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Ishibashi S, Nishiyama T, Makino T, Suzuki F, Shimada S, Tomari S, Imanari E, Higashi T, Fukumoto S, Kurata S, Mizuno Y, Morimoto T, Nakamichi H, Iida T, Ohashi K, Yamada A, Kimura T, Kuru Y, Sumi S, Tanaka Y, Ono K, Ichikawa H, DuPaul GJ, Kosaka H. Psychometrics of rating scales for externalizing disorders in Japanese outpatients: The ADHD-Rating Scale-5 and the Disruptive Behavior Disorders Rating Scale. Int J Methods Psychiatr Res 2024; 33:e2015. [PMID: 38363207 PMCID: PMC10870953 DOI: 10.1002/mpr.2015] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES This study validated the Japanese version of the Attention-Deficit/Hyperactivity Disorder-Rating Scale-5 (ADHD-RS-5) and the Disruptive Behavior Disorders Rating Scale. We extended the ADHD-RS-5 by adding the oppositional defiant disorder and conduct disorder subscales to compare the two rating scales psychometrically. METHODS We examined the internal consistency, test-retest reliability, construct validity and criterion validity of the two rating scales in 135 Japanese outpatients aged 6-18 years. RESULTS The internal consistency and test-retest reliability were good for all the subscales of the two rating scales except for the conduct disorder subscale of the ADHD-RS-5 extended. Good construct validity was revealed by expected correlational patterns between subscales from the two rating scales and the Children Behavior Checklist. The criterion validity was good for all the subscales of the two rating scales rated by parents, while teacher-ratings revealed substantially lower predictive ability for all the subscales. Agreement between parent- and teacher-ratings of the two rating scales was generally moderate and using predictive ratings alone of both ratings showed the best predictive ability among the integration methods examined. CONCLUSION The two rating scales have sound psychometric properties and will aid in screening and severity assessment of externalizing disorders in Japanese clinical settings.
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Spaan P, van den Boogert F, Grootendorst-van Mil NH, Hoogendijk WJG, Roza SJ. Screening for disruptive behavior in adolescents at risk using the strengths and difficulties questionnaire. J Res Adolesc 2023; 33:1085-1097. [PMID: 37194384 DOI: 10.1111/jora.12858] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/05/2022] [Accepted: 04/12/2023] [Indexed: 05/18/2023]
Abstract
Disruptive behavior in adolescents is burdensome and may continue into adulthood if left unidentified. The strengths and difficulties questionnaire (SDQ) can screen for disruptive behavior, but its psychometric properties in high-risk samples and ability to predict delinquency warrant further investigation. In 1022 adolescents, we investigated the predictive validity (on average 1.9 years after screening) of the self-reported SDQ on disruptive behavior disorders and delinquency, measured with multi-informant questionnaires and structured interviews. We compared three scoring methods: total, subscale, and dysregulation profile scoring. In this high-risk sample, SDQ subscale scores predicted disruptive behavior outcomes best. Predictive values for the specific types of delinquency were small. Concluding, the SDQ can be used in high-risk settings for early identification of youth with disruptive behavior.
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Affiliation(s)
- Pascalle Spaan
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank van den Boogert
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nina H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sabine J Roza
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Netherlands Institute for Forensic Psychiatry and Psychology, The Hague, The Netherlands
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Ros-DeMarize R, Klein J, Carpenter LA. Behavioral Parent Training Engagement Among Young Children With Autism Spectrum Disorder. Behav Ther 2023; 54:892-901. [PMID: 37597965 DOI: 10.1016/j.beth.2023.03.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/29/2022] [Accepted: 03/23/2023] [Indexed: 08/21/2023]
Abstract
The purpose of the current study was to examine engagement with Behavioral Parent Training (BPT) for families of children with Autism Spectrum Disorder (ASD) and assess openness to novel delivery formats for BPT (e.g., telehealth, group). Participants were caregivers of 501 children with ASD (ages 2-6) enrolled in the SPARK (Simons Foundation Powering Autism Research for Knowledge) online national registry. The study assessed: (1) rates of child disruptive behavior diagnoses, (2) engagement and satisfaction with BPT, (3) parent and child factors (e.g., diagnostic history), and (4) openness to novel delivery formats. Almost 25% of young children with ASD in this sample had disruptive behavior problems rising to the level of a diagnosis of ADHD or ODD and thus would benefit from BPT. However, only one third of these families had actually been referred to BPT. Families indicated high level of interest in participating in BPT, with a particular interest in Parent Child Interaction Therapy (PCIT) as well as novel delivery formats such as telehealth and group. Specific components of the therapy and delivery formats were indicative of parent satisfaction (e.g. groups, longer treatment sessions, longer treatment length). Specific parent and child characteristics were predictive of openness to novel formats (e.g. parental depression, more severe behavioral challenges, lower verbal skills). Results underscore the need for increased referrals and access to BPT programs the ASD population. Both parent and child characteristics are important for determining appropriate delivery formats.
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Brancati GE, Acierno D, Barbuti M, Elefante C, Gemignani S, Raia A, Perugi G. Revisiting stimulant use for emotional dysregulation in attention-deficit/hyperactivity disorder (ADHD). Expert Rev Neurother 2023; 23:981-994. [PMID: 37747111 DOI: 10.1080/14737175.2023.2263645] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/22/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Emotional dysregulation (ED) symptoms are present in a considerable portion of patients with attention-deficit/hyperactivity disorder (ADHD). In recent years, an increasing number of studies investigated the effects of stimulant medications on ED in patients with ADHD. AREAS COVERED A narrative review of the literature on stimulant treatment for ED is provided, including controlled and observational clinical studies conducted on pediatric and adult samples and neurobiological investigations. Positive effects of stimulants on irritability have been demonstrated in children. Comorbidity with disruptive behavior disorders (DBD) and disruptive mood dysregulation disorder does not prevent stimulant effectiveness. Methylphenidate has also been found to reduce temper problems, affective instability, and emotional over-reactivity in adults with ADHD, although with variable effect sizes. A variety of adverse emotional effects have been reported, especially at high doses and in special populations. However, several possible confounders of treatment-emergent ED have been highlighted. Finally, according to neuroimaging studies, stimulants may mitigate emotional processing anomalies associated with ADHD. EXPERT OPINION The findings are consistent with models including ED within the core features of ADHD. Stimulant treatment should be prioritized over antipsychotics in ADHD-DBD. It remains to be elucidated whether other medications may be more effective in specific populations with ADHD and/or ED.
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Affiliation(s)
- Giulio Emilio Brancati
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Donatella Acierno
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Margherita Barbuti
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Camilla Elefante
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Samuele Gemignani
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Accursio Raia
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giulio Perugi
- Psychiatry Unit 2, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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Brathwaite R, Sensoy Bahar O, Mutumba M, Byansi W, Namatovu P, Namuwonge F, Neilands TB, McKay MM, Hoagwood KE, Ssewamala FM. Short-Term Impact of "Amaka Amasanyufu" Multiple Family Group Intervention on Mental Health Functioning of Children With Disruptive Behavior Disorders in Uganda. J Am Acad Child Adolesc Psychiatry 2023; 62:777-790. [PMID: 36898607 PMCID: PMC10330280 DOI: 10.1016/j.jaac.2022.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/20/2021] [Revised: 12/19/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE We evaluate the mid-intervention (8 weeks) and short-term (16 weeks) impact of a culturally adapted multiple family group (MFG) intervention, "Amaka Amasanyufu," on the mental health of children with disruptive behavior disorders (DBDs) and primary caregivers in Uganda. METHOD We analyzed data from the Strengthening mental health and research training in Sub-Saharan Africa (SMART) Africa-Uganda study. Schools were randomized to the following: a control group; an MFG facilitated by parent peers (MFG-PP); or an MFG facilitated by community health workers (MFG:CHW). All participants were blinded to interventions provided to other participants and study hypotheses. At 8 weeks and 16 weeks, we evaluated differences in depressive symptoms and self-concept among children and in mental health and caregiving-related stress among caregivers. Three-level linear mixed-effects models were fitted. Pairwise comparisons of post-baseline group means were performed using the Sidak adjustment for multiple comparisons and standardized mean differences. Data from 636 children with DBDs and caregivers (controls: n = 243, n = 10 schools; MFG-PP: n = 194, n = 8 schools; MFG-CHW: n = 199, n = 8 schools) were analyzed. RESULTS There were significant group-by-time interactions for all outcomes, and differences were observed mid-intervention, with short-term effects at 16 weeks (end-intervention). MFG-PP and MFG-CHW children had significantly lower depressive symptoms and higher self-concept, whereas caregivers had significantly lower caregiving-related stress and fewer mental health problems, than controls. There was no difference between intervention groups. CONCLUSION Amaka Amasanyufu MFG intervention is effective for reducing depressive symptoms and improving self-concept among children with DBDs while reducing parental stress and mental health problems among caregivers. Given the paucity of culturally adapted mental health interventions, this provides support for adaptation and scale-up in Uganda and other low-resource settings. CLINICAL TRIAL REGISTRATION INFORMATION SMART Africa (Strengthening Mental Health Research and Training); https://clinicaltrials.gov/: NCT03081195.
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Affiliation(s)
| | | | | | | | - Phionah Namatovu
- International Center for Child Health and Development, Masaka, Uganda
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Holz NE, Floris DL, Llera A, Aggensteiner PM, Kia SM, Wolfers T, Baumeister S, Böttinger B, Glennon JC, Hoekstra PJ, Dietrich A, Saam MC, Schulze UME, Lythgoe DJ, Williams SCR, Santosh P, Rosa-Justicia M, Bargallo N, Castro-Fornieles J, Arango C, Penzol MJ, Walitza S, Meyer-Lindenberg A, Zwiers M, Franke B, Buitelaar J, Naaijen J, Brandeis D, Beckmann C, Banaschewski T, Marquand AF. Age-related brain deviations and aggression. Psychol Med 2023; 53:4012-4021. [PMID: 35450543 PMCID: PMC10325848 DOI: 10.1017/s003329172200068x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/29/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Disruptive behavior disorders (DBD) are heterogeneous at the clinical and the biological level. Therefore, the aims were to dissect the heterogeneous neurodevelopmental deviations of the affective brain circuitry and provide an integration of these differences across modalities. METHODS We combined two novel approaches. First, normative modeling to map deviations from the typical age-related pattern at the level of the individual of (i) activity during emotion matching and (ii) of anatomical images derived from DBD cases (n = 77) and controls (n = 52) aged 8-18 years from the EU-funded Aggressotype and MATRICS consortia. Second, linked independent component analysis to integrate subject-specific deviations from both modalities. RESULTS While cases exhibited on average a higher activity than would be expected for their age during face processing in regions such as the amygdala when compared to controls these positive deviations were widespread at the individual level. A multimodal integration of all functional and anatomical deviations explained 23% of the variance in the clinical DBD phenotype. Most notably, the top marker, encompassing the default mode network (DMN) and subcortical regions such as the amygdala and the striatum, was related to aggression across the whole sample. CONCLUSIONS Overall increased age-related deviations in the amygdala in DBD suggest a maturational delay, which has to be further validated in future studies. Further, the integration of individual deviation patterns from multiple imaging modalities allowed to dissect some of the heterogeneity of DBD and identified the DMN, the striatum and the amygdala as neural signatures that were associated with aggression.
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Affiliation(s)
- Nathalie E. Holz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Dorothea L. Floris
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Methods of Plasticity Research, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Alberto Llera
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Pascal M. Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Seyed Mostafa Kia
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Thomas Wolfers
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Boris Böttinger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jeffrey C. Glennon
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melanie C. Saam
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital, University of Ulm, Ulm, Germany
| | - Ulrike M. E. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital, University of Ulm, Ulm, Germany
| | - David J. Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Steve C. R. Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paramala Santosh
- Department of Child Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Trust, London, UK
| | - Mireia Rosa-Justicia
- Clinic Image Diagnostic Center (CDIC), Hospital Clinic of Barcelona; Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Institute Clinic of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Nuria Bargallo
- Clinic Image Diagnostic Center (CDIC), Hospital Clinic of Barcelona; Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain
| | - Josefina Castro-Fornieles
- Child and Adolescent Psychiatry and Psychology Department, Department of Medicine, 2017SGR881, Institute Clinic of Neurosciences, Hospital Clinic of Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Maria J. Penzol
- Child and Adolescent Psychiatry Department, Institute of Psychiatry and Mental health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Marcel Zwiers
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Barbara Franke
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Buitelaar
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Jilly Naaijen
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- Child and Adolescent Psychiatry and Psychology Department, Institute Clinic of Neurosciences, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
- Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Christian Beckmann
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Centre for Functional MRI of the Brain, University of Oxford, Oxford, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Andre F. Marquand
- Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
- Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Rajkumar RP. Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review. Biomedicines 2022; 10:2818. [PMID: 36359338 PMCID: PMC9687560 DOI: 10.3390/biomedicines10112818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/21/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 10/20/2023] Open
Abstract
Disruptive behaviour disorders (DBDs) in childhood include conduct disorder (CD) and oppositional defiant disorder (ODD). Though psychological therapies are considered to be the first-line treatment for DBDs, many patients require adjunctive pharmacotherapy for the control of specific symptoms, such as aggression. Three prior systematic reviews have examined the evidence for the use of antipsychotics in DBDs and have concluded that their efficacy is marginal and limited by adverse effects. This paper has two objectives: (i) to summarize the findings of existing systematic reviews of antipsychotics for the management of DBDs in children and adolescents (2012-2017), and (ii) to provide an update to these reviews by examining recent clinical trials of antipsychotics in this population, published in the period from 2 January 2017 to 10 October 2022. The PubMed, Scopus and ScienceDirect databases were searched for relevant citations using the search terms "disruptive behaviour disorder", "oppositional defiant disorder", "conduct disorder" and their variants, along with "antipsychotic", "atypical antipsychotic" and the generic names of all currently approved atypical antipsychotics. Six relevant trials were identified during this period, including five randomized controlled trials and one naturalistic open-label trial. These trials were critically evaluated in terms of outcome measures, efficacy and safety. Overall, the data from these trials suggests that of all available antipsychotics, risperidone appears to be effective in the short-term management of DBDs. All available antipsychotics are associated with significant metabolic adverse effects in this population. These results are discussed in the light of global trends towards increasing off-label prescription of antipsychotic medication in children and adolescents and of recent literature on the neuropharmacology of aggression in this patient population. The need for rational, short-term use of these drugs is highlighted, as well as the importance of post-marketing surveillance for long-term or severe adverse events.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605 006, India
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Goertz-Dorten A, Dose C, Hofmann L, Katzmann J, Groth M, Detering K, Hellmann A, Stadler L, Braun B, Hellmich M, Doepfner M. Effects of Computer-Assisted Social Skills Training in Children With Disruptive Behavior Disorders: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:1329-1340. [PMID: 35398192 DOI: 10.1016/j.jaac.2022.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/05/2020] [Revised: 02/07/2022] [Accepted: 03/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Computer-assisted child-focused interventions are expected to improve efficiency and personalization of therapist-led treatments for children and adolescents. However, therapist-led, outpatient interventions using computer assistance are lacking for children with oppositional defiant disorder (ODD) or conduct disorder (CD). The present randomized controlled trial examined the efficacy of individualized computer-assisted social skills training for children with aggressive behavior compared to a resource activation intervention. METHOD A total of 100 children aged 6-12 years with a diagnosis of ODD/CD and peer-related aggression were randomly (1:1) assigned to either individually delivered computer-assisted social skills training (ScouT) or an individually delivered supportive resource activation treatment (STARK). The primary outcome was parent-rated peer-related aggression, assessed with the respective scale of the Questionnaire for Aggressive Behavior of Children (FAVK) and measured at pre-assessment and after the 16-week intervention (post-assessment). Further parent-, self-, teacher- and/or clinician-rated outcomes included ODD and CD symptoms, a wide range of behavioral and emotional symptoms, callous-unemotional traits, functional impairment, and quality of life. RESULTS After correcting for multiple testing, analyses of covariance comparing the efficacy of ScouT to the efficacy of STARK yielded small to moderate treatment effects in favor of the ScouT condition regarding parent-rated peer-related aggression (primary outcome; d = -0.64, 95% CI = -1.05, -0.24), parent-rated callous and uncaring traits, and parent-rated quality of life. However, the analyses did not reveal any significant effects for self- or teacher-rated peer-related aggression assessed with the respective scale of the FAVK (self-report: d = -0.21, 95% CI = -0.69, 0.29; teacher rating: d = -0.17, 95% CI = -0.56, 0.22). Moreover, after controlling for multiple comparisons, no significant effects emerged for the following: parent-, self-, and teacher-rated adult-related aggression; parent-, self-, teacher-, and clinician-rated ODD and CD symptoms; parent-, self-, and teacher-rated emotional and behavioral symptoms; and parent-rated functional impairment. CONCLUSION According to parent ratings, school-age children with disruptive behavior disorders and peer-related aggression seem to benefit more from individualized, computer-assisted social skills training than from resource activation treatment. However, this conclusion is limited by the missing effects on the clinician-, self-, and teacher-rated measures. CLINICAL TRIAL REGISTRATION INFORMATION Treatment of Children With Peer Related Aggressive Behavior (ScouT); https://clinicaltrials.gov/; NCT02143427.
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Affiliation(s)
- Anja Goertz-Dorten
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany.
| | - Christina Dose
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
| | - Leonie Hofmann
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
| | - Josepha Katzmann
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
| | - Manuela Groth
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
| | - Kerstin Detering
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
| | - Anne Hellmann
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
| | - Laura Stadler
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
| | - Barbara Braun
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistic, Informatics and Epidemiology, University Hospital Cologne, Germany
| | - Manfred Doepfner
- University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany
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Ibrahim K, Noble S, He G, Lacadie C, Crowley MJ, McCarthy G, Scheinost D, Sukhodolsky DG. Large-scale functional brain networks of maladaptive childhood aggression identified by connectome-based predictive modeling. Mol Psychiatry 2022; 27:985-99. [PMID: 34690348 DOI: 10.1038/s41380-021-01317-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 01/05/2023]
Abstract
Disruptions in frontoparietal networks supporting emotion regulation have been long implicated in maladaptive childhood aggression. However, the association of connectivity between large-scale functional networks with aggressive behavior has not been tested. The present study examined whether the functional organization of the connectome predicts severity of aggression in children. This cross-sectional study included a transdiagnostic sample of 100 children with aggressive behavior (27 females) and 29 healthy controls without aggression or psychiatric disorders (13 females). Severity of aggression was indexed by the total score on the parent-rated Reactive-Proactive Aggression Questionnaire. During fMRI, participants completed a face emotion perception task of fearful and calm faces. Connectome-based predictive modeling with internal cross-validation was conducted to identify brain networks that predicted aggression severity. The replication and generalizability of the aggression predictive model was then tested in an independent sample of children from the Adolescent Brain Cognitive Development (ABCD) study. Connectivity predictive of aggression was identified within and between networks implicated in cognitive control (medial-frontal, frontoparietal), social functioning (default mode, salience), and emotion processing (subcortical, sensorimotor) (r = 0.31, RMSE = 9.05, p = 0.005). Out-of-sample replication (p < 0.002) and generalization (p = 0.007) of findings predicting aggression from the functional connectome was demonstrated in an independent sample of children from the ABCD study (n = 1791; n = 1701). Individual differences in large-scale functional networks contribute to variability in maladaptive aggression in children with psychiatric disorders. Linking these individual differences in the connectome to variation in behavioral phenotypes will advance identification of neural biomarkers of maladaptive childhood aggression to inform targeted treatments.
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10
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Takahashi T, Sasabayashi D, Velakoulis D, Suzuki M, McGorry PD, Pantelis C, Chanen AM. Heschl's gyrus duplication pattern and clinical characteristics in borderline personality disorder: A preliminary study. Front Psychiatry 2022; 13:1033918. [PMID: 36405909 PMCID: PMC9669378 DOI: 10.3389/fpsyt.2022.1033918] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Inter-individual variations in the sulco-gyral pattern of Heschl's gyrus (HG) might contribute to emotional processing. However, it remains largely unknown whether borderline personality disorder (BPD) patients exhibit an altered HG gyrification pattern, compared with healthy individuals, and whether such a brain morphological feature, if present, might contribute to their clinical characteristics. The present study used magnetic resonance imaging to investigate the distribution of HG gyrification patterns (single or duplicated) and their relationship to clinical characteristics in teenage BPD patients with minimal treatment exposure. No significant difference was noted for the prevalence of HG patterns between 20 BPD and 20 healthy participants. However, the BPD participants with left duplicated HG were characterized by higher prevalence of comorbid disruptive behavior disorders, with higher externalizing score compared with those with left single HG. Our preliminary results suggest that neurodevelopmental pathology associated with gyral formation might be implicated in the neurobiology of early BPD, especially for emotional and behavioral control.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Dennis Velakoulis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia.,Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne Health, Melbourne, VIC, Australia
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Patrick D McGorry
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,North Western Mental Health, Western Hospital Sunshine, St Albans, VIC, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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11
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Menon SS, Krishnamurthy K. Multimodal Ensemble Deep Learning to Predict Disruptive Behavior Disorders in Children. Front Neuroinform 2021; 15:742807. [PMID: 34899225 PMCID: PMC8652047 DOI: 10.3389/fninf.2021.742807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
Oppositional defiant disorder and conduct disorder, collectively referred to as disruptive behavior disorders (DBDs), are prevalent psychiatric disorders in children. Early diagnosis of DBDs is crucial because they can increase the risks of other mental health and substance use disorders without appropriate psychosocial interventions and treatment. However, diagnosing DBDs is challenging as they are often comorbid with other disorders, such as attention-deficit/hyperactivity disorder, anxiety, and depression. In this study, a multimodal ensemble three-dimensional convolutional neural network (3D CNN) deep learning model was used to classify children with DBDs and typically developing children. The study participants included 419 females and 681 males, aged 108–131 months who were enrolled in the Adolescent Brain Cognitive Development Study. Children were grouped based on the presence of DBDs (n = 550) and typically developing (n = 550); assessments were based on the scores from the Child Behavior Checklist and on the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version for DSM-5. The diffusion, structural, and resting-state functional magnetic resonance imaging (rs-fMRI) data were used as input data to the 3D CNN. The model achieved 72% accuracy in classifying children with DBDs with 70% sensitivity, 72% specificity, and an F1-score of 70. In addition, the discriminative power of the classifier was investigated by identifying the cortical and subcortical regions primarily involved in the prediction of DBDs using a gradient-weighted class activation mapping method. The classification results were compared with those obtained using the three neuroimaging modalities individually, and a connectome-based graph CNN and a multi-scale recurrent neural network using only the rs-fMRI data.
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Affiliation(s)
- Sreevalsan S Menon
- Department of Mechanical and Aerospace Engineering, Missouri University of Science and Technology, Rolla, MO, United States
| | - K Krishnamurthy
- Department of Mechanical and Aerospace Engineering, Missouri University of Science and Technology, Rolla, MO, United States
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12
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Wang C, Hu Y, Nakonezny PA, Melo V, Ale C, Athreya AP, Shekunov J, Lynch R, Croarkin PE, Romanowicz M. A Retrospective Examination of the Impact of Pharmacotherapy on Parent-Child Interaction Therapy. J Child Adolesc Psychopharmacol 2021; 31:685-691. [PMID: 34319785 PMCID: PMC8721494 DOI: 10.1089/cap.2021.0043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Parent-child interaction therapy (PCIT) is an evidence-based approach for children aged 2-7 years with disruptive behavior problems. This study examined the effectiveness of PCIT with and without concurrent pharmacotherapy. Methods: A convenience sample was collected from a retrospective chart review of preschool-aged children treated with PCIT at the Mayo Clinic Young Child Clinic between 2016 and 2020. Quantitative and qualitative data were abstracted from all patients. The sample was divided into two groups based on psychotropic medications status (medicated and unmedicated) at the initiation of PCIT. Effectiveness of treatment was assessed with the change in Eyberg Child Behavior Inventory (ECBI) score. The change over time in ECBI score was compared between the two PCIT groups with and without concurrent pharmacotherapy using a linear mixed model. Results: Of the 62 youth, 38.71% were females. Mean age was 4.71 ± 1.17 years. The mean baseline ECBI score was 148.74 ± 30.86, indicating clinically significant disruptive behaviors. The mean number of PCIT sessions was 6.59 ± 3.82. There was no statistically significant difference in ECBI scores between the two groups at pre-PCIT (medication group: 149.68, standard error [SE] = 11.61 vs. unmedicated group: 147.92, SE = 10.93, p = 0.8904) and at post-PCIT (medication group: 116.27 [SE = 11.89] vs. unmedicated group: 128.86 [SE = 11.57], p = 0.3464). There was a statistically significant improvement in ECBI scores for both groups after completing therapy (medication group = -33.41 [-22.32%], SE = 6.27, p < 0.0001; d = 1.144; unmedicated group = -19.06 [-12.88%], SE = 5.78, p = 0.0022; d = 1.078). Conclusions: PCIT reduced disruptive behaviors in this sample of young children regardless of concurrent pharmacotherapy. Future prospective studies should consider one particular pharmacological agent and long-term outcomes of treatment. PCIT and certain pharmacological treatments could have complex and important bidirectional priming effects for both treatments.
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Affiliation(s)
- Chris Wang
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yuliang Hu
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A. Nakonezny
- Department of Psychiatry and University of Texas Southwestern, Dallas, Texas, USA.,Department of Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, USA
| | - Valeria Melo
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Chelsea Ale
- Department of Psychiatry and Psychology, Mayo Clinic, La Crosse, Wisconsin, USA
| | - Arjun P. Athreya
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Lynch
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.,Address correspondence to: Magdalena Romanowicz, MD, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
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Smorti M, Inguaggiato E, Vezzosi L, Milone A. Parenting and Sibling Relationships in Family with Disruptive Behavior Disorders. Are Non-Clinical Siblings More Vulnerable for Emotional and Behavioral Problems? Brain Sci 2021; 11:1308. [PMID: 34679373 DOI: 10.3390/brainsci11101308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Disruptive Behavior Disorders (DBD) are the most common mental health disorders in the school-aged child population. Although harsh parenting is a key risk factor in the shaping of DBD, studies neglect the presence of siblings and differential parenting. This study aims to compare: (1) parenting style and sibling relationship in sibling dyads of clinical families, composed of a DBD child and a non-clinical sibling, with control families composed of two non-clinical siblings; (2) parenting style, sibling relationship, and emotional and behavioral problems in DBD child, non-clinical sibling, and non-clinical child of control group. Sixty-one families (composed of mother and sibling dyads), divided into clinical (n = 27) and control (n = 34) groups, completed the APQ, SRI, and CBCL questionnaires. Results indicated differential parenting in clinical families, compared to control group families, with higher negative parenting toward the DBD child than the sibling; no difference emerged in sibling relationship within sibling dyads (clinical vs. control). Finally, externalizing and internalizing problems were higher in DBD children and their siblings, compared to control, indicating DBD sibling psychopathology vulnerability. Findings suggest inclusion of siblings in the clinical assessment and rehabilitative intervention of DBD children, given that the promotion of positive parenting could improve mental health in the offspring.
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14
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van Boxtel A, Zaalberg R, de Wied M. Subnormal short-latency facial mimicry responses to dynamic emotional facial expressions in male adolescents with disruptive behavior disorders and callous-unemotional traits. Psychophysiology 2021; 59:e13945. [PMID: 34553782 PMCID: PMC9286451 DOI: 10.1111/psyp.13945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 07/29/2021] [Accepted: 09/02/2021] [Indexed: 01/04/2023]
Abstract
Using still pictures of emotional facial expressions as experimental stimuli, reduced amygdala responses or impaired recognition of basic emotions were repeatedly found in people with psychopathic traits. The amygdala also plays an important role in short‐latency facial mimicry responses. Since dynamic emotional facial expressions may have higher ecological validity than still pictures, we compared short‐latency facial mimicry responses to dynamic and static emotional expressions between adolescents with psychopathic traits and normal controls. Facial EMG responses to videos or still pictures of emotional expressions (happiness, anger, sadness, fear) were measured. Responses to 500‐ms dynamic expressions in videos, as well as the subsequent 1500‐ms phase of maximal (i.e., static) expression, were compared between male adolescents with disruptive behavior disorders and high (n = 14) or low (n = 17) callous‐unemotional (CU) traits, and normal control subjects (n = 32). Responses to still pictures were also compared between groups. EMG responses to dynamic expressions were generally significantly smaller in the high‐CU group than in the other two groups, which generally did not differ. These group differences gradually emerged during the 500‐ms stimulus presentation period but in general they were already seen a few hundred milliseconds after stimulus onset. Group differences were absent during the 1500‐ms phase of maximal expression and during exposure to still pictures. Subnormal short‐latency mimicry responses to dynamic emotional facial expressions in the high‐CU group might have negative consequences for understanding emotional facial expressions of others during daily life when human facial interactions are primarily dynamic. During human interactions, short‐latency facial mimicry responses occur to dynamic emotional facial expressions of others. These are preconscious, automatic responses which cannot be voluntarily controlled. They may be important for emotional understanding of others and appear to be subnormal in male adolescents with psychopathic traits.
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Affiliation(s)
- Anton van Boxtel
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Ruud Zaalberg
- Wageningen University & Research, Biometris, Wageningen, The Netherlands
| | - Minet de Wied
- Department of Youth and Family, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
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15
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Fleming GE, Kohlhoff J, Morgan S, Turnell A, Maiuolo M, Kimonis ER. An Effectiveness Open Trial of Internet-Delivered Parent Training for Young Children With Conduct Problems Living in Regional and Rural Australia. Behav Ther 2021; 52:110-123. [PMID: 33483109 DOI: 10.1016/j.beth.2020.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/20/2019] [Revised: 01/13/2020] [Accepted: 03/08/2020] [Indexed: 01/13/2023]
Abstract
There is accumulating evidence for the efficacy of online parent management training (PMT) programs to improve conduct problems in young children, and findings have been used to support the potential of online programs to close the research-to-practice gap in underserved rural settings. However, to date, no study has evaluated the effectiveness of online PMT under real-world conditions; that is, delivered by community practitioners as part of services-as-usual to families residing in rural communities. This has resulted in a critical lack of evidence supporting the capacity of online PMT to ameliorate actual geographical disparities in service accessibility. Accordingly, the current study evaluated effectiveness and engagement outcomes of Internet-delivered Parent-Child Interaction Therapy (I-PCIT) delivered from a community-based early childhood clinic to rural consumers. Participants were 27 mothers and their 1.5- to 4-year-old child with conduct problems (M age = 3.02, SD = 0.73) living in regional and rural New South Wales, Australia. Parent-rated and observed child conduct problems and observed parenting behaviors were assessed pre and post I-PCIT, and treatment attrition, parental satisfaction with treatment, and homework compliance provided indicators of treatment engagement. Results of linear mixed and marginal models indicated that I-PCIT produced significant improvements in parent-reported and observed child conduct problems and observed parenting behaviors, with "small" to "very large" effect sizes (ds = 0.3-1.4). Treatment retention was adequate (63%), and treatment-completing parents reported high treatment satisfaction and good homework compliance. Findings provide preliminary evidence for the real world effectiveness of I-PCIT, supporting its capacity to narrow the research-to-practice gap. Findings suggest a role for I-PCIT in a stepped care model of remote treatment for childhood conduct problems in Australia.
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Affiliation(s)
| | - Jane Kohlhoff
- University of New South Wales; Karitane Toddler Clinic, Karitane, Sydney
| | | | | | | | - Eva R Kimonis
- University of New South Wales; Karitane Toddler Clinic, Karitane, Sydney
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16
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Abstract
We first confirmed adolescents diagnosed with disruptive behavior disorders (oppositional defiant, conduct disorder; n = 158) had lower constraint and higher negative emotionality, and greater psychiatric comorbidity and psychosocial dysfunction, relative to adolescents without (n = 755), in a population-based sample enriched for externalizing psychopathology (mean age = 17.90 years; 52% female). We then explored whether different personality types, defined by patterns of personality identified via latent profile analysis, were differently associated with clinical features in adolescents with a disruptive behavior disorder diagnosis. Four distinct personality types ("disinhibited," "high distress," "low distress," "positive") were meaningfully different from one another. Results highlight personality heterogeneity as a means of identifying individuals at greatest risk for the most deleterious forms of externalizing psychopathology.
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17
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Hegewald J, Schubert M, Freiberg A, Romero Starke K, Augustin F, Riedel-Heller SG, Zeeb H, Seidler A. Traffic Noise and Mental Health: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2020; 17:E6175. [PMID: 32854453 DOI: 10.3390/ijerph17176175] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 01/03/2023]
Abstract
Recent evidence suggests that traffic noise may negatively impact mental health. However, existing systematic reviews provide an incomplete overview of the effects of all traffic noise sources on mental health. We conducted a systematic literature search and summarized the evidence for road, railway, or aircraft noise-related risks of depression, anxiety, cognitive decline, and dementia among adults. We included 31 studies (26 on depression and/or anxiety disorders, 5 on dementia). The meta-analysis of five aircraft noise studies found that depression risk increased significantly by 12% per 10 dB LDEN (Effect Size = 1.12, 95% CI 1.02–1.23). The meta-analyses of road (11 studies) and railway traffic noise (3 studies) indicated 2–3% (not statistically significant) increases in depression risk per 10 dB LDEN. Results for road traffic noise related anxiety were similar. We did not find enough studies to meta-analyze anxiety and railway or aircraft noise, and dementia/ cognitive impairment and any traffic noise. In conclusion, aircraft noise exposure increases the risk for depression. Otherwise, we did not detect statistically significant risk increases due to road and railway traffic noise or for anxiety. More research on the association of cognitive disorders and traffic noise is required. Public policies to reduce environmental traffic noise might not only increase wellness (by reducing noise-induced annoyance), but might contribute to the prevention of depression and anxiety disorders.
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18
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Cristofani C, Sesso G, Cristofani P, Fantozzi P, Inguaggiato E, Muratori P, Narzisi A, Pfanner C, Pisano S, Polidori L, Ruglioni L, Valente E, Masi G, Milone A. The Role of Executive Functions in the Development of Empathy and Its Association with Externalizing Behaviors in Children with Neurodevelopmental Disorders and Other Psychiatric Comorbidities. Brain Sci 2020; 10:E489. [PMID: 32731515 PMCID: PMC7465618 DOI: 10.3390/brainsci10080489] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022] Open
Abstract
Executive functions have been previously shown to correlate with empathic attitudes and prosocial behaviors. People with higher levels of executive functions, as a whole, may better regulate their emotions and reduce perceived distress during the empathetic processes. Our goal was to explore the relationship between empathy and executive functioning in a sample of children and adolescents diagnosed with Attention Deficit and Hyperactivity Disorder alone or associated with comorbid Disruptive Behavior Disorders and/or Autism Spectrum Disorder. We also aimed to examine the role of empathic dimensions and executive skills in regulating externalizing behaviors. The 151 participants with ADHD were assigned to four groups according to their psychiatric comorbidity (either "pure" or with ASD and/or ODD/CD) and assessed by means of either parent- or self-reported questionnaires, namely the BRIEF-2, the BES, and the IRI. No questionnaire was found to discriminate between the four groups. Affective Empathy was found to positively correlate with Emotional and Behavioral Regulation competences. Furthermore, Aggressiveness and Oppositional Defiant Problems were positively associated with Executive Emotional and Behavioral Regulation competences. On the other hand, Rule-Breaking Behaviors and Conduct Problems were negatively associated with Affective Empathy and with Behavioral skills. Our study provides an additional contribution for a better understanding of the complex relationship between empathic competence and executive functions, showing that executive functioning and empathic attitudes interact with each other to regulate aggressive behaviors. This study further corroborates developmental models of empathy and their clinical implications, for which externalizing behaviors could be attenuated by enhancing executive functioning skills.
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Affiliation(s)
- Chiara Cristofani
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Gianluca Sesso
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Paola Cristofani
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Pamela Fantozzi
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Emanuela Inguaggiato
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Pietro Muratori
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Antonio Narzisi
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Chiara Pfanner
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Simone Pisano
- Department of Neuroscience, AORN Santobono-Pausilipon, 80122 Naples, Italy;
- Department of Translational Medical Sciences, Federico II University, 80138 Naples, Italy
| | - Lisa Polidori
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Laura Ruglioni
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Elena Valente
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Gabriele Masi
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
| | - Annarita Milone
- IRCCS Stella Maris Foundation, 56128 Pisa (Calambrone), Italy; (C.C.); (G.S.); (P.C.); (P.F.); (E.I.); (P.M.); (A.N.); (C.P.); (L.P.); (L.R.); (E.V.); (G.M.)
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19
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Abstract
Behavior disorders (BD) in children can lead to delinquency, antisocial behavior, and mental disorders in adulthood. Evidence-based behavioral parent training (BPT) programs have been developed to treat early-onset BDs, yet cost analyses of BPT are deficient. We provide updated estimates of cost and cost-effectiveness of Helping the Noncompliant Child (HNC), a mastery-based BPT, delivered to low-income families. The cost of research-specific activities was $1,152 per family. HNC program delivery costs were $293 per family from a payer perspective, including the cost of therapist time ($275 per family) and non-labor resources, such as supplies and toys ($18 per family). It costs an average of $6 to improve the Eyberg Child Behavior Inventory intensity score by each additional point or $171 to improve it by one standard deviation. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs.
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Affiliation(s)
- Olga Khavjou
- Corresponding author: Olga Khavjou, RTI International, 3040 Cornwallis Rd, Durham, NC 27709, tel: 919-541-6689,
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20
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McCabe KM, Yeh M, Zerr AA. Personalizing Behavioral Parent Training Interventions to Improve Treatment Engagement and Outcomes for Culturally Diverse Families. Psychol Res Behav Manag 2020; 13:41-53. [PMID: 32021508 PMCID: PMC6966146 DOI: 10.2147/prbm.s230005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral Parent Training (BPT) interventions are efficacious for young children with externalizing behavior problems. However, not all families benefit, and ethnic minority families in particular are less likely to enroll, engage, and improve in BPT. Versions of BPT interventions tailored for specific ethnic groups have been successful at improving engagement and outcomes for ethnic minorities; however, the specificity of these models presents challenges for broad dissemination. This article presents a personalization approach (PersIn) that utilizes cultural assessment results to tailor treatment protocols to the characteristics of individual families. We believe this approach has the potential to maximize cultural sensitivity while preserving generalizability to both minority and non-minority ethnic groups. We further propose that personalization on Parent Explanatory Model (PEM) parameters that have been found to vary across ethnic groups and to impact treatment engagement and/or outcomes is a promising approach to decreasing disparities in BPTs. We describe examples of evidence-supported PEMs that present good targets for personalization and provide examples from MY PCIT to illustrate how PersIn can be applied to Parent-Child Interaction Therapy (PCIT).
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Affiliation(s)
- Kristen M McCabe
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - May Yeh
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Argero A Zerr
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- Department of Psychology, California State University Channel Islands, Camarillo, CA, USA
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21
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Abstract
OBJECTIVE To examine within an at-risk/clinical sample of preschool-aged children with externalizing problems: (1) which disruptive behavior and attention disorder symptoms (i.e., inattention, hyperactivity/impulsivity, and oppositionality/aggression) and (2) what aspects of parenting (e.g., discipline practices or stress) are related to children's sleep problems (e.g., sleep habit and night waking problems). METHOD The sample consisted of 148 children (meanage = 5.06 years, 82% male) with at-risk/clinically elevated levels of externalizing behavior problems and their primary caregiver. As part of a larger study, parents reported on their stress and parenting practices and their children's behavioral and sleep functioning. Positive and negative parenting behaviors ("do" and "don't" skills, respectively) were also observed during a 15-minute parent-child interaction during play. RESULTS Oppositionality/aggression was the only disruptive behavior and attention disorder symptom associated with more sleep habit problems. Higher levels of inconsistent discipline and "don't" skills were also associated with more sleep habit problems. Within a combined model, an interaction emerged such that the association between "don't" skills and elevated sleep habit problems was only evident at low levels of inconsistent discipline. In terms of night waking problems, there was only an association with parenting stress, whereas the other parenting factors and disruptive behavior and attention disorder symptoms were unrelated. CONCLUSION Although the directionality of our associations cannot be ascertained because of the cross-sectional nature of our study, these findings, nevertheless, highlight the importance of parenting factors (e.g., inconsistent discipline and parenting stress) when considering sleep difficulties in young children with disruptive behavior and attention disorders.
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Affiliation(s)
- Jennifer Coto
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL
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22
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Schubert M, Hegewald J, Freiberg A, Starke KR, Augustin F, Riedel-Heller SG, Zeeb H, Seidler A. Behavioral and Emotional Disorders and Transportation Noise among Children and Adolescents: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2019; 16:ijerph16183336. [PMID: 31510007 PMCID: PMC6765874 DOI: 10.3390/ijerph16183336] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 01/03/2023]
Abstract
Children and adolescents may be particularly vulnerable to environmental influences such as noise which can affect mental well-being. The aim of this systematic review was to evaluate the effect of transportation noise on behavioral and emotional disorders in children and adolescents using a meta-analytic approach. Therefore, we searched four databases (Pubmed, Embase, PsychINFO, and PSYNDEX) and grey literature until February of 2019. We identified 14 articles from 10 studies examining the effect of transportation noise exposure on the mental health of children. These studies predominately used the Strength and Difficulties Questionnaire (SDQ) and mainly focused on schoolchildren and adolescents aged 9–10 years and 15–17 years in Europe. Three studies could be included in the meta-analysis. In sum, the odds for hyperactivity/inattention and total difficulties was significantly increased by 11% (Odds Ratio, OR = 1.11 (95% Confidence Interval, CI 1.04–1.19), respectively 9% (95% CI 1.02–1.16) per 10 dB road traffic noise. Thus, we obtained evidence for an effect of road traffic noise on hyperactivity/inattention and total difficulties, although we could consider few studies. Future studies are needed that use similar techniques to assess outcomes and exposures at schools and in homes. This would make it possible to conduct an individual participant data pooled analysis of the data.
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Affiliation(s)
- Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Franziska Augustin
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, 04103 Leipzig, Germany.
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS GmbH, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28344 Bremen, Germany.
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany.
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Lindhiem O, Vaughn-Coaxum RA, Higa J, Harris JL, Kolko DJ, Pilkonis PA. Development and validation of the Knowledge of Effective Parenting Test (KEPT) in a nationally representative sample. Psychol Assess 2019; 31:781-792. [PMID: 30742461 PMCID: PMC6527471 DOI: 10.1037/pas0000699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report on the development and psychometric properties of an instrument for the assessment of knowledge of effective parenting skills specific to conduct problems using an item response theory (IRT) framework. The initial item pool (36 items) for the Knowledge of Effective Parenting Test (KEPT) was administered online to a national sample (N = 1,570) selected to match the U.S. population on key demographic variables. Items with strong psychometric properties and without significant differential item functioning (DIF) by race/ethnicity were retained, resulting in a 21-item version of the KEPT with excellent reliability and validity. We also created a brief 10-item version of the KEPT to reduce respondent burden and to enhance its utility for repeated measurement in longitudinal and intervention research. We report norms and percentiles for both the 21-item version (KEPT-Full) and the 10-item version (KEPT-Brief). (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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24
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Abstract
A cognitive neuroscience perspective seeks to understand behavior, in this case disruptive behavior disorders (DBD), in terms of dysfunction in cognitive processes underpinned by neural processes. While this type of approach has clear implications for clinical mental health practice, it also has implications for school-based assessment and intervention with children and adolescents who have disruptive behavior and aggression. This review articulates a cognitive neuroscience account of DBD by discussing the neurocognitive dysfunction related to emotional empathy, threat sensitivity, reinforcement-based decision-making, and response inhibition. The potential implications for current and future classroom-based assessments and interventions for students with these deficits are discussed.
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Affiliation(s)
- Patrick Tyler
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
- Boys Town National Research Institute, Boys Town, Nebraska, USA
| | - Stuart F. White
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | | | - R.J.R. Blair
- Center for Neurobehavioral Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
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25
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van Lith K, Veltman DJ, Cohn MD, Pape LE, van den Akker-Nijdam ME, van Loon AWG, Bet P, van Wingen GA, van den Brink W, Doreleijers T, Popma A. Effects of Methylphenidate During Fear Learning in Antisocial Adolescents: A Randomized Controlled fMRI Trial. J Am Acad Child Adolesc Psychiatry 2018; 57:934-943. [PMID: 30522739 DOI: 10.1016/j.jaac.2018.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/09/2017] [Revised: 05/23/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Although the neural underpinnings of antisocial behavior have been studied extensively, research on pharmacologic interventions targeting specific neural mechanisms remains sparse. Hypoactivity of the amygdala and ventromedial prefrontal cortex (vmPFC) has been reported in antisocial adolescents, which could account for deficits in fear learning (amygdala) and impairments in decision making (vmPFC), respectively. Limited clinical research suggests positive effects of methylphenidate, a dopamine agonist, on antisocial behavior in adolescents. Dopamine is a key neurotransmitter involved in amygdala and vmPFC functioning. The objective of this study was to investigate whether methylphenidate targets dysfunctions in these brain areas in adolescents with antisocial behavior. METHOD A group of 42 clinical referred male adolescents (14-17 years old) with a disruptive behavior disorder performed a fear learning/reversal paradigm in a randomized double-blinded placebo-controlled pharmacologic functional magnetic resonance imaging study. Participants with disruptive behavior disorder were randomized to receive a single dose of methylphenidate 0.3 to 0.4 mg/kg (n = 22) or placebo (n = 20) and were compared with 21 matched healthy controls not receiving medication. RESULTS In a region-of-interest analysis of functional magnetic resonance imaging data during fear learning, the placebo group showed hyporeactivity of the amygdala compared with healthy controls, whereas amygdala reactivity was normalized in the methylphenidate group. There were no group differences in vmPFC reactivity during fear reversal learning. Whole-brain analyses showed no group differences. CONCLUSION These findings suggest that methylphenidate is a promising pharmacologic intervention for youth antisocial behavior that could restore amygdala functioning. CLINICAL TRIAL REGISTRATION INFORMATION Fear Conditioning During Specific Conditions in Antisocial Adolescents: A Neuroimaging Study. http://www.trialregister.nl/trialreg/index.asp; NTR4088.
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Affiliation(s)
- Koen van Lith
- Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands.
| | | | | | | | | | | | - Pierre Bet
- Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands
| | | | | | | | - Arne Popma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands; Leiden University, The Netherlands
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26
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Barterian JA, Arnold LE, Brown NV, Farmer CA, Williams C, Findling RL, Kolko DJ, Bukstein OG, Molina BSG, Townsend L, Aman MG. Clinical Implications From the Treatment of Severe Childhood Aggression (TOSCA) Study: A Re-Analysis and Integration of Findings. J Am Acad Child Adolesc Psychiatry 2017; 56:1026-33. [PMID: 29173736 DOI: 10.1016/j.jaac.2017.09.426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/05/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The Treatment of Severe Childhood Aggression (TOSCA) project examined augmentation of stimulant treatment and parent training (PT) with risperidone for severe physical aggression. This article summarizes the clinical implications; reanalyzes the data to examine the utility of 4 criteria for deciding to augment; and presents a treatment algorithm. METHOD The newly analyzed 4 criteria for augmenting after 3 weeks of stimulant and PT treatment consisted of not meeting a Clinical Global Impressions-Improvement (CGI-I) score of 1 and a normal score (≤15) on the Nisonger Child Behavior Rating Form Disruptive-Total (D-Total); a CGI-I score of 1 or 2 plus 25% improvement in D-Total score; a D-Total score no higher than 15; and a CGI-Severity score of 3 (mild) or better. Effect sizes were calculated. Prior TOSCA publications were reviewed for clinically relevant findings. RESULTS All 4 criteria resulted in medium or better effect sizes (d = 0.59-0.72) when comparing risperidone with placebo. Providing risperidone to children who did not reach a CGI-I score of 1 plus a D-Total score no higher than 15 resulted in the greatest benefit. In addition, a review of clinically relevant data suggests that stimulant plus PT shows further improvement after 3 weeks even without augmentation. CONCLUSION For those children who did not attain a CGI-I score of 1 and a D-total score no higher than 15, adding risperidone maximized the number of children benefitting from treatment and the average amount of benefit. Unless clinical circumstances dictate otherwise, practitioners should delay an antipsychotic drug for at least 1 month after the optimal stimulant dose is achieved and PT has commenced. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov; NCT00796302.
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27
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Acri MC, Bornheimer LA, Jessell L, Chomancuzuk AH, Adler JG, Gopalan G, McKay MM. The intersection of extreme poverty and familial mental health in the United States. Soc Work Ment Health 2017; 15:677-689. [PMID: 29618956 PMCID: PMC5880535 DOI: 10.1080/15332985.2017.1319893] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Approximately 22% of children in the United States live in poverty, with high rates of caregiver depression and child disruptive behavior disorders (DBD). The current study aims to explore the relationships between living in extreme poverty and both child and parent mental health. Data are comprised of findings from the first effectiveness study of the 4Rs and 2Ss intervention, in addition to preliminary data from an implementation study currently underway (n = 484). Families with an annual income of less than $9,999 reported significantly greater child DBD scores and prevalence of clinically significant levels of caregiver depressive symptoms compared to income levels over $10,000. Findings support the recommendation for parental mental health to be attended to within the context of child mental health services.
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Affiliation(s)
- Mary C. Acri
- McSilver Institute for Poverty, Policy, & Research, New York University, New York, New York, USA
- New York University Medical Center, New York, New York, USA
| | - Lindsay A. Bornheimer
- McSilver Institute for Poverty, Policy, & Research, New York University, New York, New York, USA
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Lauren Jessell
- Silver School of Social Work, New York University, New York, New York, USA
| | | | - Joshua G. Adler
- College of Arts and Sciences, New York University, New York, New York, USA
| | - Geetha Gopalan
- School of Social Work, University of Maryland, Baltimore, Maryland, USA
| | - Mary M. McKay
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
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28
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Abstract
OBJECTIVE In an effort to address the lack of evidence-based interventions for ADHD in developing South Asian countries, we examined the preliminary efficacy of a behavioral parent training program in Pakistan. METHOD A quasi-experimental design was utilized. Eighty-five 4- to 12-year-old children with clinically significant ADHD symptoms participated: 55 were recruited from hospital clinics (active treatment group) and 30 were recruited from schools (waitlist control group). Parent and teacher ratings of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and impairment were collected. RESULTS Using intent-to-treat analyses, the treatment group showed significant pre-post improvement on parent-reported ODD symptoms and ADHD-related impairment. Teacher ratings showed no improvement. CONCLUSION This study provides preliminary evidence for the feasibility and effectiveness of behavioral parenting training for children with ADHD in Pakistan and represents a critical first step in identifying evidence-based treatments for Pakistani children with ADHD.
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Affiliation(s)
| | - Mary Rooney
- 2 University of California, San Francisco, CA, USA
| | | | - Naeem Tariq
- 4 Qauid E Azam University, Islamabad, Pakistan
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29
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Findling RL, Townsend L, Brown NV, Arnold LE, Gadow KD, Kolko DJ, McNamara NK, Gary DS, Kaplin DB, Farmer CA, Kipp H, Williams C, Butter EM, Bukstein OG, Rice R, Buchan-Page K, Molina BS, Aman MG. The Treatment of Severe Childhood Aggression Study: 12 Weeks of Extended, Blinded Treatment in Clinical Responders. J Child Adolesc Psychopharmacol 2017; 27:52-65. [PMID: 28212067 PMCID: PMC5327034 DOI: 10.1089/cap.2016.0081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/13/2022]
Abstract
OBJECTIVES Previous "Treatment of Severe Childhood Aggression" (TOSCA) reports demonstrated that many children with severe physical aggression and attention-deficit/hyperactivity disorder (ADHD) responded well to two randomized treatments (parent training [PT]+stimulant+placebo = Basic vs. PT+stimulant+risperidone = Augmented) for 9 weeks. An important clinical question is whether these favorable outcomes are maintained over longer times. METHODS Clinical responders to the 9-week trial (n = 103/168), defined as Clinical Global Impressions (CGI)-Improvement of much/very much improved plus substantial reduction in parent ratings of disruptiveness, were followed another 12 weeks (21 weeks total) while remaining on blinded treatment. Outcome measures included Clinical Global Impressions scale, Nisonger Child Behavior Rating Form (NCBRF), other parent/teacher-rated scales, laboratory tests, clinician ratings of abnormal movement, and other adverse events (AEs). RESULTS Parent ratings of problem behavior showed minimal worsening of behavior from end of the 9-week acute trial (expected from regression to the mean after selecting best responders), but outcomes at Extension endpoint were meaningfully improved compared with acute study baseline. As expected, outcomes for Basic and Augmented treatment did not differ among these children selected for good clinical response. During Extension, more Augmented subjects had elevated prolactin; there were no clinically confirmed cases of tardive dyskinesia. Delayed sleep onset was the most frequent Basic AE. We also conducted a last-observation-carried-forward analysis, which included both nonresponders and responders. We found that, at the end of Extension, Augmented subjects had more improvement than Basic subjects on the NCBRF Positive Social subscale (p = 0.005; d = 0.44), the Antisocial Behavior Scale Reactive Aggression subscale (p = 0.03; d = 0.36), and marginally so on the Disruptive Behavior Total subscale (p = 0.058; d = 0.29, the primary outcome). CONCLUSIONS The medium-term outcomes were good for the participants in both treatment groups, perhaps because they were selected for good response. When nonresponders were included in ITT analyses, there was some indication that Augmented surpassed Basic treatment.
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Affiliation(s)
- Robert L. Findling
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland.,Department of Psychiatry, Kennedy Krieger Institute, Baltimore, Maryland
| | - Lisa Townsend
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole V. Brown
- Center for Biostatistics, Ohio State University Medical Center, Columbus, Ohio
| | | | - Kenneth D. Gadow
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - David J. Kolko
- Department of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nora K. McNamara
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | - Devin S. Gary
- Department of Psychiatry, Kennedy Krieger Institute, Baltimore, Maryland
| | - Dana B. Kaplin
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland
| | - Cristan A. Farmer
- Pediatrics & Developmental Neuroscience Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Heidi Kipp
- Department of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Craig Williams
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio
| | - Eric M. Butter
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Robert Rice
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio
| | | | - Brooke S.G. Molina
- Department of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael G. Aman
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio
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30
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Murphy AL, Gardner DM, Kisely S, Cooke CA, Kutcher SP, Hughes J. System struggles and substitutes: A qualitative study of general practitioner and psychiatrist experiences of prescribing antipsychotics to children and adolescents. Clin Child Psychol Psychiatry 2016; 21:634-648. [PMID: 26614572 PMCID: PMC5094295 DOI: 10.1177/1359104515617518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. We conducted a qualitative study using an interpretive phenomenological analysis of physicians' experiences of antipsychotic prescribing to children and adolescents. Prescribers participated in individual interviews and a focus group. We used a staged approach for data analysis of transcriptions. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We identified themes related to context, role and identity, and decision-making and filtering Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Our results provide knowledge regarding the prescribers' experience of antipsychotics for children and adolescents. Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents.
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Affiliation(s)
- Andrea L Murphy
- College of Pharmacy, Dalhousie University, Canada .,Department of Psychiatry, Dalhousie University, Canada
| | - David M Gardner
- College of Pharmacy, Dalhousie University, Canada.,Department of Psychiatry, Dalhousie University, Canada
| | - Steve Kisely
- School of Population Health, University of Queensland, Australia
| | | | - Stanley P Kutcher
- Department of Psychiatry, Dalhousie University, Canada.,Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University and IWK Health Centre, Canada
| | - Jean Hughes
- School of Nursing, Dalhousie University, Canada
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31
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Hanson LM. School-Based Psychiatric Mental Health Nurse Practitioners to Decrease Inappropriate Psychiatric Pediatric Emergency Rooms Presentations. J Dr Nurs Pract 2016; 9:189-193. [PMID: 32750988 DOI: 10.1891/2380-9418.9.2.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An alarming number of children are being referred to pediatric emergency rooms for disruptive behavior disorders (DBDs) such as attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorders. Although presenting symptoms of an exacerbation of disruptive behaviors may be urgent, often they do not require emergency care and could have been efficiently handled through outpatient care. Inappropriate emergency room (ER) referrals have been linked to inadequate school, family, or self-referrals. This article proposes using psychiatric mental health nurse practitioners, known in some states as advanced practice registered nurses, in school-based mental health programs as an intervention with the greatest potential to decrease disparities in access to child psychiatric health care and to offer the psychoeducation and support necessary to prevent inappropriate ER presentations for DBDs.
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32
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Antonini TN, Becker SP, Tamm L, Epstein JN. Hot and Cool Executive Functions in Children with Attention-Deficit/Hyperactivity Disorder and Comorbid Oppositional Defiant Disorder. J Int Neuropsychol Soc 2015; 21:584-95. [PMID: 26416095 PMCID: PMC4589250 DOI: 10.1017/s1355617715000752] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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] [Indexed: 11/05/2022]
Abstract
While neuropsychological deficits in both "hot" and "cool" executive functions (EFs) have been documented among individuals with attention-deficit/hyperactivity disorder (ADHD), these EF deficits are not universal across all individuals with this diagnosis. One potential moderator of executive dysfunction may be the presence of comorbid oppositional defiant disorder (ODD). This study examined the association between "hot" and "cool" EFs and comorbid ODD in children with ADHD. Thirty-three children with ADHD and comorbid ODD (ADHD+ODD), 67 with ADHD without ODD (ADHD-ODD), and 30 typically developing controls participated. Children were 7-12 years of age. "Cool" EFs were assessed with a spatial span task and a card sorting test. "Hot" EFs were assessed using a delay discounting task and a gambling task. ADHD-ODD and ADHD+ODD groups performed more poorly on "cool" EF tasks than controls, but did not differ from each other. Furthermore, the number of ADHD symptoms, but not ODD symptoms, was associated with "cool" EF scores. The three groups did not differ on "hot" EF tasks and the number of ADHD or ODD symptoms was unrelated to "hot" EF scores. In sum, children with ADHD presented with "cool" EF deficits which appear to be unrelated to ODD comorbidity. However, "hot" EF deficits were not present among children with ADHD, irrespective of comorbid ODD status.
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Affiliation(s)
| | | | - Leanne Tamm
- Cincinnati Children's Hospital Medical Center,Cincinnati,Ohio
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Abstract
Decades of research have shown that youths with disruptive behavior disorders (DBD) are a heterogeneous population. Over the past 20 years, researchers have distinguished youths with DBD as those displaying high (DBD/HCU) versus low (DBD/LCU) callous-unemotional (CU) traits. These traits include flat affect and reduced empathy and remorse, and are associated with more severe, varied, and persistent patterns of antisocial behavior and aggression. Conduct problems in youths with HCU and LCU are thought to reflect distinct causal vulnerabilities, with antisocial behavior in youths with DBD/HCU reflecting a predominantly genetic etiology, while antisocial behavior in youths with DBD/LCU is associated primarily with environmental influences. Here we selectively review recent functional (fMRI) and structural (sMRI) magnetic resonance imaging research on DBD, focusing particularly on the role of CU traits. First, fMRI studies examining the neural correlates of affective stimuli, emotional face processing, empathy, theory of mind, morality, and decision-making in DBD are discussed. This is followed by a review of the studies investigating brain structure and structural connectivity in DBD. Next, we highlight the need to further investigate females and the role of sex differences in this population. We conclude the review by identifying potential clinical implications of this research.
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34
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Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 2015; 56:345-65. [PMID: 25649325 DOI: 10.1111/jcpp.12381] [Citation(s) in RCA: 1922] [Impact Index Per Article: 213.6] [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: 12/15/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The literature on the prevalence of mental disorders affecting children and adolescents has expanded significantly over the last three decades around the world. Despite the field having matured significantly, there has been no meta-analysis to calculate a worldwide-pooled prevalence and to empirically assess the sources of heterogeneity of estimates. METHODS We conducted a systematic review of the literature searching in PubMed, PsycINFO, and EMBASE for prevalence studies of mental disorders investigating probabilistic community samples of children and adolescents with standardized assessments methods that derive diagnoses according to the DSM or ICD. Meta-analytical techniques were used to estimate the prevalence rates of any mental disorder and individual diagnostic groups. A meta-regression analysis was performed to estimate the effect of population and sample characteristics, study methods, assessment procedures, and case definition in determining the heterogeneity of estimates. RESULTS We included 41 studies conducted in 27 countries from every world region. The worldwide-pooled prevalence of mental disorders was 13.4% (CI 95% 11.3-15.9). The worldwide prevalence of any anxiety disorder was 6.5% (CI 95% 4.7-9.1), any depressive disorder was 2.6% (CI 95% 1.7-3.9), attention-deficit hyperactivity disorder was 3.4% (CI 95% 2.6-4.5), and any disruptive disorder was 5.7% (CI 95% 4.0-8.1). Significant heterogeneity was detected for all pooled estimates. The multivariate metaregression analyses indicated that sample representativeness, sample frame, and diagnostic interview were significant moderators of prevalence estimates. Estimates did not vary as a function of geographic location of studies and year of data collection. The multivariate model explained 88.89% of prevalence heterogeneity, but residual heterogeneity was still significant. Additional meta-analysis detected significant pooled difference in prevalence rates according to requirement of funcional impairment for the diagnosis of mental disorders. CONCLUSIONS Our findings suggest that mental disorders affect a significant number of children and adolescents worldwide. The pooled prevalence estimates and the identification of sources of heterogeneity have important implications to service, training, and research planning around the world.
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Affiliation(s)
- Guilherme V Polanczyk
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Research Center on Neurodevelopment and Mental Health, University of São Paulo, São Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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Honeycutt AA, Khavjou OA, Jones DJ, Cuellar J, Forehand RL. Helping the Noncompliant Child: An Assessment of Program Costs and Cost-Effectiveness. J Child Fam Stud 2015; 24:499-504. [PMID: 25642124 PMCID: PMC4308978 DOI: 10.1007/s10826-013-9862-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Disruptive behavior disorders (DBD) in children can lead to delinquency in adolescence and antisocial behavior in adulthood. Several evidence-based behavioral parent training (BPT) programs have been created to treat early onset DBD. This paper focuses on one such program, Helping the Noncompliant Child (HNC), and provides detailed cost estimates from a recently completed pilot study for the HNC program. The study also assesses the average cost-effectiveness of the HNC program by combining program cost estimates with data on improvements in child participants' disruptive behavior. The cost and effectiveness estimates are based on implementation of HNC with low-income families. Investigators developed a Microsoft Excel-based costing instrument to collect data from therapists on their time spent delivering the HNC program. The instrument was designed using an activity-based costing approach, where each therapist reported program time by family, by date, and for each skill that the family was working to master. Combining labor and non-labor costs, it is estimated that delivering the HNC program costs an average of $501 per family from a payer perspective. It also costs an average of $13 to improve the Eyberg Child Behavior Inventory intensity score by 1 point for children whose families participated in the HNC pilot program. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs. These cost estimates are the first to be collected systematically and prospectively for HNC. Program managers may use these estimates to plan for the resources needed to fully implement HNC.
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Affiliation(s)
- Amanda A. Honeycutt
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Olga A. Khavjou
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Deborah J. Jones
- University of North Carolina at Chapel Hill, Campus Box 3270, Chapel Hill, NC 27599, USA
| | - Jessica Cuellar
- University of North Carolina at Chapel Hill, Campus Box 3270, Chapel Hill, NC 27599, USA
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Oruche UM, Draucker CB, Al-Khattab H, Cravens HA, Lowry B, Lindsey LM. The challenges for primary caregivers of adolescents with disruptive behavior disorders. J Fam Nurs 2015; 21:149-67. [PMID: 25504213 PMCID: PMC4575286 DOI: 10.1177/1074840714562027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Adolescents with disruptive behavior disorders (DBD), including oppositional defiant disorder and conduct disorder, present unique challenges for their families. Although, most empirically supported treatments for DBD are family-based, the emphasis is typically on the behavior of the child rather than on the life challenges and resultant distress experienced by the family members. Fifteen families of adolescents with DBD were recruited from a large publicly funded Community Mental Health Center. For this report, data from in-depth interviews with the adolescents' primary caregivers were analyzed by standard content analytic procedures to describe the challenges they experienced living with and caring for the adolescents. The primary caregivers reported that the challenges were overwhelming, demanding, and unrelenting. The two most salient challenges were (a) managing the adolescents' aggressive, defiant, and deceitful behaviors, and (b) interacting frequently with a number of child-serving agencies. A number of clinical implications are drawn from these findings.
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Affiliation(s)
| | | | | | | | - Brittany Lowry
- Indiana University-Purdue University, Indianapolis, IN, USA
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Aman MG, Bukstein OG, Gadow KD, Arnold LE, Molina BS, McNamara NK, Rundberg-Rivera EV, Li X, Kipp H, Schneider J, Butter EM, Baker J, Sprafkin J, Rice RR, Bangalore SS, Farmer CA, Austin AB, Buchan-Page KA, Arradaza NV, Hurt EA, Grondhuis SN, Findling RL. What does risperidone add to parent training and stimulant for severe aggression in child attention-deficit/hyperactivity disorder? J Am Acad Child Adolesc Psychiatry 2014; 53:47-60.e1. [PMID: 24342385 PMCID: PMC3984501 DOI: 10.1016/j.jaac.2013.09.022] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/14/2013] [Accepted: 11/14/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although combination pharmacotherapy is common in child and adolescent psychiatry, there has been little research evaluating it. The value of adding risperidone to concurrent psychostimulant and parent training (PT) in behavior management for children with severe aggression was tested. METHOD One hundred sixty-eight children 6 to 12 years old (mean age 8.89 ± 2.01 years) with severe physical aggression were randomized to a 9-week trial of PT, stimulant (STIM), and placebo (Basic treatment; n = 84) or PT, STIM, and risperidone (Augmented treatment; n = 84). All had diagnoses of attention-deficit/hyperactivity disorder and oppositional-defiant disorder (n = 124) or conduct disorder (n = 44). Children received psychostimulant (usually Osmotic Release Oral System methylphenidate) for 3 weeks, titrated for optimal effect, while parents received PT. If there was room for improvement at the end of week 3, placebo or risperidone was added. Assessments included parent ratings on the Nisonger Child Behavior Rating Form (Disruptive-Total subscale was the primary outcome) and Antisocial Behavior Scale; blinded clinicians rated change on the Clinical Global Impressions scale. RESULTS Compared with Basic treatment (PT + STIM [44.8 ± 14.6 mg/day] + placebo [1.88 mg/day ± 0.72]), Augmented treatment (PT + STIM [46.1 ± 16.8 mg/day] + risperidone [1.65 mg/day ± 0.75]) showed statistically significant improvement on the Nisonger Child Behavior Rating Form Disruptive-Total subscale (treatment-by-time interaction, p = .0016), the Nisonger Child Behavior Rating Form Social Competence subscale (p = .0049), and Antisocial Behavior Scale Reactive Aggression subscale (p = .01). Clinical Global Impressions scores were substantially improved for the 2 groups but did not discriminate between treatments (Clinical Global Impressions-Improvement score ≤2, 70% for Basic treatment versus 79% for Augmented treatment). Prolactin elevations and gastrointestinal upset occurred more with Augmented treatment; other adverse events differed modestly from Basic treatment; weight gain in the Augmented treatment group was minor. CONCLUSIONS Risperidone provided moderate but variable improvement in aggressive and other seriously disruptive child behaviors when added to PT and optimized stimulant treatment. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study), URL: http://clinicaltrials.gov, unique identifier: NCT00796302.
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Cohn MD, Popma A, van den Brink W, Pape LE, Kindt M, van Domburgh L, Doreleijers TA, Veltman DJ. Fear conditioning, persistence of disruptive behavior and psychopathic traits: an fMRI study. Transl Psychiatry 2013; 3:e319. [PMID: 24169638 DOI: 10.1038/tp.2013.89] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/21/2013] [Accepted: 09/08/2013] [Indexed: 11/29/2022] Open
Abstract
Children diagnosed with Disruptive Behavior Disorders (DBD), especially those with psychopathic traits, are at risk of developing persistent and severe antisocial behavior. Deficient fear conditioning may be a key mechanism underlying persistence, and has been associated with altered regional brain function in adult antisocial populations. In this study, we investigated the associations between the neural correlates of fear conditioning, persistence of childhood-onset DBD during adolescence and psychopathic traits. From a cohort of children arrested before the age of 12 years, participants who were diagnosed with Oppositional Defiant Disorder or Conduct Disorder in previous waves (mean age of onset 6.5 years, s.d. 3.2) were reassessed at mean age 17.6 years (s.d. 1.4) and categorized as persistent (n=25) or desistent (n=25) DBD. Using the Youth Psychopathic Traits Inventory and functional magnetic resonance imaging during a fear conditioning task, these subgroups were compared with 26 matched healthy controls from the same cohort. Both persistent and desistent DBD subgroups were found to show higher activation in fear processing-related brain areas during fear conditioning compared with healthy controls. In addition, regression analyses revealed that impulsive-irresponsible and grandiose-manipulative psychopathic traits were associated with higher activation, whereas callous-unemotional psychopathic traits were related to lower activation in fear-related areas. Finally, the association between neural activation and DBD subgroup membership was mediated by impulsive-irresponsible psychopathic traits. These results provide evidence for heterogeneity in the neurobiological mechanisms underlying psychopathic traits and antisocial behavior and, as such, underscore the need to develop personalized interventions.
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Abstract
The disruptive behavior disorders are among the most prevalent youth psychiatric disorders, and they predict numerous problematic outcomes in adulthood. This study examined multiple domains of risk during early childhood and early adolescence as longitudinal predictors of disruptive behavior disorder diagnoses among adolescent males. Early adolescent risks in the domains of sociodemographic factors, the caregiving context, and youth attributes were examined as mediators of associations between early childhood risks and disruptive behavior disorder diagnoses. Participants were 309 males from a longitudinal study of low-income mothers and their sons. Caregiving and youth risk during early adolescence each predicted the likelihood of receiving a disruptive behavior disorder diagnosis. Furthermore, sociodemographic and caregiving risk during early childhood were indirectly associated with disruptive behavior disorder diagnoses via their association with early adolescent risk. The findings suggest that preventive interventions targeting risk across domains may reduce the prevalence of disruptive behavior disorders.
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Vander Stoep A, Adrian MC, Rhew IC, McCauley E, Herting JR, Kraemer HC. Identifying comorbid depression and disruptive behavior disorders: comparison of two approaches used in adolescent studies. J Psychiatr Res 2012; 46:873-81. [PMID: 22575333 PMCID: PMC3704316 DOI: 10.1016/j.jpsychires.2012.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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: 11/01/2011] [Revised: 02/15/2012] [Accepted: 03/29/2012] [Indexed: 11/17/2022]
Abstract
Interest in commonly co-occurring depression and disruptive behavior disorders in children has yielded a small body of research that estimates the prevalence of this comorbid condition and compares children with the comorbid condition and children with depression or disruptive behavior disorders alone with respect to antecedents and outcomes. Prior studies have used one of two different approaches to measure comorbid disorders: (1) meeting criteria for two DSM or ICD diagnoses or (2) scoring .5 SD above the mean or higher on two dimensional scales. This study compares two snapshots of comorbidity taken simultaneously in the same sample with each of the measurement approaches. The Developmental Pathways Project administered structured diagnostic interviews as well as dimensional scales to a community-based sample of 521 11-12 year olds to assess depression and disruptive behavior disorders. Clinical caseness indicators of children identified as "comorbid" by each method were examined concurrently and 3-years later. Cross-classification of adolescents via the two approaches revealed low agreement. When other indicators of caseness, including functional impairment, need for services, and clinical elevations on other symptom scales were examined, adolescents identified as comorbid via dimensional scales only were similar to those who were identified as comorbid via DSM-IV diagnostic criteria. Findings suggest that when relying solely on DSM diagnostic criteria for comorbid depression and disruptive behavior disorders, many adolescents with significant impairment will be overlooked. Findings also suggest that lower dimensional scale thresholds can be set when comorbid conditions, rather than single forms of psychopathology, are being identified.
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Affiliation(s)
- Ann Vander Stoep
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle 98195, USA.
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Lebowitz ER, Omer H, Leckman JF. Coercive and disruptive behaviors in pediatric obsessive-compulsive disorder. Depress Anxiety 2011; 28:899-905. [PMID: 21769998 PMCID: PMC4006629 DOI: 10.1002/da.20858] [Citation(s) in RCA: 64] [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] [Received: 03/30/2011] [Revised: 05/24/2011] [Accepted: 05/28/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study explored the nature of disruptive and coercive behaviors in pediatric obsessive-compulsive disorder (OCD). METHOD Thirty children with OCD and a disruptive behavior disorder (DBD) were compared to 30 children with DBD alone using the Child Behavior Checklist and a novel 18-item questionnaire focused on distinctive coercive and disruptive behaviors seen in pediatric OCD (CD-POC). RESULTS Although youth with DBD alone had higher ratings of Externalizing Behaviors on the CBCL compared to the youth with OCD + DBD, their ratings on the CB-POC scale were lower. For example, 83% of OCD + DBD parents reported that their child "Imposes rules or behaviors on others due to tactile or other sensitivity and reacts to disobedience with rage or violence (e.g. forbids certain sounds, demands specific temperature settings)" compared to 23% of the parents of youth with DBD alone. Other highly discriminating behaviors included: "Demands special 'cuddling' or ritualized contact without regard for the will of others" and "Forbids the use of objects in his/her vicinity because of feelings of fear or disgust (e.g. knives, scissors, creams)." Total scores on the CD-POC were also correlated with OCD severity (P<.01). CONCLUSION The results suggest that the nature of DBD in pediatric OCD may be distinctive and worthy of further study.
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Affiliation(s)
- Eli R. Lebowitz
- Yale Child Study Center, New Haven, Connecticut,Correspondence to: Eli R. Lebowitz, PO Box 207900, New Haven, CT 06520-7900.
| | - Haim Omer
- Tel Aviv University, Tel Aviv, Israel
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Abstract
This study examines the rates of depressive symptoms and service use among caregivers whose children receive treatment for disruptive behavior disorders. Descriptive analyses examined preliminary baseline data from the Family Groups for Urban Youth with Disruptive Behaviors study for 212 caregivers to determine rates of caregiver depressive symptoms and lifetime mental health service use. Findings indicate that caregivers manifest substantially higher rates of depressive symptoms compared to national norms. Of those caregivers with clinically significant depressive symptoms, less than half reported ever receiving mental health services. Findings suggest that greater attention should be paid to identifying and treating caregiver depression among children receiving treatment for disruptive behavior disorders.
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Affiliation(s)
- Geetha Gopalan
- Department of Psychiatry, Mount Sinai School of Medicine
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Kolko DJ, Campo JV, Kelleher K, Cheng Y. Improving access to care and clinical outcome for pediatric behavioral problems: a randomized trial of a nurse-administered intervention in primary care. J Dev Behav Pediatr 2010; 31:393-404. [PMID: 20495474 PMCID: PMC3057358 DOI: 10.1097/dbp.0b013e3181dff307] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [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] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the effectiveness of an on-site modular intervention in improving access to mental health services and outcomes for children with behavioral problems in primary care relative to enhanced usual care. The study includes boys and girls from six primary care offices in metropolitan Pittsburgh, PA. METHODS One hundred sixty-three clinically referred children who met a modest clinical cutoff (75th percentile) on the externalizing behavior scale of the Pediatric Symptom Checklist-17 were randomized to a protocol for on-site, nurse-administered intervention or to enhanced usual care. Protocol for on-site, nurse-administered intervention applied treatment modules from an evidence-based specialty mental health treatment for children with disruptive behavior disorders that were adapted for delivery in the primary care setting; enhanced usual care offered diagnostic assessment, recommendations, and facilitated referral to a specialty mental health provider in the community. The main outcome measures such as standardized rating scales, including the Pediatric Symptom Checklist-17, individualized target behavior ratings, treatment termination reports, and diagnostic interviews were collected. RESULTS Protocol for on-site, nurse-administered intervention cases were significantly more likely to receive and complete mental health services, reported fewer service barriers and more consumer satisfaction, and showed greater, albeit modest, improvements on just a few clinical outcomes that included remission for categorical behavioral disorders at 1-year follow-up. Both conditions also reported several significant improvements on several clinical outcomes over time. CONCLUSIONS A psychosocial intervention for behavior problems that was delivered by nurses in the primary care setting is feasible, improves access to mental health services, and has some clinical efficacy. Options for enhancing clinical outcome include the use of multifaceted collaborative care interventions in the pediatric practice.
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Affiliation(s)
- David J. Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - John V. Campo
- Nationwide Children’s Hospital and The Ohio State University, Columbus, OH
| | - Kelly Kelleher
- Nationwide Children’s Hospital and The Ohio State University, Columbus, OH
| | - Yu Cheng
- Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA
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Hirshfeld-Becker DR, Petty C, Micco JA, Henin A, Park J, Beilin A, Rosenbaum JF, Biederman J. Disruptive behavior disorders in offspring of parents with major depression: associations with parental behavior disorders. J Affect Disord 2008; 111:176-84. [PMID: 18378320 PMCID: PMC2602871 DOI: 10.1016/j.jad.2008.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 08/16/2007] [Revised: 02/11/2008] [Accepted: 02/13/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although the offspring of parents with major depressive disorder (MDD) are at increased risk to develop disruptive behavior disorders (DBD) in addition to MDD, it remains unclear whether this heightened risk is due to MDD or to comorbid DBD in the parents. METHOD In a secondary analysis of longitudinal data from offspring at risk for MDD and panic disorder and comparison children, we stratified 169 children of parents who had been treated for MDD based upon presence (n=50) or absence (n=119) of parental history of DBD (ADHD, oppositional disorder, and conduct disorder) and contrasted them with children of parents with DBD but without MDD (n=19) and children whose parents had neither MDD nor DBD (n=106). The children had been assessed in middle childhood using structured diagnostic interviews. RESULTS Offspring of parents with MDD + DBD had significantly higher rates of MDD, DBD in general, and ADHD in particular, compared with offspring of parents with MDD alone. Offspring of parents with MDD + DBD also had higher rates of mania than controls. Both parental MDD and DBD conferred independent risk for MDD and DBD in the offspring. However, only parental DBD conferred independent risk for conduct disorder and ADHD and only parental MDD conferred independent risk for oppositional defiant disorder. CONCLUSION Elevated rates of DBD in the offspring of parents with MDD appear to be due in part to the presence of DBD in the parents. Further studies of samples not selected on the basis of parental panic disorder are needed to confirm these results.
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Affiliation(s)
- Dina R Hirshfeld-Becker
- Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, United States.
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Hirshfeld-Becker DR, Biederman J, Henin A, Faraone SV, Micco JA, van Grondelle A, Henry B, Rosenbaum JF. Clinical outcomes of laboratory-observed preschool behavioral disinhibition at five-year follow-up. Biol Psychiatry 2007; 62:565-72. [PMID: 17306774 PMCID: PMC2018681 DOI: 10.1016/j.biopsych.2006.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [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: 03/20/2006] [Revised: 09/22/2006] [Accepted: 10/08/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Behavioral disinhibition refers to a temperamental tendency to exhibit boldness, approach, and spontaneity in unfamiliar situations. We previously found it to be associated with childhood disruptive behavior and mood disorders, as well as with parental bipolar disorder. In the present study, our objective was to examine the diagnostic outcome in middle childhood of behavioral disinhibition assessed at preschool age among offspring at risk for anxiety and mood disorders. METHODS The sample consisted of 284 children, including offspring of parents with panic disorder or major depression and comparison offspring of parents without these disorders, who had been assessed with laboratory observations of temperament at ages 21 months to 6 years. We reassessed 215 of the children (77%) at 5-year follow-up (mean age 9.6 years) with structured diagnostic interviews. RESULTS Compared with noninhibited, nondisinhibited control subjects, behaviorally disinhibited children had higher lifetime rates of comorbid mood plus disruptive behavior disorders and higher current rates of any disruptive behavior disorder and of oppositional defiant disorder. CONCLUSIONS Behavioral disinhibition appears to be a temperamental antecedent of disruptive behavior disorders and their comorbidity with mood disorders in middle childhood, which may be targeted for preventive intervention.
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Affiliation(s)
- Dina R Hirshfeld-Becker
- Pediatric Psychopharmacology Program, Massachusetts General Hospital, 185 Alewife Brook Parkway, Cambridge, MA 02138, USA.
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Brookman-Frazee L, Stahmer A, Baker-Ericzén MJ, Tsai K. Parenting interventions for children with autism spectrum and disruptive behavior disorders: opportunities for cross-fertilization. Clin Child Fam Psychol Rev 2006; 9:181-200. [PMID: 17053963 PMCID: PMC3510783 DOI: 10.1007/s10567-006-0010-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Empirical support exists for parent training/education (PT/PE) interventions for children with disruptive behavior disorders (DBD) and autism spectrum disorders (ASD). While the models share common roots, current approaches have largely developed independently and the research findings have been disseminated in two different literature traditions: mental health and developmental disabilities. Given that these populations often have overlapping clinical needs and are likely to receive services in similar settings, efforts to integrate the knowledge gained in the disparate literature may be beneficial. This article provides a systematic overview of the current (1995-2005) empirical research on PT/PE for children with DBD and ASD; attending to factors for cross-fertilization. Twenty-two ASD and 38 DBD studies were coded for review. Literature was compared in three main areas: (1) research methodology, (2) focus of PT/PE intervention, and (3) PT/PE procedures. There was no overlap in publication outlets between the studies for the two populations. Results indicate that there are opportunities for cross-fertilization in the areas of (1) research methodology, (2) intervention targets, and (3) format of parenting interventions. The practical implications of integrating these two highly related areas of research are identified and discussed.
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Affiliation(s)
- Lauren Brookman-Frazee
- Child & Adolescent Services Research Center, 3020 Children's Way MC 5033, San Diego, CA 92123, USA.
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Abstract
This study investigated associations between child temperament and DSM-IV disorders in children. A total of 156 probands (97 boys, 59 girls; mean age = 10.78 years) and 154 randomly selected siblings were assessed using the Junior Temperament and Character Inventory (JTCI) and a structured DSM-IV interview. Subjects were placed in nonoverlapping groups of (1) attention-deficit hyperactivity disorder (ADHD) only, (2) disruptive behavior disorders (DBD) only, (3) DBD plus an affective and/or anxiety disorder (DBD+Int), and (4) controls with no diagnosis. Many JTCI scales were found to differ between diagnostic groups and controls. Regression analyses showed independent associations between low persistence and ADHD-only group membership, high novelty seeking (NS), and the DBD-only group and between high harm avoidance (HA) and DBD+Int group membership. The interaction NS x HA was related to the ADHD-only group. Future research is needed to determine the mechanism of these association.
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Affiliation(s)
- David C Rettew
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, Vermont 05405, USA.
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