurotransmitter in the brain, may be implicated in adolescent MDD and, more specifically, in those with anhedonia. In addition, use of a continuous rather than categorical scale of anhedonia, as in the present study, may permit greater specificity in evaluating this important clinical feature.
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Affiliation(s)
- Vilma Gabbay
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University Langone Medical Center, New York, NY 10016, USA.
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Warner CM, Colognori D, Kim RE, Reigada LC, Klein RG, Browner-Elhanan KJ, Saborsky A, Petkova E, Reiss P, Chhabra M, McFarlane-Ferreira YB, Phoon CK, Pittman N, Benkov K. Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial. Depress Anxiety 2011; 28:551-9. [PMID: 21681863 PMCID: PMC3128648 DOI: 10.1002/da.20821] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 03/22/2011] [Accepted: 03/29/2011] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. METHODS Children and adolescents (aged 8-16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were randomly assigned to a cognitive-behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting list control. RESULTS TAPS was found to be an acceptable treatment for this population and was superior to the waiting list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self- and parent ratings indicated reductions in children's somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains 3 months following treatment. CONCLUSIONS The study supports the feasibility and preliminary efficacy of a cognitive-behavioral intervention targeting co-occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children's dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments.
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Affiliation(s)
- Carrie Masia Warner
- Department of Child and Adolescent Psychiatry, NYU Child Study Center, New York, New York 10016, USA.
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Bruzzese JM, Unikel LH, Shrout PE, Klein RG. Youth and Parent Versions of the Asthma-Related Anxiety Scale: Development and Initial Testing. Pediatr Allergy Immunol Pulmonol 2011; 24:95-105. [PMID: 22276225 DOI: 10.1089/ped.2011.0076] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 04/01/2011] [Indexed: 11/12/2022]
Abstract
Among adults, anxiety related to asthma has been acknowledged to influence asthma self-management. However, it has not been addressed in pediatric samples and there have been no measures developed to assess asthma-related anxiety in youth or parents. The objective of this study was to develop and test the psychometric properties of novel instruments assessing asthma-related anxiety: the Youth Asthma-Related Anxiety Scale (YAAS) and Parent Asthma-Related Anxiety Scale (PAAS). Scale items were analyzed for content validity. We determined the factor structure using exploratory factor analysis and tested the scales' psychometric properties with 285 Hispanic and African American early adolescents with uncontrolled asthma (mean age=12.8) and their parents (n=230) who participated in a larger randomized control trial testing the efficacy of an asthma intervention; control group families (134 youth and 103 parents) provided follow-up data to assess temporal stability. Both the YAAS and PAAS contained 2 factors with Cronbach alpha coefficients ranging from 0.75 to 0.90. The 2 factors, anxiety about asthma severity and about disease-related restrictions, were highly correlated within each measure. The measures displayed content and construct validity and demonstrated moderate temporal stability over 2-3 months (range: 0.36-0.42). The YAAS and PAAS have adequate psychometric properties and can meaningfully contribute to the assessment of asthma-related anxiety in adolescents and their parents, filling a clinical need in this population.
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Mannuzza S, Castellanos FX, Roizen ER, Hutchison JA, Lashua EC, Klein RG. Impact of the impairment criterion in the diagnosis of adult ADHD: 33-year follow-up study of boys with ADHD. J Atten Disord 2011; 15:122-9. [PMID: 20378923 PMCID: PMC3033469 DOI: 10.1177/1087054709359907] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To investigate the relationship between ADHD symptoms and impairment among adults diagnosed as having ADHD in childhood (ages 6-12). METHOD Clinicians blindly interviewed 121 White males; the mean age was 41 years across the sample. DSM-IV adult ADHD behaviors were systematically rated, and impairment resulting from symptoms was scored on a 5-point Likert-type scale. RESULTS Correlations between degree of impairment and number of behaviors were high (r's = .83 to .85, p < .001). The impairment criterion had no effect on classifying any participants as having, or not having, adult ADHD. All participants who reported experiencing 5 or more inattention or hyperactive-impulsive behaviors as "often" or "very often" in adulthood were significantly impaired by their symptoms. CONCLUSIONS Contrary to results reported in children, there was a strong relationship between number of ADHD symptoms and degree of impairment. However, for several reasons (discussed in the article), it should not be concluded that the impairment criterion is superfluous.
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Affiliation(s)
- Salvatore Mannuzza
- New York University Child Study Center, 215 Lexington Avenue, Floor 13, New York, NY 10016, USA.
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Gabbay V, Klein RG, Katz Y, Mendoza S, Guttman LE, Alonso CM, Babb JS, Hirsch GS, Liebes L. The possible role of the kynurenine pathway in adolescent depression with melancholic features. J Child Psychol Psychiatry 2010; 51:935-43. [PMID: 20406333 PMCID: PMC3711227 DOI: 10.1111/j.1469-7610.2010.02245.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although adolescent major depressive disorder (MDD) is acknowledged to be a heterogeneous disorder, no studies have reported on biological correlates of its clinical subgroups. This study addresses this issue by examining whether adolescent MDD with and without melancholic features (M-MDD and NonM-MDD) have distinct biological features in the kynurenine pathway (KP). The KP is initiated by pro-inflammatory cytokines via induction of the enzyme indoleamine 2,3-dioxygenase (IDO), which degrades tryptophan (TRP) into kynurenine (KYN). KYN is further metabolized into neurotoxins linked to neuronal dysfunction in MDD. Hypotheses were that, compared to healthy controls and to NonM-MDD adolescents, adolescents with M-MDD would exhibit: (i) increased activation of the KP [i.e., increased KYN and KYN/TRP (reflecting IDO activity)]; (ii) greater neurotoxic loads [i.e., increased 3-hydroxyanthranilic acid (3-HAA, neurotoxin) and 3-HAA/KYN (reflecting production of neurotoxins)]; and (iii) decreased TRP. We also examined relationships between severity of MDD and KP metabolites. METHODS Subjects were 20 adolescents with M-MDD, 30 adolescents with NonM-MDD, and 22 healthy adolescents. MDD episode duration had to be >or= 6 weeks and Children's Depression Rating Scale-Revised (CDRS-R) scores were >or= 36. Blood samples were collected at AM after an overnight fast and analyzed using high-performance liquid chromatography. Group contrasts relied on analysis of covariance based on ranks, adjusted for age, gender, and CDRS-R scores. Analyses were repeated excluding medicated patients. Fisher's protected least significant difference was used for multiple comparisons. RESULTS As hypothesized, KYN/TRP ratios were elevated and TRP concentrations were reduced in adolescents with M-MDD compared to NonM-MDD adolescents (p = .001 and .006, respectively) and to healthy controls (p = .008 and .022, respectively). These findings remained significant when medicated patients were excluded from the analyses. Significant correlations were obtained exclusively in the M-MDD group between KYN and 3-HAA/KYN and CDRS-R. CONCLUSIONS Findings support the notion that adolescent M-MDD may represent a biologically distinct clinical syndrome.
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Affiliation(s)
- Vilma Gabbay
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY 10016, USA.
| | - Rachel G. Klein
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Yisrael Katz
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Sandra Mendoza
- Cancer Institute, New York University School of Medicine, NY, USA
| | - Leah E. Guttman
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Carmen M. Alonso
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - James S. Babb
- Radiology, Research, New York University School of Medicine, NY, USA
| | - Glenn S. Hirsch
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, NY, USA
| | - Leonard Liebes
- Cancer Institute, New York University School of Medicine, NY, USA
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Roberson-Nay R, Klein DF, Klein RG, Mannuzza S, Moulton JL, Guardino M, Pine DS. Carbon dioxide hypersensitivity in separation-anxious offspring of parents with panic disorder. Biol Psychiatry 2010; 67:1171-7. [PMID: 20172505 PMCID: PMC3617557 DOI: 10.1016/j.biopsych.2009.12.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 11/26/2009] [Accepted: 12/11/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Similar patterns of vulnerability to carbon dioxide (CO(2)) inhalation have been reported in adults with panic disorder (PD) and children with separation anxiety disorder (SAD), suggesting a link between the adult and child conditions. This study examines the influence of familial risk for PD on CO(2) responses in children with SAD. We hypothesized that offspring with SAD of parents with PD would have distinct CO(2) responses. METHODS Two hundred twelve 9- to 20-year-old offspring of parents with or without PD were exposed to maintained 5% CO(2) inhalation in the participants' homes. Anxiety symptoms, panic attacks, and respiratory physiology (respiratory frequency and tidal volume) were monitored during baseline and 15-min maintained CO(2) breathing. RESULTS As hypothesized, significant offspring SAD x parent PD interactions were obtained for anxiety symptoms, respiratory frequency, tidal volume, and a panting index during CO(2) inhalation. Offspring with both SAD and parental PD exhibited more anxiety symptoms at termination of 5% CO(2) breathing than the other offspring groups and had the most extreme values on measures of respiratory physiology. CONCLUSIONS Youth with both SAD and parental PD have respiratory responses to CO(2) similar to adult PD. They might be a subtype of SAD at particularly high risk for adult PD.
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Affiliation(s)
- Roxann Roberson-Nay
- Virginia Commonwealth University, Department of Psychiatry, Richmond, VA, USA.
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Gabbay V, Liebes L, Katz Y, Liu S, Mendoza S, Babb JS, Klein RG, Gonen O. The kynurenine pathway in adolescent depression: preliminary findings from a proton MR spectroscopy study. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:37-44. [PMID: 19778568 PMCID: PMC2815014 DOI: 10.1016/j.pnpbp.2009.09.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 09/11/2009] [Accepted: 09/15/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cytokine induction of the enzyme indoleamine 2,3-dioxygenase (IDO) has been implicated in the development of major depressive disorder (MDD). IDO metabolizes tryptophan (TRP) into kynurenine (KYN), thereby decreasing TRP availability to the brain. KYN is further metabolized into several neurotoxins. The aims of this pilot were to examine possible relationships between plasma TRP, KYN, and 3-hydroxyanthranilic acid (3-HAA, neurotoxic metabolite) and striatal total choline (tCho, cell membrane turnover biomarker) in adolescents with MDD. We hypothesized that MDD adolescents would exhibit: i) positive correlations between KYN and 3-HAA and striatal tCho and a negative correlation between TRP and striatal tCho; and, ii) the anticipated correlations would be more pronounced in the melancholic subtype group. METHODS Fourteen adolescents with MDD (seven with melancholic features) and six healthy controls were enrolled. Minimums of 6 weeks MDD duration and a severity score of 40 on the Children's Depression Rating Scale-Revised were required. All were scanned at 3T with MRI, multi-voxel 3-dimensional, high, 0.75 cm(3), spatial resolution proton magnetic resonance spectroscopic imaging. Striatal tCho concentrations were assessed using phantom replacement. Spearman correlation coefficients were Bonferroni-corrected. RESULTS Positive correlations were found only in the melancholic group, between KYN and 3-HAA and tCho in the right caudate (r=0.93, p=0.03) and the left putamen (r=0.96, p=.006), respectively. CONCLUSIONS These preliminary findings suggest a possible role of the KYN pathway in adolescent melancholic MDD. Larger studies should follow.
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Affiliation(s)
- Vilma Gabbay
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA.
| | - Leonard Liebes
- Cancer Institute, New York University School of Medicine, Tisch Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Yisrael Katz
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York. 577 First Avenue, New York, NY, 10016, United States
| | - Songtao Liu
- Radiology, Research, New York University School of Medicine, Bellevue C&D Building 122, 462 First Avenue, New York, NY, 10016, United States
| | - Sandra Mendoza
- Cancer Institute, New York University School of Medicine, Tisch Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - James S. Babb
- Radiology, Research, New York University School of Medicine, Bellevue C&D Building 122, 462 First Avenue, New York, NY, 10016, United States
| | - Rachel G. Klein
- NYU Child Study Center, Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York. 577 First Avenue, New York, NY, 10016, United States
| | - Oded Gonen
- Radiology, Research, New York University School of Medicine, Bellevue C&D Building 122, 462 First Avenue, New York, NY, 10016, United States
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Gabbay V, Klein RG, Guttman LE, Babb JS, Alonso CM, Nishawala M, Katz Y, Gaite MR, Gonzalez CJ. A preliminary study of cytokines in suicidal and nonsuicidal adolescents with major depression. J Child Adolesc Psychopharmacol 2009; 19:423-30. [PMID: 19702494 PMCID: PMC2778037 DOI: 10.1089/cap.2008.0140] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Increased systemic cytokine levels, modulators of the immune system, have been repeatedly documented in adult and adolescent major depressive disorder (MDD). This preliminary study extends this work to test the role of cytokines in suicidal symptomatology in adolescent MDD. Hypotheses were that acutely suicidal depressed adolescents would have: (1) increased plasma levels of interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and IL-1beta, and (2) a proinflammatory/antiinflammatory cytokine imbalance (indexed by plasma IFN-gamma/IL-4), compared to nonsuicidal depressed adolescents and healthy controls. METHODS Twelve suicidal adolescents with MDD (7 females [58%]; 5 medication-free/naïve), 18 nonsuicidal adolescents with MDD (12 females [67%]; 8 medication-free/naïve), and 15 controls (8 females [53%]) were enrolled. MDD had to be of at least 6 weeks duration, with a minimum severity score of 40 on the Children's Depression Rating Scale-Revised. Plasma cytokines were examined using enzyme-linked immunosorbent assays. Nonparametric tests were used to compare subject groups. RESULTS Unexpectedly, suicidal adolescents with MDD had significantly decreased plasma TNF-alpha concentrations compared to nonsuicidal adolescents with MDD (1.33 +/- 2.95 pg/mL versus 30.9 +/- 110.9 pg/mL; p = 0.03). IFN-gamma was increased in both suicidal and nonsuicidal adolescents with MDD compared to controls (2.14 +/- 6.22 and 4.20 +/- 14.48 versus 0.37 +/- 0.64; p < 0.02, p = 0.005). Findings remained evident when controlled for age and gender. CONCLUSIONS Our preliminary findings suggest that immune system dysregulation may be associated with suicidal symptomatology in adolescent MDD. These findings should be replicated in larger samples with medication-free adolescents.
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Affiliation(s)
- Vilma Gabbay
- New York University School of Medicine , NYU Child Study Center, New York, New York 10016, USA.
| | - Rachel G. Klein
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Leah E. Guttman
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - James S. Babb
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Carmen M. Alonso
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Melissa Nishawala
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Yisrael Katz
- New York University School of Medicine, NYU Child Study Center, New York, New York
| | - Marta R. Gaite
- New York University School of Medicine, NYU Child Study Center, New York, New York.,Harvard School of Public Health, Boston, Massachusetts
| | - Charles J. Gonzalez
- New York University School of Medicine, NYU Child Study Center, New York, New York.,New York State Department of Health, AIDS Institute, New York, New York
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Gabbay V, Klein RG, Alonso CM, Babb JS, Nishawala M, De Jesus G, Hirsch GS, Hottinger-Blanc PM, Gonzalez CJ. Immune system dysregulation in adolescent major depressive disorder. J Affect Disord 2009; 115:177-82. [PMID: 18790541 PMCID: PMC2770721 DOI: 10.1016/j.jad.2008.07.022] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/31/2008] [Accepted: 07/31/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND A large body of evidence suggests that immune system dysregulation is associated with Major Depressive Disorder (MDD) in adults. This study extends this work to adolescent MDD to examine the hypotheses of immune system dysregulation in adolescents with MDD, as manifested by significantly: (i) elevated plasma levels of cytokines (interferon [IFN]-gamma, tumor necrosis factor-alpha, interleukin [IL]-6, IL-1beta, and IL-4); and (ii) Th1/Th2 cytokine imbalance shifted toward Th1 as indexed by increased IFN-gamma/IL-4. METHOD Thirty adolescents with MDD (19 females; 13 medication-free/naïve; ages 12-19) of at least 6 weeks duration and a minimum severity score of 40 on the Children's Depression Rating Scale-Revised, and 15 healthy comparisons (8 females), group-matched for age, were enrolled. Plasma cytokines were examined using enzyme-linked immunosorbent assay. Mann-Whitney test was used to compare subjects with MDD and controls. RESULTS Adolescents with MDD had significantly elevated plasma IFN-gamma levels (3.38+/-11.8 pg/ml versus 0.37+/-0.64 pg/ml; p<0.003), and IFN-gamma/IL-4 ratio (16.6+/-56.5 versus 1.76+/-2.28; p=0.007). A trend for IL-6 to be elevated in the MDD group was also observed (1.52+/-2.88 pg/ml versus 0.49+/-0.90 pg/ml; p=0.09). Importantly, findings remained evident when medicated subjects were excluded. CONCLUSIONS Findings suggest that immune system dysregulation may be associated with adolescent MDD, with an imbalance of Th1/Th2 shifted toward Th1, as documented in adult MDD. Larger studies with medication-free adolescents should follow.
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Affiliation(s)
- Vilma Gabbay
- New York University School of Medicine, NYU Child Study Center, NY 10016, United States.
| | - Rachel G. Klein
- New York University School of Medicine, NYU Child Study Center, United States
| | - Carmen M. Alonso
- New York University School of Medicine, NYU Child Study Center, United States
| | - James S. Babb
- New York University School of Medicine, Department of Radiology, Research, United States
| | - Melissa Nishawala
- New York University School of Medicine, NYU Child Study Center, United States
| | - Georgette De Jesus
- New York University School of Medicine, NYU Child Study Center, United States
| | - Glenn S. Hirsch
- New York University School of Medicine, NYU Child Study Center, United States
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Abstract
Because of their high prevalence and their negative long-term consequences, child anxiety disorders have become an important focus of interest. Whether pathological anxiety and normal fear are similar processes continues to be controversial. Comparative studies of child anxiety disorders are scarce, but there is some support for the current classification of anxiety disorders in children and adolescents, except for generalized anxiety disorder. The greatly differing rates of anxiety disorders in child population studies, and of specific disorders in clinical samples, inconsistent findings regarding course, and disparate placebo response rates all suggest a need for more precise, validated, criteria for symptoms, distress, and impairment. Several treatments have documented efficacy, and promising prevention efforts are encouraging.
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Affiliation(s)
- Rachel G Klein
- New York University Child Study Center, 215 Lexington Avenue, New York, NY 10016, USA.
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Mannuzza S, Klein RG, Moulton JL. Lifetime criminality among boys with attention deficit hyperactivity disorder: a prospective follow-up study into adulthood using official arrest records. Psychiatry Res 2008; 160:237-46. [PMID: 18707766 PMCID: PMC2581455 DOI: 10.1016/j.psychres.2007.11.003] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 07/03/2007] [Accepted: 11/02/2007] [Indexed: 11/20/2022]
Abstract
This study investigates the relationship between childhood attention deficit hyperactivity disorder (ADHD) and later criminality. White boys (n=207, ages 6-12) with ADHD, free of conduct disorder, were assessed at ages 18 and 25 by clinicians who were blind to childhood status. A non-ADHD group served as comparisons. Lifetime arrest records were obtained when subjects were 38 years old for subjects who resided in New York State throughout the follow-up interval (93 probands, 93 comparisons). Significantly more ADHD probands than comparisons had been arrested (47% vs. 24%), convicted (42% vs. 14%), and incarcerated (15% vs. 1%). Rates of felonies and aggressive offenses also were significantly higher among probands. Importantly, the development of an antisocial or substance use disorder in adolescence completely explained the increased risk for subsequent criminality. Results suggest that even in the absence of comorbid conduct disorder in childhood, ADHD increases the risk for developing antisocial and substance use disorders in adolescence, which, in turn, increases the risk for criminal behavior in adolescence and adulthood.
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Affiliation(s)
- Salvatore Mannuzza
- New York University Child Study Center, Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York, NY 10016, USA.
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Biel MG, Klein RG, Mannuzza S, Roizen ER, Truong NL, Roberson-Nay R, Pine DS. Does major depressive disorder in parents predict specific fears and phobias in offspring? Depress Anxiety 2008; 25:379-82. [PMID: 17935207 DOI: 10.1002/da.20383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Evidence suggests a relationship between parental depression and phobias in offspring as well as links between childhood fears and risk for major depression. This study examines the relationship between major depressive disorder (MDD) and anxiety disorders in parents and specific fears and phobias in offspring. Three hundred and eighteen children of parents with lifetime MDD, anxiety disorder, MDD+anxiety disorder, or neither were psychiatrically assessed via parent interview. Rates of specific phobias in offspring did not differ significantly across parental groups. Specific fears were significantly elevated in offspring of parents with MDD+anxiety disorder relative to the other groups (MDD, anxiety disorder, and controls, which did not differ). We failed to find increased phobias in offspring of parents with MDD without anxiety disorder. Elevated rates of specific fears in offspring of parents with MDD+anxiety disorder may be a function of more severe parental psychopathology, increased genetic loading, or unmeasured environmental influences.
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Affiliation(s)
- Matthew G Biel
- Department of Child and Adolescent Psychiatry, NYU Child Study Center, NYU School of Medicine, New York University, New York, USA.
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Mannuzza S, Klein RG, Truong NL, Moulton JL, Roizen ER, Howell KH, Castellanos FX. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: prospective follow-up into adulthood. Am J Psychiatry 2008; 165:604-9. [PMID: 18381904 PMCID: PMC2967384 DOI: 10.1176/appi.ajp.2008.07091465] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Animal studies have shown that age at stimulant exposure is positively related to later drug sensitivity. The purpose of this study was to examine whether age at initiation of stimulant treatment in children with attention deficit hyperactivity disorder (ADHD) is related to the subsequent development of substance use disorders. METHOD The authors conducted a prospective longitudinal study of 176 methylphenidate-treated Caucasian male children (ages 6 to 12) with ADHD but without conduct disorder. The participants were followed up at late adolescence (mean age=18.4 years; retention rate=94%) and adulthood (mean age=25.3; retention rate=85%). One hundred seventy-eight comparison subjects also were included. All subjects were diagnosed by blinded clinicians. The Cox proportional hazards model included the following childhood predictor variables: age at initiation of methylphenidate treatment, total cumulative dose of methylphenidate, treatment duration, IQ, severity of hyperactivity, socioeconomic status, and lifetime parental psychopathology. Separate models tested for the following four lifetime outcomes: any substance use disorder, alcohol use disorder, non-alcohol substance use disorder, and stimulant use disorder. Other outcomes included antisocial personality, mood, and anxiety disorders. RESULTS There was a significant positive relationship between age at treatment initiation and non-alcohol substance use disorder. None of the predictor variables accounted for this association. Post hoc analyses showed that the development of antisocial personality disorder explained the relationship between age at first methylphenidate treatment and later substance use disorder. Even when controlling for substance use disorder, age at stimulant treatment initiation was significantly and positively related to the later development of antisocial personality disorder. Age at first methylphenidate treatment was unrelated to mood and anxiety disorders. CONCLUSIONS Early age at initiation of methylphenidate treatment in children with ADHD does not increase the risk for negative outcomes and may have beneficial long-term effects.
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Affiliation(s)
- Salvatore Mannuzza
- New York University Child Study Center, New York University Department of Child and Adolescent Psychiatry, New York 10016, USA.
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Brotman LM, Gouley KK, Huang KY, Rosenfelt A, O'Neal C, Klein RG, Shrout P. Preventive Intervention for Preschoolers at High Risk for Antisocial Behavior: Long-Term Effects on Child Physical Aggression and Parenting Practices. Journal of Clinical Child & Adolescent Psychology 2008; 37:386-96. [DOI: 10.1080/15374410801955813] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Monk CS, Klein RG, Telzer EH, Schroth EA, Mannuzza S, Moulton JL, Guardino M, Masten CL, McClure-Tone EB, Fromm S, Blair RJ, Pine DS, Ernst M. Amygdala and nucleus accumbens activation to emotional facial expressions in children and adolescents at risk for major depression. Am J Psychiatry 2008; 165:90-8. [PMID: 17986682 DOI: 10.1176/appi.ajp.2007.06111917] [Citation(s) in RCA: 260] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Offspring of parents with major depressive disorder face a threefold higher risk for major depression than offspring without such family histories. Although major depression is a significant cause of morbidity and mortality, neural correlates of risk for major depression remain poorly understood. This study compares amygdala and nucleus accumbens activation in children and adolescents at high and low risk for major depression under varying attentional and emotional conditions. METHOD Thirty-nine juveniles, 17 offspring of parents with major depression (high-risk group) and 22 offspring of parents without histories of major depression, anxiety, or psychotic disorders (low-risk group) completed a functional magnetic resonance imaging study. During imaging, subjects viewed faces that varied in intensity of emotional expressions across blocks of trials while attention was unconstrained (passive viewing) and constrained (rate nose width on face, rate subjective fear while viewing face). RESULTS When attention was unconstrained, high-risk subjects showed greater amygdala and nucleus accumbens activation to fearful faces and lower nucleus accumbens activation to happy faces (small volume corrected for the amygdala and nucleus accumbens). No group differences emerged in amygdala or nucleus accumbens activation during constrained attention. Exploratory analysis showed that constraining attention was associated with greater medial prefrontal cortex activation in the high-risk than in the low-risk group. CONCLUSIONS Amygdala and nucleus accumbens responses to affective stimuli may reflect vulnerability for major depression. Constraining attention may normalize emotion-related neural function possibly by engagement of the medial prefrontal cortex; face-viewing with unconstrained attention may engage aberrant processes associated with risk for major depression.
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Affiliation(s)
- Christopher S Monk
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA.
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Gabbay V, Hess DA, Liu S, Babb JS, Klein RG, Gonen O. Lateralized caudate metabolic abnormalities in adolescent major depressive disorder: a proton MR spectroscopy study. Am J Psychiatry 2007; 164:1881-9. [PMID: 18056244 PMCID: PMC2774821 DOI: 10.1176/appi.ajp.2007.06122032] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Proton magnetic resonance spectroscopy ((1)H-MRS) has been increasingly used to examine striatal neurochemistry in adult major depressive disorder. This study extends the use of this modality to pediatric major depression to test the hypothesis that adolescents with major depression have elevated concentrations of striatal choline and creatine and lower concentrations of N-acetylaspartate. METHOD Fourteen adolescents (ages 12-19 years, eight female) who had major depressive disorder for at least 8 weeks and a severity score of 40 or higher on the Children's Depression Rating Scale-Revised and 10 healthy comparison adolescents (six female) group-matched for gender, age, and handedness were enrolled. All underwent three-dimensional 3-T (1)H-MRS at high spatial resolution (0.75-cm(3) voxels). Relative levels of choline, creatine, and N-acetylaspartate in the left and right caudate, putamen, and thalamus were scaled into concentrations using phantom replacement, and levels were compared for the two cohorts. RESULTS Relative to comparison subjects, adolescents with major depressive disorder had significantly elevated concentrations of choline (2.11 mM versus 1.56 mM) and creatine (6.65 mM versus 5.26 mM) in the left caudate. No other neurochemical differences were observed between the groups. CONCLUSIONS These findings most likely reflect accelerated membrane turnover and impaired metabolism in the left caudate. The results are consistent with prior imaging reports of focal and lateralized abnormalities in the caudate in adult major depression.
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Affiliation(s)
- Vilma Gabbay
- NYU Child Study Center, Department of Psychiatry, New York University School of Medicine, 557 First Avenue, New York, NY 10016, USA.
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Abstract
BACKGROUND Anxiety disorders are often undetected and untreated in adolescents. This study evaluates the relative efficacy of a school-based, cognitive-behavioral intervention compared to an educational-supportive treatment for adolescents with social anxiety disorder. METHODS Thirty-six students (30 females), ages 14 to 16, were randomized to a 12-week specific intervention, Skills for Social and Academic Success (SASS), or a credible attention control matched for structure and contact, conducted in school. RESULTS Independent evaluations and adolescent self-reports indicated significant reduction in social anxiety for SASS compared to the control group. Parent reports of their children's social anxiety did not discriminate between treatments. In the specific intervention, 59%, compared to 0% in the control, no longer met criteria for social anxiety disorder following treatment. Superiority of the SASS intervention was maintained 6 months after treatment cessation. CONCLUSIONS The study provides evidence that intervention for social anxiety disorder that emphasizes exposure and social skills is efficacious. Results indicate that clinical improvement is sustained for at least 6 months, and that, overall, adolescents with social anxiety disorder do not respond to non-specific treatment. This investigation has public health implications by demonstrating that effective interventions can be transported to nonclinical settings.
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Vasa RA, Roberson-Nay R, Klein RG, Mannuzza S, Moulton JL, Guardino M, Merikangas A, Carlino AR, Pine DS. Memory deficits in children with and at risk for anxiety disorders. Depress Anxiety 2007; 24:85-94. [PMID: 16850413 DOI: 10.1002/da.20193] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are limited data on the neurocognitive correlates of childhood anxiety disorders. The objective of this study was to examine whether visual and verbal memory deficits of nonemotional stimuli are (1) a shared feature of three common childhood anxiety disorders (social phobia, separation anxiety disorder, and generalized anxiety disorder) or whether these deficits are restricted to specific anxiety disorders, and (2) present in offspring who possess at least one of the following established risk factors for anxiety disorders, parental history of panic disorder (PD), or major depressive disorder (MDD). One hundred and sixty offspring, ages 9-20 years, were recruited from parents with lifetime diagnoses of PD, MDD, PD plus MDD, or neither illness. Different clinicians blindly administered semistructured diagnostic interviews to offspring and parents. Verbal and visual memory subtests of the Wide Range Assessment of Memory and Learning were administered to offspring. The results showed that offspring with ongoing social phobia demonstrated reduced visual but not verbal memory scores compared to those without social phobia when controlling for offspring IQ, separation anxiety disorder, and generalized anxiety disorder. No other offspring anxiety disorder predicted memory performance. Neither parental PD nor parental MDD was associated with offspring memory performance. These findings are relevant to understanding the phenomenology of childhood anxiety disorders and may provide insights into the neural circuits underlying these disorders.
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Affiliation(s)
- Roma A Vasa
- Johns Hopkins University School of Medicine, Baltimore, Maryland 21211, USA.
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Krain AL, Hefton S, Pine DS, Ernst M, Castellanos FX, Klein RG, Milham MP. An fMRI examination of developmental differences in the neural correlates of uncertainty and decision-making. J Child Psychol Psychiatry 2006; 47:1023-30. [PMID: 17073981 DOI: 10.1111/j.1469-7610.2006.01677.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maturation of prefrontal circuits during adolescence contributes to the development of cognitive processes such as decision-making. Recent theories suggest that these neural changes also play a role in the shift from generalized anxiety disorder (GAD) to depression that often occurs during this developmental period. Cognitive models of the development of GAD highlight the role of intolerance of uncertainty (IU), which can be characterized behaviorally by impairments in decision-making. The present study examines potential developmental differences in frontal regions associated with uncertain decision-making, and tests the impact of IU on these circuits. METHODS Twelve healthy adults (ages 19-36) and 12 healthy adolescents (ages 13-17) completed a decision-making task with conditions of varied uncertainty while fMRI scans were acquired. They also completed measures of worry and IU, and a questionnaire about their levels of anxiety and certainty during the task. RESULTS Combined group analyses demonstrated significant linear effects of uncertainty on activity within anterior cingulate cortex (ACC). Region of interest (ROI)-based analysis found a significant interaction of group and IU ratings in ACC. Increased IU was associated with robust linear increases in ACC activity only in adolescents. An ROI analysis of feedback-related processing found that adolescents demonstrated greater activation during incorrect trials relative to correct trials, while the adults showed no difference in neural activity associated with incorrect and correct feedback. CONCLUSIONS This decision-making task was shown to be effective at eliciting uncertainty-related ACC activity in adults and adolescents. Further, IU impacts ACC activity in adolescents during uncertain decision-making, providing preliminary support for a developmental model of GAD.
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Affiliation(s)
- Amy L Krain
- NYU Child Study Center, NYU School of Medicine, New York, NY 10016, USA.
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Terleph TA, Klein RG, Roberson-Nay R, Mannuzza S, Moulton JL, Woldehawariat G, Guardino M, Pine DS. Stress responsivity and HPA axis activity in juveniles: results from a home-based CO2 inhalation study. Am J Psychiatry 2006; 163:738-40. [PMID: 16585453 DOI: 10.1176/ajp.2006.163.4.738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A previous laboratory-based study found elevated cortisol levels in anxious children susceptible to CO(2)-induced panic, but the effects of parent diagnosis were not considered. The current home-based study tested the hypothesis that parental panic disorder and offspring response to CO(2) are associated with elevated cortisol levels in juvenile offspring. METHOD A total of 131 offspring (ages 9-19) of parents with panic disorder, major depression, and no mental disorder underwent CO(2) inhalation. Parent and child diagnoses were assessed. Salivary cortisol was assayed before and after CO(2) inhalation. RESULTS Neither parents with panic disorder, parents with major depression, or offspring anxiety predicted offspring cortisol levels. Independent of parent and child diagnoses, anxiety response to CO(2) predicted elevated cortisol levels in offspring. CONCLUSIONS As in adults, anxiety response to CO(2) in juveniles is associated with elevated cortisol levels, but elevated cortisol levels are not related to parent or child diagnoses.
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Affiliation(s)
- Thomas A Terleph
- NIMH, NIH, Bldg. 15-K, Rm. 110, MSC-2670, Bethesda, MD 20817-2670, USA.
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Brotman LM, Gouley KK, Chesir-Teran D, Dennis T, Klein RG, Shrout P. Prevention for preschoolers at high risk for conduct problems: immediate outcomes on parenting practices and child social competence. J Clin Child Adolesc Psychol 2006; 34:724-34. [PMID: 16232069 DOI: 10.1207/s15374424jccp3404_14] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study investigated the immediate impact of an 8-month center- and home-based prevention program for preschoolers at high risk for conduct problems. We report immediate program effects on observed and self-rated parenting practices and observed child behavior with peers. Ninety-nine preschool-age siblings of adjudicated youths and their families were randomly assigned to an enhanced version of the Incredible Years Series (Webster-Stratton, 1989; n = 50) or to a no-intervention control condition (n = 49). In an intent-to-treat design, the intervention yielded significant effects on negative parenting, parental stimulation for learning, and child social competence with peers. Improvements in negative parenting, stimulation for learning, and child social competence support the potential of the intervention to prevent later conduct problems in high-risk children.
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Masia-Warner C, Klein RG, Dent HC, Fisher PH, Alvir J, Albano AM, Guardino M. School-Based Intervention for Adolescents with Social Anxiety Disorder: Results of a Controlled Study. J Abnorm Child Psychol 2005; 33:707-22. [PMID: 16328746 DOI: 10.1007/s10802-005-7649-z] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2003] [Revised: 07/19/2004] [Accepted: 08/15/2004] [Indexed: 11/26/2022]
Abstract
Social anxiety disorder, whose onset peaks in adolescence, is associated with significant impairment. Despite the availability of effective treatments, few affected youth receive services. Transporting interventions into schools may circumvent barriers to treatment. The efficacy of a school-based intervention for social anxiety disorder was examined in a randomized wait-list control trial of 35 adolescents (26 females). Independent evaluators, blind to treatment condition, evaluated participants at preintervention, postintervention, and 9 months later. Adolescents in the intervention group demonstrated significantly greater reductions than controls in social anxiety and avoidance, as well as significantly improved overall functioning. In addition, 67% of treated subjects, compared to 6% of wait-list participants, no longer met criteria for social phobia following treatment. Findings support the possible efficacy of school-based intervention for facilitating access to treatment for socially anxious adolescents.
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Affiliation(s)
- Carrie Masia-Warner
- New York University Child Study Center, NYU School of Medicine, 215 Lexington Avenue 13th Floor, New York, NY 10016, USA.
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Abstract
OBJECTIVE Panic disorder (PD) has been linked to perturbed processing of threats. This study tested the hypotheses that offspring of parents with PD and offspring with anxiety disorders display relatively greater sensitivity and attention allocation to fear provocation. METHOD Offspring of adults with PD, major depressive disorder (MDD), or no disorder (ages 9-19) viewed computer-presented face photographs depicting angry, fearful, and happy faces. Offspring rated (1) subjectively experienced fear level, (2) how hostile the face appeared, and (3) nose width. Attention allocation was indexed by latency to perform ratings. RESULTS Compared with offspring of parents without PD (n = 79), offspring of PD parents (n = 65) reported significantly more fear and had slower reaction times to rate fear, controlling for ongoing anxiety disorder in the offspring. Offspring with an anxiety disorder (n = 65) reported significantly more fear than offspring without an anxiety disorder but not when parental PD was controlled. Social phobia but no other anxiety disorder in offspring was associated with slower reaction times for fear ratings (but not greater fear ratings). Parental PD and offspring social phobia independently predicted slower reaction time. CONCLUSIONS Results support an association between parental PD and offspring responses to fear provocation. Social phobia in children may have a specific relationship to allocation of attention to subjective anxiety during face viewing.
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Affiliation(s)
- Daniel S Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health Intramural Research Program, Bethesda, MD 20817-2670, USA.
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Pine DS, Klein RG, Roberson-Nay R, Mannuzza S, Moulton JL, Woldehawariat G, Guardino M. Response to 5% carbon dioxide in children and adolescents: relationship to panic disorder in parents and anxiety disorders in subjects. ACTA ACUST UNITED AC 2005; 62:73-80. [PMID: 15630075 DOI: 10.1001/archpsyc.62.1.73] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Carbon dioxide (CO(2)) sensitivity is postulated to be a familial risk marker of panic disorder (PD). Exaggerated responses to CO(2) inhalation have been reported in adults with PD and their unaffected adult relatives, as well as in clinic-referred children with anxiety disorders. OBJECTIVE To test in a family-based design whether CO(2) hypersensitivity is a familial risk marker for PD and associated with current anxiety disorders in children and adolescents. SETTING AND PARTICIPANTS One hundred forty-two offspring (aged 9-19 years) of parents with PD, major depressive disorder, or no disorder. Forty-five (32%) had a current anxiety disorder, excluding specific phobia. DESIGN AND MAIN OUTCOME MEASURES Parents and offspring received diagnostic assessments. Offspring underwent 5% CO(2) inhalation at home. Panic symptoms and panic attacks were rated with the Acute Panic Inventory at baseline, while anticipating CO(2) delivery ("threat"), and during CO(2) inhalation. Respiratory rate and volume were measured with spirometry. RESULTS No group differences were found in Acute Panic Inventory ratings at baseline or in respiratory measures during threat. Risk for PD was not associated with CO(2) sensitivity (panic symptoms and respiratory physiologic response). During CO(2) inhalation, offspring with anxiety disorders, relative to offspring without anxiety disorders, experienced significantly more panic symptoms and panic attacks, as well as elevated respiratory rates. During threat, panic symptoms were significantly and independently associated with both parental PD and offspring anxiety disorders. CONCLUSIONS No support was obtained for CO(2) hypersensitivity as a familial risk marker for PD in children and adolescents. Links between childhood anxiety disorders and CO(2) sensitivity were replicated. Familial risk for PD in children and adolescents may be associated with vulnerability to anticipatory anxiety.
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Affiliation(s)
- Daniel S Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health Intramural Research Program, Bethesda, MD 20817, USA.
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Fisher PH, Masia-Warner C, Klein RG. Skills for social and academic success: a school-based intervention for social anxiety disorder in adolescents. Clin Child Fam Psychol Rev 2005; 7:241-9. [PMID: 15648278 DOI: 10.1007/s10567-004-6088-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper describes Skills for Academic and Social Success (SASS), a cognitive-behavioral, school-based intervention for adolescents with social anxiety disorder. Clinic-based treatment studies for socially anxious youth are reviewed, and a strong rationale for transporting empirically-based interventions into schools, such as SASS, is provided. The SASS program consists of 12, 40-min group sessions that emphasize social skills and in-vivo exposure. In addition to group sessions, students are seen individually at least twice and participate in 4 weekend social events with prosocial peers from their high schools. Meetings with teachers provide information about social anxiety and facilitate classroom exposures for socially anxious participants. Parents attend 2 psychoeducational meetings about social anxiety, its treatment, and approaches for managing their child's anxiety. Initial findings regarding the program's effectiveness are presented. We conclude by discussing the challenges involved in implementing treatment protocols in schools and provide suggestions to address these issues.
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Affiliation(s)
- Paige H Fisher
- New York University School of Medicine, NYU Child Study Center, New York, USA
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Mannuzza S, Klein RG, Abikoff H, Moulton JL. Significance of childhood conduct problems to later development of conduct disorder among children with ADHD: a prospective follow-up study. J Abnorm Child Psychol 2004; 32:565-73. [PMID: 15500034 DOI: 10.1023/b:jacp.0000037784.80885.1a] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study investigates whether low to moderate levels of childhood oppositional defiant disorder (ODD) and conduct disorder (CD) behaviors contribute to the development of clinically diagnosed CD in adolescence, in children with attention deficit hyperactivity disorder (ADHD). Participants were 207 White boys (ages 6-12) with ADHD free of conduct disorder diagnoses. Parent and teacher ratings were obtained. Participants were assessed at mean age 18 by clinicians blind to childhood status. A non-ADHD group (recruited in adolescence) was also studied. ODD behavior ratings did not predict CD in adolescence, whereas CD behavior ratings did. No single ODD or CD behavior predicted adolescent outcome. ADHD probands with very low ratings (Not at all, Just a little) by parents and teachers on all CD behaviors were still at significantly increased risk for CD in adolescence, compared to non-ADHD controls. The same relationships were found between childhood ODD and CD behaviors, and antisocial personality disorder in adulthood (mean age, 25). We conclude that childhood ADHD is a developmental precursor of later antisocial disorder, even in the absence of comorbid ODD or CD in childhood. However, low levels of CD-type problems are not innocuous, because they predict later CD among children with ADHD without comorbid CD.
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Affiliation(s)
- Salvatore Mannuzza
- New York University Child Study Center, NYU School of Medicine, New York, New York 10016, USA.
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Pine DS, Lissek S, Klein RG, Mannuzza S, Moulton JL, Guardino M, Woldehawariat G. Face-memory and emotion: associations with major depression in children and adolescents. J Child Psychol Psychiatry 2004; 45:1199-208. [PMID: 15335340 DOI: 10.1111/j.1469-7610.2004.00311.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Studies in adults with major depressive disorder (MDD) document abnormalities in both memory and face-emotion processing. The current study used a novel face-memory task to test the hypothesis that adolescent MDD is associated with a deficit in memory for face-emotions. The study also examines the relationship between parental MDD and memory performance in offspring. METHODS Subjects were 152 offspring (ages 9-19) of adults with either MDD, anxiety disorders, both MDD and anxiety, or no disorder. Parents and offspring were assessed for mental disorders. Collection of face-memory data was blind to offspring and parent diagnosis. A computerized task was developed that required rating of facial photographs depicting 'happy,"fearful,' or 'angry' emotions followed by a memory recall test. Recall accuracy was examined as a function of face-emotion type. RESULTS Age and gender independently predicted memory, with better recall in older and female subjects. Controlling for age and gender, offspring with a history of MDD (n = 19) demonstrated significant deficits in memory selectively for fearful faces, but not happy or angry faces. Parental MDD was not associated with face-memory accuracy. DISCUSSION This study found an association between MDD in childhood or adolescence and perturbed encoding of fearful faces. MDD in young individuals may predispose to subtle anomalies in a neural circuit encompassing the amygdala, a brain region implicated in the processing of fearful facial expressions. These findings suggest that brain imaging studies using similar face-emotion paradigms should test whether deficits in processing of fearful faces relate to amygdala dysfunction in children and adolescents with MDD.
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Affiliation(s)
- Daniel S Pine
- Section on Development and Affective Neuroscience, Mood and Anxiety Disorders Program, National Institute of Mental Health Intramural Research Program, Bethesda, Maryland, USA.
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Abikoff H, Hechtman L, Klein RG, Gallagher R, Fleiss K, Etcovitch J, Cousins L, Greenfield B, Martin D, Pollack S. Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. J Am Acad Child Adolesc Psychiatry 2004; 43:820-9. [PMID: 15213583 DOI: 10.1097/01.chi.0000128797.91601.1a] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test that methylphenidate combined with intensive multimodal psychosocial intervention, which includes social skills training, significantly enhances social functioning in children with attention-deficit/hyperactivity disorder (ADHD) compared with methylphenidate alone and methylphenidate plus nonspecific psychosocial treatment (attention control). METHOD One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to short-term methylphenidate were randomized for 2 years to receive (1) methylphenidate alone, (2) methylphenidate plus multimodal psychosocial treatment that included social skills training, or (3) methylphenidate plus attention control treatment. Assessments included parent, child, and teacher ratings of social function and direct school observations in gym. RESULTS No advantage was found on any measure of social functioning for the combination treatment over methylphenidate alone or methylphenidate plus attention control. Significant improvement occurred across all treatments and continued over 2 years. CONCLUSIONS In young children with ADHD, there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior. Significant benefits from methylphenidate were stable over 2 years.
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Affiliation(s)
- Howard Abikoff
- NYU Child Study Center, New York University School of Medicine, New York, NY 10016, USA.
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