A four-fold model for subgrouping the hyperkinetic/MBD syndrome

The major finding of this study is that the presence or absence of aggressive symptomatology differentiates a group of 84 six to twelve year-old Hyperkinetic/MBD boys on a number of important measures at initial referral, during treatment with methylphenidate, and at subsequent five-year-follow-up. When the sample is sorted into high and low aggression groups, several findings emerge which would otherwise have been obscured. Furthermore, there are no significant interactions between aggression (control deficits, negative affect, aggressive interpersonal behavior) and hypertactivity (judgment deficits, hyperactivity, inattention). The value of differentiating between exclusive hyperactivity with aggression) is indicated by the present study.

Stimulant treatment in young boys with symptoms suggesting childhood mania: a report from a longitudinal study

This study used data from a completed longitudinal study to examine the effects of methylphenidate on 6-12-year-old boys presumably at risk for bipolar disorder. Of 75 boys referred, diagnosed with hyperkinetic reaction of childhood (minimal brain dysfunction), treated clinically with methylphenidate, and followed as young adults, 23% (the maximorbid or MAX group) had childhood symptoms of irritability and emulated DSM-IV diagnoses of attention deficit hyperactivity disorder (ADHD), plus oppositional defiant or conduct disorder (ODD/CD) and anxiety or depression or both. The remaining boys (the minimorbid or MIN group) had fewer symptoms and disorders. MAX and MIN groups did not differ in rated response to methylphenidate, duration of treatment, clinically determined maintenance doses, concurrent or subsequent treatment with other medications, or other aspects of medication experience. At ages 21-23, individuals with bipolar-related lifetime diagnoses (adult mania, hypomania, or cyclothymia) did not differ from those without bipolar-related diagnoses in any aspect of early methylphenidate treatment history. These findings indicate that ADHD boys with symptoms suggesting childhood mania do not respond differently to methylphenidate than boys without such symptoms, and there is no evidence here that methylphenidate precipitates young adult bipolar disorders in susceptible individuals.

Predictors of adult height and weight in boys treated with methylphenidate for childhood behavior problems

OBJECTIVE

To examine associations between childhood treatment with methylphenidate (MPH) and adult height and weight.

METHOD

Subjects were 97 boys, aged 4 to 12 years, with behavior problems who were (1) referred to a child psychiatry outpatient clinic, (2) treated clinically with MPH for an average of 36 months, and (3) reevaluated between ages 21 and 23 years. Hierarchical analyses predicted adult height and weight from sets of non-medication and medication-related variables.

RESULTS

Medicated subjects' age, height, and parental socioeconomic status (SES) at referral predicted 44.8% of variation in adult height. Medicated subjects' birth weight, age, height and weight at referral, and parental SES predicted 61.8% of variation in adult weight. With these non-medication variables held constant, initial nausea and vomiting side effects predicted 4.4% incremental variation in adult height, and MPH maintenance dose predicted 3.2% incremental variation in adult weight.

CONCLUSIONS

Medicated individuals who had attained their final stature did not differ in average height or weight from family, community, or unmedicated controls. Most aspects of medication were not associated with adult height or weight. In some individuals, nausea and vomiting side effects and treatment with higher doses of MPH were associated with adult growth decrements.

Utility of behavior ratings by examiners during assessments of preschool children with attention-deficit/hyperactivity disorder

This study examines the clinical utility of behavior ratings made by nonclinician examiners during assessments of preschool children with Attention-Deficit/Hyperactivity Disorder (AD/HD). Matched samples of children with (n = 127) and without (n = 125) AD/HD were utilized to test the internal, convergent, concurrent, and incremental validity of ratings completed by examiners on the Hillside Behavior Rating Scale (HBRS). Results indicated that HBRS ratings were internally consistent, possessed sufficient interrater reliability, and were significantly associated with parent and teacher reports of AD/HD when controlling for age, gender, intelligence, and symptoms of other psychopathology. HBRS ratings also were significantly associated with other measures of functioning, and provided a significant increment in the prediction of impairment over parent and teacher report alone. These findings suggest that behavioral ratings during testing provide a unique source of clinical information that may be useful as a supplement to parent and teacher reports.

Childhood inattention-overactivity, aggression, and stimulant medication history as predictors of young adult outcomes

This study examined the contributions of childhood symptom dimensions and aspects of methylphenidate (MPH) treatment to the prediction of young adult outcomes in boys who were referred to a child psychiatry outpatient clinic. They were diagnosed with hyperkinetic reaction of childhood/minimal brain dysfunction, and given MPH for an average of 30 months. Including significant effects and statistical trends, childhood Inattention-Over-activity was uniquely associated with fewer than 10% of adult outcomes such as schizotypic features, impairment on the Global Assessment Scale (GAS), and unemployment. Childhood aggression was uniquely associated with 38% of adult outcomes such as lifetime diagnoses of major depression, drug abuse disorder, and antisocial personality disorder; MMPI PD, PA, and SC scores; and six additional measures of adult impairment and life circumstances-extending external validation of the two-factor model to young adulthood. For 20 young adult outcomes (63%), aspects of childhood treatment with MPH had no lasting effects. For one adult outcome (3%), a lasting negative effect of childhood drug treatment was found; better initial response to medication was associated with not graduating from high school. For 11 young adult outcomes (34%), however, aspects of childhood MPH treatment had positive effects that lasted long after treatment was discontinued. Higher dosage was associated with fewer diagnoses of alcoholism or suicide attempts. Better response to medication was associated with lower MMPI D scores and better social functioning. Longer medication duration was associated with fewer schizotypic features, lower MMPI MA scores, higher WAIS Performance and Full Scale IQs, and better WRAT Reading and Arithmetic performance.

Young referred boys with DICA-P manic symptoms vs. two comparison groups

A total of 23 boys met DICA-P manic symptom and clustering criteria in a diagnostic investigation of 233 outpatient boys between ages 6 and 10. In this manic-symptom group, the most frequently endorsed of an average of five manic symptoms were extreme mood changes, difficulty concentrating, feeling too 'up' to sit still, and racing thoughts. Comparison groups were 23 non-manic boys seen next in the investigation and 23 non-manic boys matched to the manic-symptom boys on symptoms of three comorbid disruptive disorders (ADHD, ODD and CD). Manic-symptom boys differed significantly from next-seen boys, but not from matched comorbid boys, in number of oppositional symptoms and pervasiveness of problems. Manic-symptom boys differed significantly from next-seen boys on six of eight mother-rated RCBCL factors. In contrast, manic-symptom and matched comorbid boys did not differ on any of eight RCBCL factors, which suggests that the RCBCL differences can be attributed to shared ADHD, ODD and/or CD. However, manic-symptom and matched comorbid boys tended to differ on RCBCL Anxiety/Depression. On the teacher-rated TRF, manic-symptom boys were rated higher than next-seen boys on four internalizing factors, and higher than matched comorbid boys on two of those factors, including Anxiety/Depression. Thus, manic symptomatology also predicted substantial emotionality, which was not a controlled comorbidity. The findings of this and other studies suggest that there is a mania dimension or syndrome, which may be an indicator of true bipolar disorder--or simply a marker for disruptive comorbidity, behavioral and emotional multimorbidity, or general severity of psychopathology.

Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children

OBJECTIVE

Little is known about the validity of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children. Moreover, the results of the DSM-IV field trials raised concerns that inclusion of the new predominantly hyperactive-impulsive type of ADHD in DSM-IV might increase the likelihood of the diagnosis being given to active but unimpaired preschool and primary school children.

METHOD

The validity of DSM-IV criteria for each subtype of ADHD was evaluated in 126 children, aged 4 through 6 years, and 126 matched comparison children. Probands and controls were classified by using structured diagnostic interviews of the parent and a DSM-IV checklist completed by the teacher.

RESULTS

Children who met DSM-IV criteria for each subtype of ADHD according to parent and teacher reports differed consistently from controls on a wide range of measures of social and academic impairment, even when other types of psychopathology and other potential confounds were controlled.

CONCLUSIONS

When diagnosed by means of a structured diagnostic protocol, all three DSM-IV subtypes of ADHD are valid for 4- through 6-year-old children in the sense of identifying children with lower mean scores on measures of adaptive functioning that are independently associated with ADHD.

Associations between clinic-referred boys and their fathers on childhood inattention-overactivity and aggression dimensions

The question asked in this study of 70 clinically referred 6- to 12-year-old boys with behavior problems was whether or not childhood inattention-overactivity and aggression are transmitted specifically from biological fathers to sons. Fathers' self-reported childhood inattention-overactivity on a retrospectively valid measure was exclusively associated with parents' ratings of their sons' current attention problems on the Mothers' Operational Measure for Subgrouping (MOMS), the Revised Child Behavior Checklist (RCBCL), and an approximated DSM-IV inattention dimension. Fathers' self-reported childhood aggression was not associated with ratings of their sons' aggression on the MOMS or DADS (a parallel instrument for fathers), nor on DSM-III oppositional or conduct disorder dimensions, but it was exclusively associated with RCBCL ratings of sons' aggressive and delinquent behavior. None of the nonspecific correlations (father inattention-overactivity with son aggression or father aggression with son inattention-overactivity) was significant.

External validation of oppositional disorder and attention deficit disorder with hyperactivity

Validity of the distinction between oppositional disorder (OD) and attention deficit disorder with hyperactivity (ADDH) was examined in a sample of 6- to 12-year-old boys with behavior problems. Problem identification, cognitive/attentional, family context, and behavioral symptom differences were examined among nine boys with OD only, 20 with ADDH, 40 with comorbid OD and ADDH, and 28 with neither disruptive behavior disorder. Systematic comparisons of groups including and excluding the OD and ADDH diagnoses were undertaken to determine the existence of pure OD and pure ADDH disorder effects. The most consistent result was the lack of evidence for either pure OD or pure ADDH effects. Most of the significant findings reflected differences between the nondisruptive (neither) and comorbid groups. The results support the importance of comorbidity, but they provide little support for disorder-specific distinctions between oppositional and attention deficit disorders.

Enzyme activity and behavior in hyperactive children grown up

Thirty-one men, originally seen as children for problems with overactivity, distractibility, and impulsiveness, were reevaluated at ages 21-23 years. Subjects were interviewed and tested and provided a blood sample for analyses of dopamine-beta-hydroxylase (DBH), monoamine oxidase (MAO), and catechol-O-methyl-transferase (COMT). A series of Pearson correlations between the biological variables and psychological measures revealed that MAO levels were negatively associated with measures of drug involvement, cigarette use, fire-setting, and sensation seeking; DBH levels were positively associated with measures of sensation-seeking; and COMT levels were negatively associated with a measure of hostility and positively correlated with a measure of impulsiveness.

Discovering the voice in the children's museum

The authors report on a special section of a Children's Museum which is designed to involve the child and parent in actively learning about vocal function. This approach is recommended as an excellent way to promote interest in healthy vocal function.

Cortical atrophy in young adults with a history of hyperactivity in childhood

A computed tomographic (CT) brain scan study was conducted in 24 young males treated and followed up for hyperactivity since childhood. Compared to 27 matched controls, adults with a history of hyperactivity had a significantly greater frequency of cerebral atrophy. No differences in cerebellar atrophy frequency or in lateral cerebral ventricle-to-brain ratio (VBR) were found. The possible associations of hyperactivity or perhaps stimulant drug treatment to atrophic brain changes are discussed.

A multitrait-multimethod analysis of variance of teachers' ratings of aggression, hyperactivity, and inattention

The convergent and discriminant validities of three teacher rating scale measures of the traits of hyperactivity, aggression, and inattention were explored, using the multitrait-multimethod matrix approach of Campbell and Fiske (1959), as well as an analysis of variance procedure (Stanley, 1961). In the present study teachers rated children from their elementary school classrooms on the above traits. The results provided strong evidence for convergent validity. Data also indicated that these traits can be reliable differentiated by teachers, suggesting that research aimed at better understanding the unique contributions of hyperactivity, aggression, and inattention is warranted. The respective benefits of analyzing multitrait-multimethod matrices by employing the ANOVA procedure or by using the Campbell and Fiske (1959) criteria were discussed.

Hyperkinesis comes of age: what do we know and where should we go?

The first heuristic description of the hyperkinetic impulse disorder made its appearance in the literature just over twenty years ago. Although there are many who are made restless and irritable by continuing ambiguities and controversies surrounding the hyperkinetic syndrome, the past two decades have brought considerable maturation in our knowledge of this concept. The present paper sketches the state of the art in regard to hyperkinesis, and draws conclusions about directions for both research and clinical work.

Comparing psychological and pharmacological treatments for hyperkinetic boys and their classmates

This study compares the short-term effects of methylphenidate and of teacher consultation on the on-task behavior of diagnosed hyperkinetic outpatient boys and selected classmates. Statistically significant treatment effects were found for both drug-treated and behaviorally treated hyperkinetic boys; the size of these effects did not differ between the two types of treatment. Within the behavioral group, the treatment effect spilled over, so that there was also a significant treatment effect on overactive classmates of the behaviorally treated hyperkinetic children and a trend toward a significant treatment effect on their average classmates. Some implications of the findings are discussed.

Hyperkinetic/aggressive boys in treatment: predictors of clinical response to methylphenidate

Data on 84 nonretarded boys aged 6--12 with the hyperkinetic/MBD syndrome were drawn from a comprehensive, longitudinal investigation in the interest of identifying factors that contribute significantly to variation in clinically rated improvement during treatment with methylphenidate. The size of the multiple correlation (R = .50) indicates that 25% of the variation in the children's response to methylphenidate is jointly predictable from age at referral, degree of perinatal complications, and score on the hyperactivity factor. The authors discuss stepwise multiple regression analysis as the method of choice in drug response prediction studies and the possible effects on the results of such studies of differing definitions of improvements.

Responses of hyperactive boys to a behaviorally focused school attitude questionnaire

The Teacher Approval-Disapproval Scale was administered to three groups of elementary school boys: those considered by a teacher as hyperactive and referrable; those considered as among the most active but not referrable; and normoactive classmates. The three groups of boys differed significantly in their responses to 8 of 11 individual scale items, which ask the child about the amount of teacher approval and disapproval directed toward himself personally or about the frequency of his own happiness and unhappiness in the classroom. The three groups of boys differed significantly on only 2 of 11 countepart class items, which ask the child about teacher behaviors toward the class as a whole or about the happiness and unhappiness of the entire class. The hyperactive boys said they received significantly less approval from m teachers from academic, motivational, and social behaviors than did the normoactive boys and significantly more general disapproval. The present study is among the few that report differences between hyperactive and comparison groups on self-report questionnaires. The results suggest that what appears to be greater teacher disapproval of boys than of girls may in fact be simply greater teacher disapproval of children with disruptive behavior problems, most of whom are boys.

Familial alcoholism in anorexia nervosa

Few studies have been published about psychiatric illness among relatives of patients with anorexia nervosa. Even less information is available concerning alcohol abuse in relatives of such patients. Theander (10) found a 2.5 per cent incidence of alcohol abuse among uncles and aunts of patients with anorexia nervosa. Six out of 94 fathers, 6.5 per cent, were alcohol abusers, whereas none of the 94 mothers so indulged. In a recent report of 13 male cases of anorexia nervosa Crisp and Toms (3) describe one father who was a severe alcoholic. Kay and Leigh (6), in a study of 38 patients with anorexia nervosa, noted alcoholism in four parents out of a total of 76 (5 per cent). Alcoholism in actual anorexia nervosa patients has been mentioned, but no incidence figures were given. Crisp (2) commented that ‘those chronic patients who have progressed to a state of overeating and vomiting not infrequently appear to become dominated by oral behaviour, and may sometimes present with alcoholism’. Toms and Crisp (11) hold that alcohol and drugs may be used as substitutes or diversions for the suppression of normal appetite.