Long-term stability of the Child Behavior Checklist in a clinical sample of youth with attention deficit hyperactivity disorder

Associations between cortical thickness and anxious/depressive symptoms differ by the quality of early care

A variety of childhood experiences can lead to anxious/depressed (A/D) symptoms. The aim of the present study was to explore the brain morphological (cortical thickness and surface area) correlates of A/D symptoms and the extent to which these phenotypes vary depending on the quality of the parenting context in which children develop. Structural magnetic resonance imaging (MRI) scans were acquired on 45 children with Child Protective Services (CPS) involvement due to risk of not receiving adequate care (high-risk group) and 25 children without CPS involvement (low-risk group) (range_age = 8.08-12.14; M_age = 10.05) to assess cortical thickness (CT) and cortical surface area (SA). A/D symptoms were measured using the Child Behavioral Checklist. The association between A/D symptoms and CT, but not SA, differed by risk status such that high-risk children showed decreasing CT as A/D scores increased, whereas low-risk children showed increasing CT as A/D scores increased. This interaction was specific to CT in prefrontal, frontal, temporal, and parietal cortical regions. The groups had marginally different A/D scores, in the direction of higher risk being associated with lower A/D scores. Results suggest that CT correlates of A/D symptoms are differentially shaped by the quality of early caregiving experiences and should be distinguished between high- and low-risk children.

Behavioral Changes in Preschool- and School-Age Korean Children: A Network Analysis

The relationships between symptoms that comprise behavioral problems in children can be traced longitudinally to provide long-term support. This study identified signs that should be considered important in school age children by tracking changes in the relationships between different symptoms of behavioral problems in preschool and school age children. This study used Gaussian graphical network analysis to clarify the interaction of the overall subscales constituting the K-CBCL (Korean Child Behavior Checklist) and centrality in the network. In the Panel Study on Korean Children (PSKC), the K-CBCL/1.5–5 was used for children up to age six (first grade, elementary school), and the K-CBCL/6–18 was used for older children. In this study, 1323 PSKC samples (boys, n = 671; girls, n = 652) were used to distinguish nonclinical and (sub)clinical groups (T-score ≥ 60) compared to node centrality in each group’s CBCL subscale networks. Depression/anxiety was a persistent core symptom of the behavioral problem network in 5- and 7-year-old children. A new core symptom in 7-year-old children was posttraumatic stress problems added in version CBCL/6-18. Based on these results, it is necessary to consider both anxiety/depression and posttraumatic stress problems in preschool children to support the adaptation of school-age children.

Exploring the role of perceived vs. observed behavioral outcomes in parental grief reaction following pediatric acquired brain injury

BACKGROUND

Pediatric acquired brain injury may result in a significant gap between the "pre" and "post-injury" child.

OBJECTIVE

We aimed to quantitatively explore the mechanism underlying parents' loss experience by examining the mediating role of behavioral outcomes (observed-problems and perceived-change) in the relationship between injury severity and grief.

METHOD

The study employed a cross-sectional retrospective design and comprised 40 parents of children (aged 3-18 years) with moderate-severe brain injury. Data for each parent included an adapted version of the Two-Track Bereavement Questionnaire and Socio-demographics; Data for each child included the child's Information Processing Speed Index; the Child Behavioral Checklist and Parental Perception of Behavioral Changes scale.

RESULTS

Slowed information processing speed was significantly associated with elevated ratings on both measures of behavioral outcomes and with intensified grief. Mediation analyses revealed that parental perceived behavioral change, significantly mediate the relationship between information processing speed and grief; the Child Behavioral Checklist total score also mediated the same relationship but only in 90% confidence interval.

CONCLUSIONS

Findings reveal the adverse impact of behavioral outcomes on grief and suggest parents' loss experience to be stemming primarily from their subjective perception over their "changed-child", rather than the observed problems. Implications for clinical practice are discussed.

Family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD)

PURPOSE

To evaluate the associations between family structure, birth order, and aggressive behaviors among school-aged boys with attention deficit hyperactivity disorder (ADHD).

METHODS

We conducted a matched case-control study. Data were retrieved from medical records at a psychiatry center in northern Taiwan. School-aged boys with ADHD who first visited the outpatient department at the psychiatric center between 2000 and 2011 were identified. The Child Behavior Checklist was used for aggressive behavior assessment. Boys with ADHD with T scores higher than 70 on the aggressive subscale were classified as cases and others with T scores lower than 70 were classified as controls at a 1:4 ratio. After controlling for other familial, personal, and parental factors, a multivariate conditional logistic regression was performed to evaluate the effects of family structure and birth order on aggressive behaviors of boys with ADHD.

RESULTS

277 cases and 1108 controls were included in the final analysis. Compared with living in a traditional family with both parents, living in a non-traditional family in which one or both parents were absent increased the risk of aggressive behaviors by 1.47-fold, with the highest risk for those in single parent families. Being the firstborn increased risk by 1.45-fold and the risk was higher when the firstborn had siblings.

CONCLUSIONS

Living in non-traditional families in which one or both parents were absent, and being the firstborn increased risk of aggression in school-aged boys with ADHD. Identification of this high-risk population and development of adequate preventive strategies are warranted.

Measurement Based Care in Child Welfare-Involved Children and Youth: Reliability and Validity of the PSC-17

This study evaluates whether the psychometric properties of the Pediatric Symptoms Checklist-17 (PSC-17), a common behavioral health measure typically used as a dichotomous screening tool for mental health needs, support its use as a continuous measure for tracking behavioral health over time. A total of 6492 foster parents of children and youth aged 5.5-17 completed the PSC-17. Convergent and discriminant validity was assessed by comparing raw PSC-17 subscale scores with associated outcomes (e.g. psychiatric diagnoses). Long-term test-retest reliability was assessed over 6 months. Scores on the PSC-17 demonstrated good convergent and divergent validity. PSC-17 subscale scores were most strongly associated with analogous diagnoses. Test-retest reliability was moderate, as expected for a time window of this length. This study provides moderate support for the psychometric qualities of the PSC-17 when used with children and youth in the child welfare system as a continuous measure of psychosocial functioning over time.

Associations between cognition and internalizing problems in young adults with early-onset schizophrenia: A 13-year follow-up study

The present follow-up study examines the associations between cognition and parent-rated internalizing problems among adolescents with early-onset schizophrenia (EOS) at baseline (T1) and self-rated internalizing problems 13 years later (T2). Twelve individuals (8 male/4 female) with EOS and 30 healthy controls (16 male/14 female) were included in the study. All were between 12 and 18 years of age at T1. Internalizing problems were measured with the Achenbach System of Empirically Based Assessment Internalizing Scale. Cognition was examined with a neuropsychological test battery measuring auditory attention/working memory, visuomotor processing, cognitive flexibility and verbal memory. Compared to healthy controls, the EOS group had significant cognitive deficits and more internalizing problems both at T1 and T2. There was no correlation between parent-rated internalizing problems at T1 and self-rated internalizing problems at T2 in the EOS group. However, deficits in auditory attention/working memory at T1 were significantly associated with internalizing problems at T2. A focus on improving the treatment of cognitive impairments may be important in preventing the development of internalizing problems in young patients with schizophrenia. The small sample size of the study is a limitation and further research is recommended.

ADHD, learning difficulties and sleep disturbances associated with KCNJ11-related neonatal diabetes

OBJECTIVES

Mutations in KCNJ11 are the most common cause of permanent neonatal diabetes mellitus (NDM). Approximately 25% of patients have obvious neurological dysfunction, but whether milder related problems might be more common has been unclear. We sought to assess the prevalence of parental concerns about learning, behavior, attention deficit hyperactivity disorder (ADHD), social competency, and sleep in subjects with KCNJ11-related NDM compared to unaffected sibling controls.

STUDY DESIGN

Subjects or their guardians in the University of Chicago Monogenic Diabetes Registry completed a survey examining learning, behavior, ADHD and sleep. Thirty subjects with KCNJ11 -related NDM and 25 unaffected sibling controls were assessed. Data were analyzed using GraphPad Prism 6. Nonparametric analysis was performed using Fisher's exact test for group comparisons.

RESULTS

Thirteen (43%) individuals with KCNJ11 -related NDM had treatment for or a diagnosis of ADHD compared to two (8%) of the sibling controls (P < 0.05). Compared to their sibling controls, individuals with KCNJ11 mutations had significant differences in behavior difficulties, social awareness, academic achievement and the need for an Individualized Education Plan (IEP). As seen in other neurodevelopmental disorders, individuals with KCNJ11 mutations also had significantly higher rates of sleep difficulties (P < 0.01).

CONCLUSION

Patients with KCNJ11 -related NDM are at an increased risk for delays in learning, social-emotional and behavioral development, ADHD and sleep difficulties based on parent report. Early identification, along with integrated medical and developmental support, may promote better neurodevelopmental outcomes for this unique population. Further investigation utilizing detailed neuropsychological testing will better define the neurodevelopmental consequences of K_ATP mutations.

Cortical morphology as a shared neurobiological substrate of attention-deficit/hyperactivity symptoms and executive functioning: a population-based pediatric neuroimaging study

BACKGROUND

Attention-deficit/hyperactivity symptoms have repeatedly been associated with poor cognitive functioning. Genetic studies have demonstrated a shared etiology of attention-deficit/hyperactivity disorder (ADHD) and cognitive ability, suggesting a common underlying neurobiology of ADHD and cognition. Further, neuroimaging studies suggest that altered cortical development is related to ADHD. In a large population-based sample we investigated whether cortical morphology, as a potential neurobiological substrate, underlies the association between attention-deficit/hyperactivity symptoms and cognitive problems.

METHODS

The sample consisted of school-aged children with data on attention-deficit/hyperactivity symptoms, cognitive functioning and structural imaging. First, we investigated the association between attention-deficit/ hyperactivity symptoms and different domains of cognition. Next, we identified cortical correlates of attention-deficit/hyperactivity symptoms and related cognitive domains. Finally, we studied the role of cortical thickness and gyrification in the behaviour-cognition associations.

RESULTS

We included 776 children in our analyses. We found that attention-deficit/hyperactivity symptoms were associated specifically with problems in attention and executive functioning (EF; b = -0.041, 95% confidence interval [CI] -0.07 to -0.01, p = 0.004). Cortical thickness and gyrification were associated with both attention-deficit/hyperactivity symptoms and EF in brain regions that have been previously implicated in ADHD. This partly explained the association between attention-deficit/hyperactivity symptoms and EF (b_indirect = -0.008, bias-corrected 95% CI -0.018 to -0.001).

LIMITATIONS

The nature of our study did not allow us to draw inferences regarding temporal associations; longitudinal studies are needed for clarification.

CONCLUSION

In a large, population-based sample of children, we identified a shared cortical morphology underlying attention-deficit/hyperactivity symptoms and EF.

Behavioral and cognitive outcomes for clinical trials in children with neurofibromatosis type 1

OBJECTIVE

To evaluate the appropriateness of cognitive and behavioral outcome measures in clinical trials in neurofibromatosis type 1 (NF1) by analyzing the degree of deficits compared to reference groups, test-retest reliability, and how scores correlate between outcome measures.

METHODS

Data were analyzed from the Simvastatin for cognitive deficits and behavioral problems in patients with neurofibromatosis type 1 (NF1-SIMCODA) trial, a randomized placebo-controlled trial of simvastatin for cognitive deficits and behavioral problems in children with NF1. Outcome measures were compared with age-specific reference groups to identify domains of dysfunction. Pearson r was computed for before and after measurements within the placebo group to assess test-retest reliability. Principal component analysis was used to identify the internal structure in the outcome data.

RESULTS

Strongest mean score deviations from the reference groups were observed for full-scale intelligence (-1.1 SD), Rey Complex Figure Test delayed recall (-2.0 SD), attention problems (-1.2 SD), and social problems (-1.1 SD). Long-term test-retest reliability were excellent for Wechsler scales (r > 0.88), but poor to moderate for other neuropsychological tests (r range 0.52-0.81) and Child Behavioral Checklist subscales (r range 0.40-0.79). The correlation structure revealed 2 strong components in the outcome measures behavior and cognition, with no correlation between these components. Scores on psychosocial quality of life correlate strongly with behavioral problems and less with cognitive deficits.

CONCLUSIONS

Children with NF1 show distinct deficits in multiple domains. Many outcome measures showed weak test-retest correlations over the 1-year trial period. Cognitive and behavioral outcomes are complementary. This analysis demonstrates the need to include reliable outcome measures on a variety of cognitive and behavioral domains in clinical trials for NF1.

Intelligence, Attention, and Behavioral Outcomes in Internationally Adopted Girls with a History of Institutionalization

OBJECTIVE

The aim of this study was to investigate the association of neurocognitive functioning with internalizing and externalizing problems and school and social competence in children adopted internationally.

METHOD

Participants included girls between the ages of 6-12 years who were internationally adopted from China (n = 32) or Eastern Europe (n = 25) and a control group of never-adopted girls (n = 25). Children completed the Vocabulary and Matrix Reasoning subtests from the Wechsler Abbreviated Scale of Intelligence and the Score! and Sky Search subtests from the Test of Everyday Attention for Children. Parents completed the Child Behavior Checklist and the Home and Community Social Behavior Scales.

RESULTS

Compared to the controls, the Eastern European group evidenced significantly more problems with externalizing behaviors and school and social competence and poorer performance on measures of verbal intelligence, perceptual reasoning, and auditory attention. More internalizing problems were reported in the Chinese group compared to the controls. Using generalized linear regression, interaction terms were examined to determine whether the associations of neurocognitive functioning with behavior varied across groups. Eastern European group status was associated with more externalizing problems and poorer school and social competence, irrespective of neurocognitive test performance. In the Chinese group, poorer auditory attention was associated with more problems with social competence.

CONCLUSIONS

Neurocognitive functioning may be related to behavior in children adopted internationally. Knowledge about neurocognitive functioning may further our understanding of the impact of early institutionalization on post-adoption behavior.

Gap Effect Abnormalities during a Visually Guided Pro-Saccade Task in Children with Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that starts in early childhood and has a comprehensive impact on psychosocial activity and education as well as general health across the lifespan. Despite its prevalence, the current diagnostic criteria for ADHD are debated. Saccadic eye movements are easy to quantify and may be a quantitative biomarker for a wide variety of neurological and psychiatric disorders, including ADHD. The goal of this study was to examine whether children with ADHD exhibit abnormalities during a visually guided pro-saccadic eye-movement and to clarify the neurophysiological mechanisms associated with their behavioral impairments. Thirty-seven children with ADHD (aged 5–11 years) and 88 typically developing (TD) children (aged 5–11 years) were asked to perform a simple saccadic eye-movement task in which step and gap conditions were randomly interleaved. We evaluated the gap effect, which is the difference in the reaction time between the two conditions. Children with ADHD had a significantly longer reaction time than TD children (p < 0.01) and the gap effect was markedly attenuated (p < 0.01). These results suggest that the measurement of saccadic eye movements may provide a novel method for evaluating the behavioral symptoms and clinical features of ADHD, and that the gap effect is a potential biomarker for the diagnosis of ADHD in early childhood.

Children's emotional and behavioral problems and their mothers' labor supply

It has been documented that about 20% of children and adolescents suffer from a diagnosable mental or addictive disorder in the United States. The high prevalence of children’s emotional and behavioral problems (EBP) might have a negative effect on their mothers’ labor market outcomes because children with EBP require additional time for treatment. However, these children may require additional financial resources, which might promote mothers’ labor supply. Previous studies have only considered chronic conditions in analyzing the impact of children’s health on parental work activities. Moreover, most of these studies have not accounted for endogeneity in children’s health. This article estimates the effects of children’s EBP on their mothers’ labor supply by family structure while accounting for endogeneity in children’s health. We used the 1997 and 2002 Child Development Supplements (CDS) to the Panel Study of Income Dynamics (PSID). We used probit and bivariate probit models to estimate mothers’ probability of employment, and tobit and instrumental variable tobit models to estimate the effects of children’s EBP on their mothers’ work hours. Findings show negative effects of children’s EBP on their married mothers’ employment and on their single mothers’ work hours.

Cortical thickness and inattention/hyperactivity symptoms in young children: a population-based study

BACKGROUND

While many neuroimaging studies have investigated the neurobiological basis of attention deficit hyperactivity disorder (ADHD), few have studied the neurobiology of attention problems in the general population. The ability to pay attention falls along a continuum within the population, with children with ADHD at one extreme of the spectrum and, therefore, a dimensional perspective of evaluating attention problems has an added value to the existing literature. Our goal was to investigate the relationship between cortical thickness and inattention and hyperactivity symptoms in a large population of young children.

METHOD

This study is embedded within the Generation R Study and includes 6- to 8-year-old children (n = 444) with parent-reported attention and hyperactivity measures and high-resolution structural imaging data. We investigated the relationship between cortical thickness across the entire brain and the Child Behavior Checklist Attention Deficit Hyperactivity Problems score.

RESULTS

We found that greater attention problems and hyperactivity were associated with a thinner right and left postcentral gyrus. When correcting for potential confounding factors and multiple testing, these associations remained significant.

CONCLUSIONS

In a large, population-based sample we showed that young (6- to 8-year-old) children who show more attention problems and hyperactivity have a thinner cortex in the region of the right and left postcentral gyrus. The postcentral gyrus, being the primary somatosensory cortex, reaches its peak growth early in development. Therefore, the thinner cortex in this region may reflect either a deviation in cortical maturation or a failure to reach the same peak cortical thickness compared with children without attention or hyperactivity problems.

The implementation of life space crisis intervention in residential care and special education for children and adolescents with EBD: an effect study

When working with children and adolescents with emotional and behavioural disorders, conflicts are a part of daily life. At present, a variety of conflict resolution or conflict management programs, that can be divided into three categories, are described in the literature. A first category contains programs that focus on training for children and adolescents, and are often curriculum-based. The second category focuses on training for parents, and the third category contains programs that focus on training for professionals. The presents study was designed to evaluated the effectiveness of Life Space Crisis Intervention (LSCI), a therapeutic and verbal strategy developed by Long that fits into this third category of conflict management programs. Throughout a four-year project, al staff in a Flemish centre offering residential care and special education were trained in LSCI. On a yearly basis, data with regard to time in program, academic achievement, behavioural problems and anxiety problems were collected. The results show an increase in time spent in program and in academic achievement, and a decrease in youths' anxiety, indicating that the implementation of LSCI contributes constructively to the treatment of children and adolescents with EBD.

The validities and efficiencies of korean ADHD rating scale and korean child behavior checklist for screening children with ADHD in the community

OBJECTIVE

The purpose of this study is to examine the validity of primary screening tools for attention deficit hyperactivity disorder (ADHD) in a community-based sample of children using the Korean version of the Child Behavior Checklist (K-CBCL) and the Korean version of the ADHD Rating Scale (K-ARS).

METHODS

A large-scale community-based study for ADHD screening was conducted in the Jeollabuk province in the Republic of Korea. In 2010-2011, we surveyed a total of 49,088 first- and fourth-grade elementary school students. All of the participants in this study were assessed by the K-ARS-Parent version (K-ARS-P) and the K-ARS-Teacher version (K-ARS-T) as the primary screening instruments. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used for confirming the diagnosis of ADHD. DISC-IV was administered to subjects who received top 10% scores in the K-ARS-P or K-ARS-T tests.

RESULTS

Of the 3,085 subjects who completed the DISC-IV, 1,215 were diagnosed as having ADHD. A reasonable level of sensitivity, specificity, and negative predictive value were obtained when the total K-ARS-P scores were ≥90th percentile. The positive predictive value and specificity increased significantly when the total K-ARS-P scores were ≥90th percentile, T scores were ≥60 in the attention problems of K-CBCL, and T scores were ≥63 in the total problems of K-CBCL.

CONCLUSION

These results suggested that the K-ARS-P could effectively serve as a primary screening tool to identify elementary school children with ADHD in the community. Also, there might be some increment in the effectiveness of K-ARS-P when combined with K-CBCL-A and K-CBCL-T as a secondary screening tool.

Reliability of Autism-Tics, AD/HD, and other Comorbidities (A-TAC) inventory in a test-retest design

The Autism-Tics, AD/HD, and other Comorbidities (A-TAC) inventory is used in epidemiological research to assess neurodevelopmental problems and coexisting conditions. Although the A-TAC has been applied in various populations, data on retest reliability are limited. The objective of the present study was to present additional reliability data. The A-TAC was administered by lay assessors and was completed on two occasions by parents of 400 individual twins, with an average interval of 70 days between test sessions. Intra- and inter-rater reliability were analysed with intraclass correlations and Cohen's kappa. A-TAC showed excellent test-retest intraclass correlations for both autism spectrum disorder and attention deficit hyperactivity disorder (each at .84). Most modules in the A-TAC had intra- and inter-rater reliability intraclass correlation coefficients of > or = .60. Cohen's kappa indi- cated acceptable reliability. The current study provides statistical evidence that the A-TAC yields good test-retest reliability in a population-based cohort of children.

Adolescent and caregiver reports of ADHD symptoms among inner-city youth: agreement, perceived need for treatment, and behavioral correlates

OBJECTIVE

This study investigated adolescent and caregiver reports of ADHD symptoms in a sample of clinically referred inner-city adolescents.

METHOD

Participants (N = 168) included youth ages 12-18 (54% male, 98% ethnic minority) and their caregivers who each completed diagnostic interviews of ADHD symptoms and assessments of perceived need for ADHD treatment and correlated behavior problems.

RESULTS

Informants showed poor agreement on DSM-IV diagnostic categories and also dimensional scales, Inattention/Disorganization (I/D) and Hyperactivity/Impulsivity (H/I). Both caregiver and adolescent reports of I/D symptoms, but not H/I symptoms, were related to perceived need for ADHD treatment. Caregiver reports were linked to behavioral correlates typically associated with ADHD: I/D symptoms correlated with planning/organization and socioemotional deficits, and H/I symptoms correlated with externalizing and behavior regulation deficits. In contrast, adolescent reports of I/D were related to internalizing and externalizing problems, and their reports of H/I correlated with externalizing only. Few gender effects were found.

CONCLUSION

Study results underscore the developmental salience of I/D symptoms and have implications for ADHD diagnosis and treatment planning for adolescents.

Bidirectional relations between parenting practices and child externalizing behavior: a cross-lagged panel analysis in the context of a psychosocial treatment and 3-year follow-up

In the current study, we examined longitudinal changes in, and bidirectional effects between, parenting practices and child behavior problems in the context of a psychosocial treatment and 3-year follow-up period. The sample comprised 139 parent-child dyads (child ages 6-11) who participated in a modular treatment protocol for early-onset ODD or CD. Parenting practices and child behavior problems were assessed at six time-points using multiple measures and multiple reporters. The data were analyzed using cross-lagged panel analyses. Results indicated robust temporal stabilities of parenting practices and child behavior problems, in the context of treatment-related improvements, but bidirectional effects between parenting practices and child behavior were less frequently detected. Our findings suggest that bidirectional effects are relatively smaller than the temporal stability of each construct for school-age children with ODD/CD and their parents, following a multi-modal clinical intervention that is directed at both parents and children. Implications for treatment and intervention are discussed.

The Role of Obsessive-Compulsive Symptoms

Objective: The study examines the role of obsessive-compulsive symptoms (OCS) as a part of the psychopathology of children with chronic tic disorders (CTD) and/or attention-deficit hyperactivity disorder (ADHD). Method: We assessed the psychopathology of four large patient groups without further psychiatric disorders: CTD (n = 112), CTD + ADHD (n = 82), ADHD (n = 129), and controls (n = 144)) by implementing the Child Behavior Checklist (CBCL). We compared the main effects for CTD and ADHD with and without including OCS as covariates. Results: Including OCS led to substantially different main effects for CTD on seven out of eight CBCL subscales. Slightly different main effects for ADHD were determined with respect to ADHD, mainly on the subscale withdrawn. Conclusions: OCS are closely related to CTD-associated psychopathology and – to a lesser extent, but nevertheless of importance in daily clinical practice – on ADHD-related symptoms. This information can be helpful in implementing more precise diagnostics and treatment in daily routine care.

Shared and nonshared symptoms in youth-onset psychosis and ADHD

OBJECTIVE

We compared ratings of behavior and attention problems between youth-onset psychosis and ADHD, two disorders in which attentional impairments play a key role, and examined the effect of psychostimulant use on age of onset in psychosis.

METHOD

Parent and teacher ratings of behavioral problems and ADHD symptoms were collected using the Achenbach CBCL, TRF, and SNAP-IV Teacher Rating Scales on 42 participants with psychosis, 36 with ADHD and 57 controls (ages 8-19).

RESULTS AND CONCLUSIONS

Results suggested that academic, externalizing, and attention problems reflect symptoms shared between the disorders, whereas internalizing, social and thought problems reflect factors that differ between disorders. Furthermore, participants with psychosis who had been prescribed psychostimulants had a younger age of onset of psychotic symptoms than those who had not. This difference could reflect dissimilarities in symptom severity symptom between subgroups or potentially harmful effects of psychostimulants in individuals predisposed to develop psychosis.

The prevalence of specific phobia and associated co-morbid features in children and adolescents

OBJECTIVE

The aims of this study were to investigate the prevalence, associated co-morbid psychiatric disorders and behavioral/emotional problems associated with the subtypes of specific phobia in children and adolescents.

METHODS

A total of 2673 randomly selected children and adolescents from Seoul, Korea were assessed using the parent version of the Diagnostic Interview Schedule for Children (DISC-IV) and Children's Behavior Checklist (CBCL). We analyzed differences in psychiatric co-morbidities and CBCL profiles among the subtypes of specific phobia.

RESULTS

The 1-year prevalence of specific phobia was 7.9% (95% CI 7.63-8.17). Animal phobia was associated with anxiety disorder (OR 8.68, 95% CI 1.91-39.51) and oppositional defiant disorder (OR 2.55, 95% CI 1.27-5.12). Nature-environment phobia was associated with anxiety disorder (OR 25.70, 95% CI 6.16-107.10). Blood-injection-injury phobia showed associations with attention-deficit/hyperactivity disorder (ADHD: OR 6.74, 95% CI 2.81-16.15). Subjects with nature-environment phobia scored higher than did controls on the anxious/depressed, social problems, attention problems, and total behavioral problem profiles of the CBCL. Subjects with blood-injection-injury phobia scored significantly higher than did controls on the attention problems, aggressive behaviors, and externalizing problem profiles.

CONCLUSIONS

Contrary to animal phobias, nature-environment and blood-injection-injury phobias were associated with various behavioral and emotional problems and approximately correlated to their co-morbid psychiatric disorders. Among these subtypes, significant differences were found in demographic characteristics, co-morbid psychiatric disorders, and emotional/behavioral problems. These findings suggest that distinctive clinical characteristics might be related with different subtypes of specific phobia and clinician must consider psychiatric co-morbidities when treating children & adolescents with specific phobia.

Child behavior checklist clinical scales discriminate referred youth with autism spectrum disorder: a preliminary study

OBJECTIVE

To evaluate the properties of clinical scales of the Child Behavior Checklist in discriminating referred children with autism spectrum disorders (ASDs) (autistic disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified) from psychiatrically referred children without ASDs.

METHOD

Comparisons were made between children with ASDs (n = 65) with intelligence quotient >70 and children without ASDs (N = 83) on the clinical scales of the Child Behavior Checklist. Stepwise logistic regression was used to identify those scales that best predicted ASDs when compared with the non-ASD comparison group. Receiver operating characteristic curves examined the ability of the significant predictor T-scores to identify ASDs versus the non-ASD subjects.

RESULTS

Withdrawn, Social Problems, and Thought Problems T-scores were the best independent predictors of ASD status. The Withdrawn + Social + Thought Problems T-scores yielded an area under the curve of 0.86, indicating an 86% chance that a randomly selected sample of ASD subject will have abnormal scores on these scales than a randomly selected sample of non-ASD subjects.

CONCLUSION

These findings suggest that a new Child Behavior Checklist-ASD profile consisting of the Child Behavior Checklist-Withdrawn, Social, and Thought Problems scales could serve as a rapid and cost-effective screening instrument to help identify cases likely to meet clinical criteria for ASDs in the clinical setting.

Does oppositional defiant disorder have temperament and psychopathological profiles independent of attention deficit/hyperactivity disorder?

BACKGROUND

Most studies on temperamental and behavioral/emotional characteristics of oppositional defiant disorder (ODD) did not rule out the effect of comorbid attention-deficit/hyperactivity disorder (ADHD). The main objective of this study was to identify the temperamental and psychopathological patterns of ODD independent of comorbid ADHD. We also aimed to compare the patterns of temperament and psychopathology between ODD with and without ADHD.

METHOD

Parents of 2673 students, randomly selected from 19 representative schools in Seoul, Korea, completed the Diagnostic Interview Schedule for Children Version IV. Among 118 children and adolescents with ODD diagnosed by the Diagnostic Interview Schedule for Children Version IV, the parents of 94 subjects (mean age, 10.4 +/- 3.0 years) and the parents of a random sample of 94 age- and gender-matched non-ODD/non-ADHD children and adolescents completed the parent's version of the Child Behavior Checklist (CBCL) and the Junior Temperament and Character Inventory.

RESULTS

Subjects with ODD showed temperament and character profiles of high Novelty Seeking, low Self-directedness, and low Cooperativeness, a distinct pattern on the CBCL, and were at increased risk for anxiety and mood disorders compared to the controls after controlling for the effect of comorbid ADHD. The children and adolescents with both ODD and ADHD showed decreased levels of Persistence and Self-directedness and higher scores on 4 subscales of the CBCL (Anxious/Depressed, Attention Problems, Delinquent Behaviors, and Aggressive Behaviors) compared to those with ODD only.

CONCLUSIONS

Oppositional defiant disorder is associated with specific temperamental and behavioral/emotional characteristics, independent of ADHD. Moreover, the results of this study support that co-occurring ADHD and ODD have differentially higher levels of behavioral and emotional difficulties.

Effectiveness of behavioral parent therapy in preschool children with attention-deficit hyperactivity disorder

The purpose of this study was to assess the effectiveness of a behavioral parent therapy (BPT) program in children with attention-deficit hyperactivity disorder (ADHD) using multidimensional evaluations, the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). Between 2001 and 2005, the parents of 21 preschool children with ADHD were divided into six groups and participated in a series of 11 BPT sessions. Before and after BPT, the parents completed the CBCL, and the teachers completed the TRF. The behavioral and emotional problems of the children showed improvement after the BPT sessions, specifically for the following categories: internalizing problems, anxious/depressed syndromes, somatic complaints, externalizing problems, rule-breaking behaviors, aggressive behaviors, social problems, thought problems, and attention problems. In the DSM-oriented scale of the CBCL, affective problems, anxiety problems, somatic problems, ADHD problems, oppositional defiant disorder problems, and conduct disorder problems showed significant improvements. On the DSM scale of the TRF, Inattention syndrome improved significantly after the BPT sessions, while other syndromes showed non-significant changes. We conclude that the BPT program significantly improved the childrens behavioral problems at home and inattention problems at school.

Full syndrome and subthreshold attention-deficit/hyperactivity disorder in a Korean community sample: comorbidity and temperament findings

OBJECTIVE

The main objective of this study was to investigate the comorbid disorders and temperamental profiles of full syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD).

METHOD

A sample of 2,493 students was randomly selected from six representative elementary schools in Seoul, Korea. Among 245 children with full syndrome and subthreshold ADHD diagnosed by the diagnostic interview schedule for children-4th version, parents of 185 subjects (mean age 9.0 +/- 1.7 years) and of a random sample of 185 age- and gender-matched non-ADHD children have completed the parent's version of the children behavior checklist (CBCL) and the juvenile temperament and character inventory (JTCI).

RESULTS

The prevalence rates of full syndrome and subthreshold ADHD were, respectively, 5.90% (95% confidence interval = 4.74-7.06) and 9.00% (95% confidence interval = 7.58-10.41). Subthreshold ADHD cases did not differ from full syndrome ADHD in any JTCI profile, showing high novelty seeking/low persistence/low self-directedness than controls. Subthreshold ADHD also showed increased risk for externalizing disorders and higher scores in eight CBCL scales (somatic complaints, anxious/depressed, social problems, attention problems, delinquent behaviors, aggressive behaviors, externalizing problems and total behavioral problems) compared to the controls.

CONCLUSIONS

These results support the clinical relevance of subthreshold ADHD in Asian culture. Increased clinical awareness for children with subthreshold ADHD is needed.

Personality and psychopathology in Flemish referred children: five perspectives of continuity

The present study investigates five types of continuity of personality and internalizing and externalizing problems (i.e., structural, differential, mean-level, individual-level and ipsative continuity) in a sample of referred children and adolescents (N = 114) with a broad variety of psychological problems. Mothers were administered a child personality and psychopathology measure, i.e., the Hierarchical Personality Inventory for Children [Handleiding hiërarchische persoonlijkheidsvragenlijst voor kinderen (manual hierarchical personality inventory for children). Ghent University, Department of Developmental, Personality, and Social Psychology, Ghent, 2005] and the Child Behavior Checklist [Handleiding voor de cbcl/4-18: (Manual of the CBCL/4-18), Afdeling Kinder- en Jeugdpsychiatrie. Erasmus Universiteit Rotterdam, The Netherlands, 1996] at two measurement occasions, with a 26-months interval. Personality was substantially stable, paralleling findings for non-referred peers. Internalizing and Externalizing Problem Behavior were almost as stable as personality traits, suggesting that childhood psychopathology is more persistent than generally assumed. Strengths and limitations of the present study and implications for further research are discussed.

CBCL clinical scales discriminate ADHD youth with structured-interview derived diagnosis of oppositional defiant disorder (ODD)

OBJECTIVE

To evaluate the association between the clinical scales of the child behavior checklist (CBCL) and the comorbid diagnosis of oppositional defiant disorder (ODD) in a large sample of youth with attention deficit hyperactivity disorder (ADHD).

METHOD

The sample consisted of 101 girls and 106 boys ages 6 to17 with ADHD. Conditional probability analysis was used to examine the correspondence between CBCL Clinical Scales with the structured-interview derived diagnosis of ODD.

RESULTS

Conditional probability analysis showed that the CBCL Aggression Scale best predicted a structured-interview derived diagnosis of ODD in boys and girls with ADHD.

CONCLUSION

These findings suggest that the CBCL Aggression Scale could serve as a rapid and cost-effective screening instrument to help identify cases likely to meet clinical criteria for ODD in the context of ADHD

Emotional and behavioral characteristics over a six-year period in youths with persistent and nonpersistent dyscalculia

The authors examined behavior problems in a matched sample of 58 youths with persistent dyscalculia (PD) and nonpersistent dyscalculia (NPD). Participants were classified as having dyscalculia at age 10-11 years. Parents completed the Child Behavior Checklist for their children at ages 10-11, 13-14, and 16-17 years, while the youths did so at the last two age periods. Only at age 16-17 years were there significantly more problems, particularly attention problems and externalizing problems, reported by parents for PD youths compared to NPD youths. A higher percentage in the PD group than in the NPD group received scores in the clinical range for externalizing problems. However, the mean levels of behavior problems at this age and the earlier ages were within the normal range for both groups. For youth-reported problems, the only significant difference was for attention problems at 16-17 years. Therapeutic interventions should focus on the academic domain and improving and altering behavioral patterns.

Implementation and effect of life space crisis intervention in special schools with residential treatment for students with emotional and behavioral disorders (EBD)

The increase of violence in present-day society calls for adequate crisis interventions for students with behavioral problems. Life Space Crisis Intervention (LSCI) is a systematic and formatted response to a student's crisis, based on cognitive, behavioral, psychodynamic and developmental theory. The following research article evaluates a LSCI Program with students referred to special schools with residential treatment because of severe behavioral problems. The evaluation was conducted using a quasi experimental pre-test-post-test control group design. Thirty-one match paired students were pre-tested before the interventions started and post-tested after a period of 11 months. Five standardized questionnaires were examined to assess the effectiveness of the LSCI Program. General Linear Model (GLM) with repeated measures was used to analyze all data. For the total group of subjects (n = 62) it was found that students' perception about their athletic competence decrease significantly after 11 months in residential care. A positive effect of LSCI was found on direct aggression and social desirability.

Mother and Adolescent Reports of Interparental Discord among Parents of Adolescents with and without Attention-Deficit Hyperactivity Disorder

Evidence is scarce regarding the prevalence of interparental discord in families of adolescents with attention-deficit hyperactivity disorder (ADHD). Using data collected from adolescents with childhood ADHD and comorbid oppositional-defiant disorder (ODD; n = 46) or conduct disorder (CD; n =23), with childhood ADHD-only (n = 26), and without ADHD (n = 88), and their mothers, maternal and adolescent reports of interparental discord were compared. Adolescents with ADHD+CD reported witnessing more frequent and unresolved interparental conflict than adolescents without ADHD and with ADHD-Only. Adolescents with ADHD+CD also indicated more frequent conflict than adolescents with ADHD+ODD. However, differences in conflict resolution were nonsignificant when household income was covaried and maternal ratings of interparental discord did not differ across groups. Findings highlight the potential utility of adolescents with ADHD as informants of interparental relationship quality.

Familial transmission of derived phenotypes for molecular genetic studies of substance use disorders

Although family, twin, and adoption studies indicate that genes play a significant etiologic role in the development of substance use disorders (SUDs), detecting specific genes has been difficult due to uncertainties about how to define SUDs, genetic heterogeneity and variable phenotypic expression of SUD genotypes. We used data from families recruited into six contemporaneous studies of children and adults to derive candidate SUD phenotypes using principle factors factor analysis with varimax rotation. We previously found evidence of two SUD phenotypes in offspring: a psychopathology dimension and a cognitive impairment dimension. We found evidence for one SUD-related phenotype in adults that we term Psychopathology and Cognitive Impairment. Parental factor scores significantly predicted both offspring phenotypes, as well as parental SUD (OR=1.41, p<0.001) and offspring SUD (mother's phenotype: OR=1.34, p=0.04; father's phenotype: OR=1.33, p=0.01). Offspring phenotype predicted offspring SUD (psychopathology phenotype: OR=2.96, p<0.001; cognitive impairment: OR=1.33, p=0.04); in offspring, baseline psychopathology predicted SUD at follow-up assessments (OR=1.55, p=0.01). Results suggest that these candidate SUD phenotypes may be useful for genetic studies of SUD.

A cross-cultural comparison between samples of Brazilian and German children with ADHD/HD using the Child Behavior Checklist

INTRODUCTION

This study aims to assess cross-cultural similarities and differences in broadband psychopathology in two naturalistic clinical samples of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) combined type according to DSM-IV criteria or with Hyperkinetic Disorder (HD) according to ICD-10 criteria.

METHODS

We compared two clinical samples of children with ADHD combined type (Brazil, N=248) and HD (Germany; N=154) to controls (Brazil N=71; Germany N=135) using the Child Behavior Checklist (CBCL). ROC-curves (Receiver Operating Characteristic) were determined to evaluate the discriminating validity of the CBCL Attention Problem scale. A two-factorial ANOVA was computed across all 8 scales of the CBCL.

RESULTS

Although Brazilian parents reported significantly higher scores on all CBCL scales than German parents (P<0.05), a similar CBCL profile was detected in both cultures.

CONCLUSION

Despite the use of different diagnostic systems (DSM-IV vs. ICD-10) and the presence of other clinical differences, the similar broadband psychopathological profile of the CBCL in the two samples provides evidence that dimensional symptoms associated with the categorical diagnosis of ADHD combined type might be comparable in two clinical settings with diverse cultural background.

Attention problems in very low birth weight preschoolers: are new screening measures needed for this special population?

PROBLEM

Children born prematurely have been shown to have a range of problems that often result in delayed academic achievement.

METHODS

The current study assessed both attention problem scores (Child Behavior Checklist) and actual performance on tasks tapping three attention networks in a sample of children (n = 94) born with very low birth weights (VLBW; < or = 1500 grams).

FINDINGS

Attention problem scores were extremely low and did not predict children's actual attention performance.

CONCLUSIONS

A body of research is developing that suggests VLBW children may have specific, yet subtle, attention problems that may differ from those of other children.

Deriving phenotypes for molecular genetic studies of substance use disorders: a family study approach

Although, family, twin, and adoption studies indicate that genes play a significant etiologic role in the development of substance use disorders (SUDs), the specific genes involved have been difficult to detect due, in part, to uncertainties about how best to define SUDs, the possibility of genetic heterogeneity and the variable phenotypic expression of SUD genotypes. The goal of the present work was to determine if phenotypes external to the diagnosis of SUD such as psychopathology and cognitive functioning would show evidence of utility as phenotypes for genetic studies of SUD. We did this by applying factor analysis to multiple measures collected from our family-study program and then determining if these factors were heritable and were co-familial with SUDs. We used data from families recruited into six contemporaneous studies of four psychiatric conditions in children and adults. We found evidence for two SUD related phenotypes. One was an index of Psychopathology and Psychosocial Impairment; the other was an index of school failure and cognitive dysfunction. Both factors showed evidence of heritability, longitudinal stability and familial association with Parental SUD but these findings were stronger for the index of school failure and cognitive dysfunction. Results provide some support for the idea that candidate SUD phenotypes such as psychopathology and cognitive functioning, which are external to the diagnostic criteria for SUDs, may be useful for genetic studies of SUD.

Manic symptoms and behavioral dysregulation in youth with velocardiofacial syndrome (22q11.2 deletion syndrome)

Mania and bipolar disorder have been reported in adolescents and adults with velocardiofacial syndrome (VCFS; also known as 22q11.2 deletion syndrome). Children with VCFS have a high prevalence of attention-deficit/hyperactivity disorder (ADHD), which may constitute a risk factor for the eventual development of bipolar disorder in this population. Therefore, we sought to determine whether children with VCFS exhibit more manic symptoms than community controls that also may have learning disorders and ADHD. The study population consisted of 86 children with VCFS and 36 community controls from ages 9 to 15 years, using measures of Young Mania Rating Scale-Parent Version, Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), Child Behavior Checklist (CBCL), and Wechsler Intelligence Scale for Children-3rd edition (WISC-III). The results indicate that manic symptoms were not more prevalent in VCFS than in a community sample of children with learning disorders and ADHD. However, after accounting for symptoms of depression and ADHD, we found that manic symptoms in VCFS predicted uniquely to scores on four Child Behavior Checklist (CBCL) subscales, including anxiety, somatization, thought, and conduct problems. In contrast, manic symptoms in controls predicted uniquely to conduct problems only. Accordingly, our findings of severe behavioral impairment in youth with VCFS and manic symptoms suggest that these children may warrant more intensive monitoring and treatment relative to youth with VCFS and ADHD only.

Comparison of the Child Behavior Checklist Profiles between community- and clinic-based children with attention deficit hyperactivity disorder in Korea

OBJECTIVE

The aim of this study was to examine whether there is a difference in the behavioural characteristics of community- and clinic-based children with attention-deficit hyperactivity disorder (ADHD) in Korea.

METHOD

The study included 75 community-based and 72 clinic-based subjects with ADHD. The parents of all the children completed the parent versions of the Child Behavior Checklist (CBCL).

RESULTS

The community-based ADHD subjects scored significantly higher (P < 0.01) than clinic-based subjects in the Somatic Complaints and Delinquent Behaviour profiles of the CBCL. The community-based subjects with ADHD, combined subtype, showed significantly higher mean scores in the Somatic Complaints (P < 0.01) and Thought Problems (P < 0.05) profiles than the clinic-based subjects with ADHD, combined subtype.

CONCLUSION

These findings suggest the possibility of an increased incidence of behavioural or emotional problems in community-based ADHD subjects when compared with clinic-based subjects in Korea.

Psychopathological profile in children with chronic tic disorder and co-existing ADHD: additive effects

The nature of the co-occurrence of chronic tic disorders (CTD) and attention deficit hyperactivity disorder (ADHD) is unclear. Especially in the field of psychopathology, the relationship of CTD and ADHD remains to be clarified. Thus, the aim of the present chart review study was to specify the contribution of CTD and/or ADHD to the psychopathological profile of the comorbid group (CTD+ADHD). The psychopathological profiles of four large groups (CTD-only (n=112), CTD+ADHD (n=82), ADHD-only (n=129), controls (n=144)) were measured by the eight subscales of the Child Behavior Checklist (CBCL) and analyzed by a 2x2 factorial design followed by contrasts. There were main effects of ADHD diagnosis on all but one subscale of the CBCL (Somatic Complaints). For CTD diagnosis, main effects were found for Attention Problems, Anxious/Depressed, Thought Problems, Social Problems and Somatic Complaints. The only interaction effect was seen for Somatic Complaints. While CTD and ADHD were both related to internalizing psychopathology of children in the CTD+ADHD group, ADHD had the largest effect on externalizing psychopathology in the comorbid group. At the level of psychopathology, an additive model for the co-occurrence of CTD and ADHD is strongly supported. In the comorbid group (CTD+ADHD), the ADHD diagnosis shows the strongest relation to externalizing psychopathology.

The CBCL as a screen for psychiatric comorbidity in paediatric patients with ADHD

AIMS

To examine the informativeness of the Child Behavior Checklist (CBCL) as a screening tool to identify comorbid and non-comorbid cases of attention deficit hyperactivity disorder (ADHD) in a paediatrically referred population. It was hypothesised that specific scales of the CBCL would help identify specific comorbidities within ADHD cases in the primary care setting.

METHODS

The sample consisted of children and adolescents 6-17 years old of both genders with ADHD (n = 121). A receiver operating curve (ROC) approach was used to determine which CBCL scales best differentiated between ADHD cases with and without its comorbidities with conduct, anxiety, and mood disorders.

RESULTS

ROC analysis showed that the CBCL Delinquent Behavior and Aggressive Behavior scales predicted the structured interview derived diagnoses of conduct and bipolar disorder, the Anxious/Depressed and Aggressive Behavior scales predicted major depression, and the Anxious/Depressed and Attention problems scales predicted anxiety disorders.

CONCLUSIONS

These results extend to a paediatrically referred population with previously reported findings in psychiatric samples documenting good convergence between structured interview diagnoses and syndrome congruent CBCL scales. These findings support the utility of the CBCL as a screening tool for the identification of psychiatric comorbidity in ADHD youth in the primary care setting.

The child behavior checklist together with the ADHD rating scale can diagnose ADHD in Korean community-based samples

OBJECTIVE

The purpose of this study was to examine the clinical validities and efficiencies of the Child Behavior Checklist (CBCL) and the ADHD Rating Scale-IV (ARS) in identifying children with attention-deficit hyperactivity disorder (ADHD) in Korean community-based samples.

METHOD

A large sample of elementary school students (n = 1668) participated in this study. We used the CBCL and the ARS as the screening instruments. Diagnoses were determined by clinical psychiatric interviews and confirmed by DSM-IV-based structured interviews.

RESULTS

Of the 46 subjects who underwent clinical psychiatric interviews, 33 were diagnosed as having ADHD. A T score of 60 with regard to the Attention Problems profile of the CBCL resulted in a reasonable level of sensitivity or positive predictive value in the diagnosis of ADHD. In both the parent and teacher reports of the ARS, 90th percentile cut-off points resulted in a high level of predictive value. The highest levels of specificity and positive predictive value were obtained when we combined the CBCL (T > or = 60 in Attention Problems) and the ARS (parent-teacher total > or = 90th percentile) reports.

CONCLUSIONS

These findings suggest that the combined use of the CBCL and the ARS could serve as a rapid and useful clinical method of predicting or even diagnosing children with ADHD in epidemiologic case definitions.

The course of neuropsychological functions in children with attention deficit hyperactivity disorder from late childhood to early adolescence

OBJECTIVE

The aim of this follow-up study was to investigate the course of performance in attentional tasks in children with ADHD and normal controls in late childhood and preadolescence over short periods of time. The development of two dimensions of attention was compared: alertness/arousal and inhibitory control.

METHOD

Children with ADHD (N=28) and normal controls (N=25) were examined at three times: at baseline (age mean=10.8 years, SD=1.5), after one year (age mean=12.0 years, SD=1.6), and after 2.6 years (age mean=13.3 years, SD=1.6). They performed two tasks of a computerized battery for attentional performance: Alertness--a test of simple reaction time to visual stimuli contrasting a condition with and without auditory warning signal, and Incompatibility--a test of spatial interference/inhibitory control. Clinical diagnosis according to DSM-III-R criteria was established at time 1 and time 3 by structured diagnostic interviews.

RESULTS

In the Alertness task significant group differences regarding increased reaction time variability in ADHD, but not for reaction time itself, were found at time 1 and more pronounced at time 2. At time 3 group differences had disappeared. In the Incompatibility task group differences in number of errors were not observed at time 1, whereas children with ADHD made significantly more errors at time 2 and less pronounced at time 3. The degree of clinical symptom remission after 2.6 years was not related to changes in neuropsychological performance.

CONCLUSION

When measuring attentional functions, the selection of an appropriate time window seems to be essential for the detection of group differences between ADHD children and controls, because group differences are most pronounced before adolescence. The different developmental course of selective components of attention should be taken into account.

Behavioural problems and psychiatric symptoms in 5-13 year-old Swedish children-a comparison of parent ratings on the FTF (Five to Fifteen) with the ratings on CBCL (Child Behavior Checklist)

As part of the validation procedure of a new parent questionnaire ("Five to Fifteen" or the FTF) a random sample of 1500 children aged 5-13 years from the Swedish Population Register (SPAR) was approached. The FTF and the Child Behavior Checklist (CBCL) were sent to the parents of the children together with questions about background conditions. After two reminders the response rate was 55.6%. The final sample had a mean age of 9.12 years (SD=1.89) and a sex distribution with 55% boys and 45% girls. Analysis of attrition did not support overrepresentation of foreigners/immigrants in the attrition population. FTF like CBCL showed sensitivity to sociodemographic variables. On the FTF fewer problems were indicated for girls in all domain scales, whereas this was true for the summary scale Externalizing and Mixed problems of the CBCL. The effects of age and area of residence were slight, but parental education was negatively related to all domain scales of the FTF and to all the CBCL scales. The intercorrelations of the FTF and CBCL scales with common content showed substantial overlap supporting the validity of the FTF scales. The correlation between scales within the FTF however also indicates a substantial comorbidity. This is also supported by the substantial correlation between problem score of the FTF domains perception, language, motor skills and the CBCL scale scores Attention, Social problems as well as the summary scale Mixed problems. These findings indicate that problems with inattention and social relations are shared across the various problem domains. Factor analysis of the FTF subdomain scores resulted in two factors, one representing learning problems and the other behavioural/emotional problems. Despite the low response rate the representativity of the sample was supported by the fact that the total problem score of CBCL was very similar to that of another Swedish sample with a relatively high response rate. The finding of a frequency of AD/HD symptoms in the FTF rating corresponding to the figures of prevalence of AD/HD in several international epidemiological studies could also be seen as support for the relevance of the findings. Thus, the results give support to the usefulness of the FTF questionnaire as an instrument that can help in delineating specific problem areas within the field of child neuropsychiatry. Through the comparison with the CBCL the validity of the FTF for the parts that the two instruments share could be ascertained and the value of tapping a broader problem area could be elucidated.

Clinical course of attention-deficit/hyperactivity disorder from childhood toward early adolescence

OBJECTIVE

To study the course of attention-deficit/hyperactivity disorder (ADHD) in late childhood to adolescence using a multi-informant and multi-assessment procedure.

METHOD

Subjects were 35 children with ADHD and 35 matched controls with a mean age of 10 years at first assessment. DSM-III-R-based structured diagnostic interviews and behavioral questionnaires based on parents, teachers, and youth informants were used. Cross-informant behavioral syndromes were obtained by use of the Child Behavior Checklist, the Teacher's Report Form, and the Youth Self-Report. Subjects were reassessed after 1.5 and 2.6 years.

RESULTS

Behavioral differences between the two groups were significant for the majority of scales for all three informants at all three times. Diagnostic interviews revealed a persistence rate of 46% over 2.6 years. However, there were only few significant behavioral differences across informants between the nonpersistent and the persistent groups. The fit between interview-derived syndrome scores reflecting subtypes of ADHD and both parents and youth questionnaire data was good, whereas for the teacher ratings it was poor. A high rate of 89% correct classification of the outcome diagnoses was possible based on behavioral data at time 1.

CONCLUSIONS

The study of the course of ADHD should be based both on interview and questionnaire data and should include several informants. Operationally defined diagnoses alone may lead to an underestimation of persistent behavioral problems.