Fluctuations in clinical symptoms with changes in serum 25(OH) vitamin D levels in autistic children: Three cases report

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder caused by complicated interactions between genetic and environmental factors. Clinical trials, including case reports, case-control studies, and a double-blinded randomized clinical study, have suggested that high-dose vitamin D3 regimens may ameliorate the core symptoms of ASD. Vitamin D3 supplementation was effective in about three-quarters of children with ASD. To further investigate the relationship between vitamin D and ASD symptoms in vitamin D-responsive autistic children, changes in symptoms were assessed in three children with ASD who were given vitamin D3 supplementation followed by a long interruption. The core symptoms of ASD were remarkably improved during the vitamin D3 supplementation period when serum 25-hydroxyvitamin D [25(OH)]D levels reached over 40.0 ng/mL. However, symptoms reappeared after the supplementation was stopped, when serum 25(OH)D levels fell below 30.0 ng/mL but were again improved with re-administration of vitamin D3 after the interruption, when serum 25(OH)D levels exceeded 40.0 ng/mL. Overall, these results showed that the core symptoms of ASD fluctuated in severity with changes in serum 25(OH)D levels in children, indicating that maintaining a responsive 25(OH)D level is important for treating ASD. Maintaining a serum 25(OH)D level between 40.0 and 100.0 ng/ml may be optimal for producing therapeutic effects in vitamin D-responsive individuals with ASD.

Ghrelin and leptin levels in children with anxiety disorders

Background Anxiety disorders are common psychiatric disorders in childhood and an important health problem that is associated with the risk of serious mental, educational and economical problems. Researchers have mentioned many different mechanisms in the etiopathology of anxiety disorders. This study aimed to investigate ghrelin and leptin levels in children with anxiety disorders and thus to contribute to the clarification of anxiety in children. Methods Forty-three children aged 6-12 years with a diagnosis of the Anxiety Disorder according to DSM 5 and 21 healthy children age- and gender-matched to the study group were included. All the subjects were assessed with Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL) and State-Trait Anxiety Inventory for Children (STAI-C) scale. Blood samples were obtained in the morning and serum ghrelin and leptin levels were measured with enzyme-linked immunosorbent assay (ELISA) kits. Results In the anxiety group the ghrelin levels were higher than the control group (p = 0.037) but there was no significant difference between the leptin levels (p = 0.430). Also, when the girls in the anxiety group and the girls in the control group were compared, ghrelin levels were higher in the anxiety group (p < 0.01). Conclusions These findings suggest that ghrelin may play a significant role in the etiologic mechanisms of anxiety disorders. However, more detailed studies are needed to explain the linkage between anxiety disorders and neuropeptides.

Elevated Gestational IL-13 During Fetal Development Is Associated With Hyperactivity and Inattention in Eight-Year-Old Children

Maternal immune activation (MIA) during fetal development leads to behavioral and psychological disorders in the offspring. Concomitantly, insufficient supply of polyunsaturated fatty acids (PUFAs) is suspected to contribute to early neuronal maldevelopment due to the immune modulatory capabilities of PUFAs. However, human data are missing considering both of these aspects and their impact on children's behavioral outcomes. In line, this study aimed to elucidate the influence of gestational cytokines and PUFA-containing lipids during late pregnancy on behavioral sequelae in childhood, particularly focusing on an immune activation shaped by a history of maternal atopic diseases instead of a pathogen-mediated immune response. Based on the prospective mother-child cohort LINA we assessed the unstimulated blood cytokine profiles and concentrations of PUFA-containing lipids of 293 mothers at the 34th week of pregnancy. Maternal history of atopic diseases was obtained from questionnaires and behavior in eight-year-old children was assessed by the standardized Strength and Difficulties Questionnaires (SDQ) generating scores for hyperactivity/inattention, emotional symptoms, conduct problems, and peer relationship problems. Elevated IL-13 increased the risk for the child to show behavioral difficulties, in particular, hyperactive/inattentive behavior [adj. OR (95% CI): 2.47 (1.51-4.02), n = 255 vs. 38] at the age of eight years. Although the presence of maternal atopic dermatitis (AD) was associated with increased gestational IL-13 concentrations [adj. MR (95% CI): 1.17 (1.04-1.32)], no effect on children's behavioral difficulties was observed. However, a decrease in the PUFA containing lipid species PC aa C38:6 was not only associated with an increased gestational IL-13 concentration but also mediated the indirect effect of low PC aa C38:6 concentrations on children's abnormal behavior independent of maternal AD. We additionally assessed whether maternal IL-13 and PC aa C38:6 concentrations translate their effect by altering children's cord blood PC aa C38:6 and IL-13. While also the children's cord blood IL-13 was related to children's behavior, no effect of children's PC aa C38:6 was observed. This is the first study demonstrating that elevated gestational IL-13 increases the risk for children to develop behavioral difficulties. Analyses suggest that a reduced supply of gestational PC aa C38:6 contributes to elevated gestational IL-13 leading to behavioral sequelae in the offspring.

MECHANISMS IN ENDOCRINOLOGY: Maternal thyroid dysfunction during pregnancy and behavioural and psychiatric disorders of children: a systematic review

BACKGROUND

Maternal thyroid dysfunction during pregnancy may lead to persistent neurodevelopmental disorders in the offspring appearing in later life. This study aimed to review the available evidence concerning the relationship between maternal thyroid status during pregnancy and offspring behavioural and psychiatric disorders.

METHODS

Systematic electronic database searches were conducted using PubMed, Embase, PsycNET, Scopus, Google Scholar and Cochrane library. Studies including gestational thyroid dysfunction as the exposure and offspring behavioural and psychiatric disorders as the outcome were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed and, after thorough screening by two independent reviewers, 13 articles remained eligible for inclusion in this study.

RESULTS

Indicators of maternal thyroid dysfunction, including low and high thyroid hormone level and autoimmune thyroiditis, during early pregnancy, were found to be associated with several offspring behavioural and psychiatric disorders such as attention deficit hyperactivity disorder (ADHD), autism, pervasive developmental problems, externalising behaviour, in addition to epilepsy and seizure. The majority of associations were found with low maternal thyroid hormone level.

CONCLUSION

Maternal thyroid function during pregnancy, particularly hypothyroidism, is associated with behavioural and psychiatric disorders in children. Further studies are needed with a capacity to adjust for a fuller range of confounding factors.

Maternal thyroid hormone trajectories during pregnancy and child behavioral problems

There is ample evidence demonstrating the importance of maternal thyroid hormones, assessed at single trimesters in pregnancy, for child cognition. Less is known, however, about the course of maternal thyroid hormone concentrations during pregnancy in relation to child behavioral development. Child sex might be an important moderator, because there are sex differences in externalizing and internalizing behavioral problems. The current study examined the associations between maternal thyroid hormone trajectories versus thyroid assessments at separate trimesters of pregnancy and child behavioral problems, as well as sex differences in these associations. In 442 pregnant mothers, serum levels of TSH and free T4 (fT4) were measured at 12, 24, and 36weeks gestation. Both mothers and fathers reported on their children's behavioral problems, between 23 and 60months of age. Latent growth mixture modeling was used to determine the number of different thyroid hormone trajectories. Three trajectory groups were discerned: 1) highest and non-increasing TSH with lowest fT4 that decreased least of the three trajectories; 2) increasing TSH and decreasing fT4 at intermediate levels; 3) lowest and increasing TSH with highest and decreasing fT4. Children of mothers with the most flattened thyroid hormone trajectories (trajectory 1) showed the most anxiety/depression symptoms. The following trimester-specific associations were found: 1) lower first-trimester fT4 was associated with more child anxiety/depression, 2) higher first-trimester TSH levels were related to more attention problems in boys only. A flattened course of maternal thyroid hormone concentrations during pregnancy was a better predictor of child anxiety/depression than first-trimester fT4 levels.

Low blood zinc, iron, and other sociodemographic factors associated with behavior problems in preschoolers

Previous research supports the link among malnutrition, cognitive dysfunction, and behavioral outcomes; however, less research has focused on micronutrient deficiencies. This study investigates whether micronutrient deficiencies, specifically blood zinc and iron levels, will be associated with increased behavior problem scores, including internalizing and externalizing behaviors. 1314 Children (55% boys and 45% girls) from the Jintan Preschool Cohort in China participated in this study. Venous blood samples were collected and analyzed for zinc and iron when the children were 3-5 years old. Behavior problems were measured with the Child Behavior Checklist (CBCL), which was completed by the parents when children were in their last months of preschool (mean age 5.6 years). General linear multivariate modeling was used, with adjustment for important sociodemographic variables. The results indicate that low zinc levels alone (p = 0.024) and combined low zinc and iron levels (p = 0.022) are significantly associated with increased reports of total behavior problems. We did not find an association between low iron and behavior problems. With regards to sociodemographics, living in the suburbs is associated with increased internalizing problems, while higher mother's education and being female were associated with decreased externalizing problems. This study suggests that micronutrient deficiencies and sociodemographic facts are associated with behavior problems in preschoolers.

Umbilical cord blood testosterone and childhood internalizing and externalizing behavior: a prospective study

Antenatal testosterone exposure influences fetal neurodevelopment and gender-role behavior in postnatal life and may contribute to differences in developmental psychopathology during childhood. We prospectively measured the associations between umbilical cord blood testosterone levels at birth and childhood behavioral development in both males and females from a large population based sample. The study comprised 430 females and 429 males from the Western Australian Pregnancy Cohort (Raine) Study where umbilical cord blood had been collected. Total testosterone concentrations were determined by mass spectrometry and bioavailable testosterone (BioT) levels were calculated. At two, five, eight and ten years of age, the participants completed the Child Behavior Checklist (CBCL). Linear regression models were used to analyse the relationship between BioT concentrations (in quartiles) and CBCL scores (total, internalizing, externalizing and selected syndrome). Boys had higher mean CBCL T-scores than girls across all ages of follow-up. There was no significant relationship between cord blood BioT quartiles and CBCL total, internalizing and externalizing T-scores at age two or five to ten combined. In the syndrome score analyses, higher BioT quartiles were associated with significantly lower scores for attention problems for boys at age five, eight and ten, and greater withdrawal symptoms in pre-school girls (age five). We did not identify a consistent relationship between antenatal testosterone exposure and total, internalizing or externalizing behavioral difficulties in childhood. Higher umbilical cord BioT levels were associated with lower scores for attention problems in boys up to 10 years and more withdrawn behavior in 5-year-old girls; however, these findings were not consistent across ages and require further investigation in a larger sample.

The association of 25-hydroxyvitamin D3 and D2 with behavioural problems in childhood

BACKGROUND

Higher serum concentrations of 25-hydroxyvitamin D (25(OH)D), an indicator of vitamin D synthesis and intake, have been associated with better mental health and cognitive function. Concentrations of 1,25-dihydroxyvitamin D(3) (the active vitamin D(3) metabolite) have been associated with openness and extrovert behaviour, but 25(OH)D concentrations have not been associated with behavioural problems in humans.

METHODS

We investigated the prospective association between the different forms of 25(OH)D - 25(OH)D(3) and 25(OH)D(2)- and childhood behavioural problems in Avon Longitudinal Study of Parents and Children (ALSPAC). Serum 25(OH)D(3) and 25(OH)D(2) concentrations were assessed at mean age 9.9 years. Incident behavioural problems were assessed with Strengths and Difficulties Questionnaire (SDQ; emotional symptoms, conduct problems, hyperactivity-inattention problems, peer relationship problems and pro-social behaviour subscales and total difficulties score) at mean age 11.7. Sample sizes varied between 2413-2666 depending on the outcome.

RESULTS

Higher 25(OH)D(3) concentrations were weakly associated with lower risk of prosocial problems (fully adjusted odds ratio: OR (95% confidence interval: CI) 0.85 (0.74, 0.98)). Serum 25(OH)D(3) or 25(OH)D(2) concentrations were not associated with other subscales of SDQ or total difficulties score after adjusting for concfounders and other measured analytes related to vitamin D.

CONCLUSIONS

Our findings do not support the hypothesis that 25-hydroxyvitamin D status in childhood has important influences on behavioural traits in humans.

Blunted cortisol responses to stress signal social and behavioral problems among maltreated/bullied 12-year-old children

BACKGROUND

Evidence from animal and human studies suggests that early-life stress such as physical maltreatment has long-lasting effects on the hypothalamic-pituitary-adrenal (HPA) axis and is associated with blunted HPA axis reactivity in adulthood. Few studies have investigated whether blunted HPA axis reactivity observed in children exposed to early-life stress signals social, emotional, and behavioral problems.

METHODS

Participants were 190 12-year-old children (50.5% males) recruited from the Environmental Risk Longitudinal Twin Study, a nationally representative 1994 to 1995 cohort of families with twins. Cortisol responses to psychosocial stress were measured in maltreated/bullied (n = 64) and comparison children (n = 126). We ascertained maltreatment and bullying victimization using mothers' reports and assessed children's social, emotional, and behavioral problems at ages 5 and 12 using mothers' and teachers' reports.

RESULTS

Piecewise multilevel growth curve analyses indicated that maltreated/bullied and comparison children showed distinct cortisol responses to stress. Specifically, maltreated/bullied children had lower cortisol responses than comparison children who exhibited a significant increase. Lower cortisol responses were, in turn, associated with more social and behavioral problems among maltreated/bullied children.

CONCLUSIONS

These findings provide support for the influence of childhood harm on blunted HPA axis reactivity and its potential impact on children's functioning. Our findings emphasize the need to integrate stress biomarkers in guiding prevention efforts for young victims.

Androgen levels and anger and impulsivity measures as predictors of physical, verbal and indirect aggression in boys and girls

Previous studies indicate that androgen levels and certain psychological characteristics such as anger and impulsivity are related to the development and maintenance of aggression. Further studies are required to analyze the potential predictor role of the interaction of said factors on aggressive behavior. 90 nine-year-old children (44 boys and 46 girls) were assessed in relation to their levels of physical, verbal and indirect aggression, using a peer-rating technique. Testosterone and androstenedione levels were analyzed using an enzymoimmunoassay technique in saliva samples. Anger (state and trait) and anger control were measured using the STAXI-NA, and impulsivity was measured through the MFF-20. A General Linear Model revealed that sex was the best predictor for aggression measures, with boys scoring higher than girls in physical, verbal and indirect aggression; after sex, testosterone was found to be the best predictor (in a positive sense) of all three types of aggressive behavior studied. In addition to observing a main effect of androstenedione on physical and verbal aggression, a 'state anger*androstenedione' interaction was found to predict these types of aggression, with androstenedione acting as a moderator (inhibitor) of the effects of anger on these behaviors; also, a 'state anger*testosterone' interaction was found to predict verbal aggression. The results support the idea that, after sex, androgens constitute a biological marker to be taken into consideration in relation to individual differences in aggressive behavior. It is possible that at the age of 9, testosterone tends to increase aggression, while androstenedione tends to moderate (inhibit) the effects of anger on aggression.

Concurrent and longitudinal associations of basal and diurnal cortisol with mental health symptoms in early adolescence

Recent biosocial theories postulate that both biological risk and the social context influence the development of mental health problems [Boyce and Ellis (2005) Development and Psychopathology, 17(2), 271-301]. Guided by this framework, we examined whether basal cortisol and its diurnal rhythm were associated with mental health symptoms in early adolescence. Because cross-sectional and longitudinal investigations sometimes reveal different cortisol-mental health associations, we examined the association both concurrently and longitudinally when children transition to middle school, a time which entails a major change in social context from single to multiple teachers, classrooms, and sets of classmates. Salivary cortisol was measured three times a day (waking, afternoon, and bedtime) across 3 days when adolescents were 5th graders. Mental health was measured when adolescents were in 5th and 7th grades, just before and after the transition to middle school. To deal with the substantial comorbidity of internalizing and externalizing symptoms at this developmental stage, mental health measures distinguished overall symptom severity from the preponderance of internalizing versus externalizing symptoms (i.e., directionality). A three-level Hierarchical Linear Model was used to extract basal cortisol and its diurnal rhythm separate from the day-to-day and within-the-day fluctuations in cortisol in response to daily experiences. Results were specific to symptom severity, suggesting that cortisol is a nonspecific risk factor for mental health symptoms in young adolescents. At 5th grade, low basal cortisol was associated with concurrent symptom severity. However, longitudinally, it was adolescents with high cortisol at 5th grade who were at risk for increasing mental health symptoms by 7th grade. Flat diurnal rhythms in 5th grade were related to levels of symptom severity at both 5th and 7th grades. Considering the change in social context, as defined by the transition to middle school, helped resolve seemingly inconsistent evidence that both hypo- and hyper-arousal were associated with mental health symptoms in early adolescence.

Early deprivation and home basal cortisol levels: a study of internationally adopted children

Animal studies reveal that early deprivation impairs regulation of the hypothalamic-pituitary-adrenocortical (HPA) axis, potentially increasing vulnerability to stressors throughout life. To examine early deprivation effects on basal HPA axis activity in humans, basal cortisol levels were examined in 164 internationally adopted children who had experienced varying degrees of preadoption deprivation. Duration of institutional care, age at adoption, and parent ratings of preadoption neglect indexed a latent factor of Deprived Care. Adoption measures of height and weight standardized to World Health Organisation norms indexed a latent factor of Growth Delay that was viewed as another reflection of deprivation. Cortisol samples were collected 3.3-11.6 years postadoption (Md = 7.3 years) at home on 3 days approximately 30 min after wakeup and before bedtime. Both early a.m. levels and the decrease in cortisol across the day were examined. A structural equation model revealed that preadoption Deprived Care predicted Growth Delay at adoption and Growth Delay predicted higher morning cortisol levels and a larger diurnal cortisol decrease.

Cortisol is inversely correlated with aggression for those boys with attention deficit hyperactivity disorder who retain their reactivity to stress

We examined the relationship between the cortisol response to stress and aggression in patients with attention deficit hyperactivity disorder (ADHD). Based on a report stating that only some of the patients with ADHD retain their hypothalamic-pituitary-adrenal axis reactivity to stress, we separately analyzed the relationship between aggression and the cortisol response to stress in two groups according to their reactivity to stress. Using psychological testing as an indicator of stress, we measured the cortisol level in the saliva before and after administering a psychological test. Behavioral problems, including aggression, were assessed using the Korean version of the Child Behavior Checklist (K-CBCL). The increase of the cortisol level was inversely correlated with aggression in patients who retained their reactivity to stress. The absolute value of the decrease was negatively correlated with the attention score of the CBCL for the patients who showed decreases in cortisol after stress. For the patients who showed increases in their concentration of cortisol in reaction to stress, cortisol may play a protective role against aggression.

Differences in cortisol response affect the distinction of observed reactive and proactive aggression in children with aggressive behaviour disorders

Various researchers distinguished two categories of aggressive behaviour, namely reactive and proactive aggression. Reactive aggression is an aggressive response to a perceived threat or provocation, whereas proactive aggression is behaviour that anticipates a reward. In the present study, including both a sample of disruptive behaviour disordered (DBD) and normal control (NC) children, we observed reactive and proactive aggressive behaviour during an experimental dyadic play session. DBD children showed more observed reactive and proactive aggression. Subsequently, we investigated whether the observed measures correlated with parent-rated measures of reactive and proactive aggression in. We distinguished in both NC and DBD children a subgroup showing a rise in cortisol level, i.e. responders, and a subgroup who did not show a rise in cortisol, i.e. non-responders. Results suggest that differences in the cortisol response affects the correspondence between observed and parent-rated reactive and proactive aggression since only DBD non-responders showed the expected correlations.

Salivary dehydroepiandrosterone responsiveness to social challenge in adolescents with internalizing problems

BACKGROUND

Dehydroepiandrosterone (DHEA) is an adrenal androgen which is stress responsive and a trigger for pubertal maturation. Studies on basal DHEA suggest protective benefits against anxiety and depression, yet it is unknown whether DHEA responsivity is protective.

METHODS

Structural equation modeling examined salivary DHEA responses to a public speaking task (PST) and parent-child conflict discussion paradigm (CDP) in adolescents.

RESULTS AND CONCLUSIONS

DHEA levels were higher in girls than boys, and in older and more physically developed adolescents, indicative of DHEA's function during pubertal maturation. DHEA levels increased during the PST, indicating responsiveness of DHEA to acute stressors. Across both tasks, girls with internalizing problems showed sharper rises in DHEA by 40 minutes post-task, ending with the highest DHEA. In internalizing adolescent girls, DHEA may serve as a marker of responsivity in stressful or conflictual contexts. A failure of these girls with internalizing problems to show a normal diurnal decline in the afternoon extended this conclusion to naturalistic environments. DHEA may be one possible mechanism linking stress responsivity and physical maturation that helps to explain adolescents' risk for psychopathology within a biobehavioral framework.

Antibody-mediated neuronal cell signaling in behavior and movement disorders

Behavioral and movement disorders may have antibody responses where mimicry and signal transduction may lead to neuropsychiatric abnormalities. In our study, antibodies in pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS) reacted with the neuronal cell surface and caudate-putamen and induced calcium-calmodulin dependent protein (CaM) kinase II activity in neuronal cells. Depletion of serum IgG abrogated CaM kinase II cell signaling and reactivity of CSF was blocked by streptococcal antigen N-acetyl-beta-d-glucosamine (GlcNAc). Antibodies against GlcNAc in PANDAS sera were inhibited by lysoganglioside G(M1). Results suggest that antibodies from an infection may signal neuronal cells in some behavioral and movement disorders.

Blood glucose levels and problem behavior

The relationship between varying blood glucose levels and problem behavior during daily scheduled activities was examined. The effects that varying blood glucose levels had on problem behavior during daily scheduled activities were examined. Prior research has shown that differing blood glucose levels can affect behavior and mood. Results of this study showed that often, when blood glucose levels were high, the rate of problem behavior was higher than when blood glucose levels were within normal range. Future research should continue to evaluate the effects that differing blood glucose conditions have on problem behavior in people with developmental disabilities.

Association of serum cholesterol and history of school suspension among school-age children and adolescents in the United States

The dietary guidelines developed for adults have been extended to children, but the role of serum cholesterol in the neurodevelopment of children is poorly understood. In the Third National Health and Nutrition Examination Survey (1988-1994), serum total cholesterol was measured in 4,852 children aged 6-16 years. Psychosocial development was evaluated by interviewing the mother regarding the child's history of school suspension or expulsion and difficulty in getting along with others. After adjustment for family socioeconomic status, maternal marital status and education, children's nutrition, and academic performance, the odds ratios of children with various concentrations of total cholesterol showed the children to be equally comfortable in their own peer subculture and not to be different in the proportion that had seen a mental health professional. However, non-African-American children with a serum total cholesterol concentration below the 25th percentile (<145 mg/dl) were almost threefold more likely to have been suspended or expelled from schools than their peers with total cholesterol at or above the 25th percentile (odds ratio = 2.96, 95% confidence interval: 1.55, 5.64). The authors concluded that, among non-African-American children, low total cholesterol is associated with school suspension or expulsion and that low total cholesterol may be a risk factor for aggression or a risk marker for other biologic variables that predispose to aggression.

Low basal salivary cortisol is associated with teacher-reported symptoms of conduct disorder

Cortisol has been implicated in psychobiological explanations of antisocial behavior. This study measured basal salivary cortisol in a sample of 25 children (age range 6 to 12 years) selected to vary in levels of antisocial behavior. Regression analyses were used to predict cortisol concentrations from parent- and teacher-reported symptoms. Parent-reported symptoms did not predict basal cortisol. Teacher-reported conduct disorder (CD) symptoms explained 38% of the variance in the cortisol concentrations, with high symptom severity associated with low cortisol. When a distinction was made between aggressive and non-aggressive CD symptoms, aggressive CD symptoms were more clearly related to low cortisol than non-aggressive CD symptoms. In contrast to previous research, no evidence was found for a mediating role of anxiety symptoms in the relationship between CD and cortisol. The results support biologically based models of antisocial behavior in children that involve reduced autonomic activity.

Hypothalamic hamartoma secreting corticotropin-releasing hormone. Case report

The authors describe a unique case of a 2-year-old boy with a hypothalamic hamartoma secreting corticotropin-releasing hormone (CRH). The patient presented with a history of behavioral disturbances progressing over 12 months. His neurological status was intact. Magnetic resonance imaging demonstrated a 1.8 x 1.6 x 1.2-cm isointense, nonenhancing hypothalamic lesion. Endocrinological workup revealed elevated serum CRH and adrenocorticotropic hormone levels, nonsuppression with low-dose dexamethasone, and partial suppression with high-dose dexamethasone. He underwent tumor resection via a right frontotemporal craniotomy. Pathological examination of the tissue confirmed a hypothalamic hamartoma with CRH immunostaining. Postoperatively, his hormone levels normalized and his behavioral disturbances abated. The radiographic and clinical characteristics of hypothalamic hamartomas are reviewed and therapeutic considerations discussed.

[Social conditions of the exposure to environmental lead observed in children from Piekary Slaskie]

The aim of the paper was to evaluate the social conditions of the exposure to environmental lead observed in children from Piekary Slaskie, the patients of The Environmental Health Outpatient Department. The examinations were conducted in 1995, in 183 children: 95 (52%) girls and 88 (48%) boys, which is 5.3% of the total population of children aged 3-12 living in the districts of Piekary Slaskie with the higher risk of lead intoxication: Brzeziny Slaskie, Dabrówka Wielka and Brzozowice-Kamień. The examinations were conducted in the period of April and May. They comprised the following parameters: environmental and paediatric interview, physical examination--evaluation of total condition of the child, and laboratory determination of lead concentration in blood with the method of atomic flameless spectrophotometry. The collected data was statistically elaborated with the use of the "STATISTICA 5.1 PL" programme in the Computer Laboratory at the Silesian Engineering College in Katowice. In 1995 the average lead concentration in blood of 183 children from Piekary Slaskie aged 3-12 ranged from 2.2 to 39.6 microg/dl, and the average population concentration was of 8.22 microg/dl SD: 4.7 microg/dl. Significantly higher average lead concentration in blood was observed in nursery children aged 3-4 (9.56 microg/dl SD: 4.2 microg/dl) when compared to school children (7.4 microg/dl SD: 3.8 microg/dl). In the examined population 19.8% of children crossed the level of 10.0 microg/dl. The conclusions of the examinations may be as follows: bad social-economic conditions (especially unemployment and pathology of families), hygienic customs and nutrition habits of the native population of Piekary Slaskie as well as only the primary or professional education of parents influence the rise in average lead concentration in blood at nursery and school children.

[Plasma zinc and copper levels in boys with oppositional defiant disorder]

OBJECTIVE

Oppositional defiant disorder consists of negativistic, hostile, or defiant behavior, created in one of three domains of functioning (academic, occupational, or social), and lasting at least six months. Alterations in zinc and copper levels of plasma in animals and humans are associated with behavioral and cognitive abnormalities. The aim of this study is to compare plasma zinc and copper levels between children with oppositional defiant disorder (ODD) and controls.

METHOD

Plasma zinc and copper levels were measured in 21 boys with ODD having a mean age of 8.6 +/- 2.0 years and in 24 healthy boys having a mean age of 8.3 +/- 2.1 years by atomic absorption spectrophotometry. An ODD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). About 61% of the children with ODD had comorbid attention deficit hyperactivity disorder.

RESULTS

Plasma zinc was significantly lower in ODD children compared to the controls (p < .05). No significant difference in plasma copper measurements was found between the two groups (p >.05).

CONCLUSION

The results of the present study suggested that the plasma copper level in boys with ODD did not differ from that in normal subjects. Although ODD children had a lower plasma zinc level than normal subjects, the mean plasma zinc level was within the normal range for the population. Further studies investigating the Zn and Cu metabolism in ODD are needed.

Lack of a relation between human neonatal thyroxine and pediatric neurobehavioral disorders

The growth and differentiation of the central nervous system are closely related to the presence of iodine and thyroid hormones. It has been hypothesized that neurobehavioral disabilities of childhood, such as attention deficit hyperactivity disorder (ADHD), learning disorders, and autism can be attributed to fetal thyroidal endocrine disruption in utero. To determine whether there is an association between neonatal thyroid status and a subsequent diagnosis of a neurobehavioral disability, neonatal thyroxine (T(4)) levels have been used as the indicator of the presence of intrauterine thyroidal dysfunction. Neonatal T(4) levels were obtained from the neonatal hypothyroidism screening program. All cases were diagnosed at medical school diagnostic clinics, the diagnostic categories being ADHD, autism spectrum disorder, behavioral disorder, cognitive disorder, developmental delay, emotional disorder, learning disability, and speech/language disorder. Conditional logistic regression analysis was performed for each clinical condition. Odds ratios for the conditions ranged from 0.92 to 1.13 with p values ranging between 0.19 and 0.84. No significant differences were detected between neonatal T(4) values of the cases and the controls for any of the neurobehavioral conditions. All neonatal T(4) values were within normal ranges. The data provide no evidence to suggest that intrauterine thyroid status as reflected by the neonatal T(4) values had an impact on the neurologic disorders diagnosed in childhood.

Stress hormone levels of children of depressed mothers

Research suggests that disruptions in early caretaking can have long-term effects on the hypothalamic-pituitary-adrenal (HPA) axis, which mediates the stress response. Children of depressed mothers are at increased risk for developing internalizing problems in part because of disruptions in their caretaking environment. The present study investigated whether children of depressed mothers exhibit elevated salivary cortisol levels. Salivary cortisol samples were collected from 45 7- to 8-year-old children of mothers with a history of depression and 29 children of nondepressed mothers. Samples were collected soon after arrival to the laboratory and after a mild laboratory stressor and at home after wakeup and before bedtime. Children who had elevated levels of intemalizing symptoms and whose mothers had a history of depression showed elevated laboratory baseline cortisol levels. Children who were reported to have clinically significant internalizing symptoms were also more likely to show an elevated stress response to a mild laboratory stressor. When the longitudinal history of maternal depression was examined, matemal depression during the child's first 2 years of life was the best predictor of elevations in baseline cortisol at age 7 years. This study provides evidence that internalizing symptoms exist in conjunction with a more reactive hormonal stress system in children of depressed mothers. The results also provide preliminary evidence that exposure to maternal depression in the first 2 years of life may be related to children's cortisol levels later in life.

Should children with developmental and behavioural problems be routinely screened for lead?

AIM

To test the hypothesis that children with behavioural and/or developmental problems have significantly higher blood lead concentrations than the general childhood population.

METHODS

Blood samples were taken from 69 children with behavioural and/or developmental problems and 136 controls (children admitted for elective day case surgery under general anaesthetic). Blood lead estimations were carried out using graphite furnace atomic absorption

RESULTS

Children with behavioural and/or developmental problems had higher lead concentrations than controls, both in terms of their distribution across the group (mean(geometric) lead concentrations: 40.7 (cases), 29.2 (controls), ratio of the means(geometric) 1.35 (95% CI 1.17, 1.58)) and the proportion of children with lead concentrations above those commonly defined as "toxic"-that is, 100 microg/l (12% (cases), 0.7% (controls); p < 0.001). Multiple linear regression suggested that this difference was not explained by differences in age, sex, or socioeconomic status of the two comparison groups.

CONCLUSIONS

Children with behavioural and/or developmental problems are more likely to have significantly higher blood lead concentrations than the general childhood population. Lead, a known and more importantly, a treatable neurotoxin, would further contribute to the impairment suffered by these children. We argue that this group of children should be routinely screened for lead.

Long-term neurobehavioral outcomes in children with neuroblastoma and opsoclonus-myoclonus-ataxia syndrome: relationship to MRI findings and anti-neuronal antibodies

OBJECTIVES

Opsoclonus-myoclonus-ataxia (OMA) syndrome affects 2% to 3% of patients with neuroblastoma. This study examined relationships between long-term neurobehavioral outcomes and potential biologic markers of OMA, including chronic changes on magnetic resonance imaging (MRI) brain scanning and prevalence of late antineuronal antibodies.

STUDY DESIGN

Children with neuroblastoma and OMA were identified through medical record review of patients treated at the University of California at San Francisco Medical Center from 1979 to 1999. Eleven patients with a mean follow-up time of 7.6 years underwent standard neurologic, neurocognitive, developmental/behavioral, and academic assessments. Consenting patients underwent MRI brain scanning and a blood draw. Sera were analyzed for the presence of antineuronal immunoreactivity.

RESULTS

Two (18%) patients had no observed neurologic abnormalities, 7 (64%) demonstrated mild deficits, and 2 (18%) had severe neurologic deficits. However, on neurocognitive, behavioral, and academic assessments, 6 (55%) children performed within the average range, 1 (9%) was moderately below average and 4 (36%) had severe cognitive and behavioral deficiencies. Brain MRI in 5 of 5 patients was notable for cerebellar atrophy without supratentorial involvement. Antineuronal activity was detected in sera of 0 of 10 children at follow-up.

CONCLUSIONS

Certain patients with neuroblastoma associated OMA may achieve average-range neurobehavioral function in spite of residual neurologic abnormalities, with suggestion of continued improvement over time. Late cerebellar atrophy appears to be a common finding regardless of neurologic outcome, whereas antineuronal immune reactivity does not appear to be a long-term feature of OMA.

Neuropsychological function in mild hyperphenylalaninemia

Whether specific cognitive deficits related to frontal-lobe dysfunction that have been reported in individuals with phenylketonuria (PKU) are also characteristic of mild hyperphenylalaninemia (MHP) was investigated. Tests of executive function and control tasks not assessing executive function were administered to a group of individuals with MHP and a group without MHP, similar in age, gender, and IQ. Tests of academic skills and behavior-rating questionnaires were also administered to the group with MHP. No group differences were found for any measure, suggesting that the mild elevations of phenylalanine in individuals with MHP are not sufficient to produce behavioral and cognitive impairments characteristic of PKU.

[Lithium salts in child and adolescent psychiatry]

Lithium is--besides neuroleptics--the drug of choice for the treatment of manic episodes. If the use of antidepressive drugs, during unipolar depressive illness, does not lead to a positive response, the additional administration of lithium is appropriate, even during a depressive episode. Lithium is also considered as the drug of choice for prophylactic treatment of bipolar affective disorders. This holds true also for adolescents. In contrast to the indications in adults, in adolescents an early administration is desirable to reduce risk factors of psychosocial development. Additional indications may be the presence of severe aggressivity in conduct disordered children. In these cases, a treatment with lithium salts can result in a behavioral improvement. This may be also the case in impulsive self-injurious behavior. The dosage and serum levels of lithium, as well as its adverse effects are comparable with those known from adults. At present, lithium treatment cannot be recommended for children under 12 years of age--except under in-patient conditions.

Overt behavior problems and serotonergic function in middle childhood among male and female offspring of alcoholic fathers

A large body of literature indicates that the serotonergic system is involved in behavioral regulation, as evidenced by the inverse relationship between impulsive aggression and serotonergic function found in adult alcoholics and nonalcoholics. However, studies of this relationship among child and adolescent offspring of alcoholics (COAs) have not previously been done. This study examines the potentially parallel relationship between behavioral dysregulation and low serotonergic function in young COAs. The relationship is of potential interest as a phenotypic marker of biological vulnerability to aggressiveness, which itself has been hypothesized to be a risk factor for later antisocial alcoholism. The present work is part of an ongoing prospective study of the development of risk for alcohol abuse/dependence and other problematic outcomes in a sample of families subtyped by the fathers' alcoholism classification. We examined the relationship between overt behavior problems in middle childhood (mean age = 10.5 +/- 1.7 years) and whole blood serotonin (5-HT) in a subsample of the offspring (N = 32 boys and 12 girls). Using a Child Behavior Checklist (CBCL) index of behavioral undercontrol, we obtained results indicating that high total behavior problem (TBP) children had lower levels of whole blood 5-HT than did low-TBP children (p < 0.01). These results support the hypothesis that there is an inverse relationship between whole blood serotonin levels and behavior problems in young male and female COAs. A father's alcoholism status was not significantly related to his child's 5-HT level, i.e., the child's phenotypic expression of behavioral dysregulation was more reliably connected to serotonergic function than was paternal alcoholism.

Altered antioxidant enzyme activities in children with a serious adverse experience related to valproic acid therapy

Specific oxidative metabolites of valproic acid (VPA) have been associated with the clinically defined toxicity of the drug. To investigate the role of enzymatic detoxification in clinical toxicity, we compared activities of five antioxidant enzymes in 15 patients with a serious adverse experience (SAE) related to VPA therapy, to enzyme activities measured in 35 patients with good clinical tolerance of VPA, and 50 healthy, age-matched subjects. These enzymes included glutathione peroxidase (GSH-Px), glutathione reductase (GSSG-R), glutathione transferase, superoxide dismutase, and catalase in erythrocytes; and GSH-Px in plasma. We also determined levels of Se, Cu, and Zn, trace elemental cofactors for these enzymes, in plasma from each individual. In patients with a VPA-associated SAE, GSH-Px was significantly depressed and GSSG-R was significantly elevated relative to values for the other groups. Selenium and zinc concentrations were lower in SAE patients than in controls. These findings may indicate a role for selenium dependent antioxidant activity in individual susceptibility to an SAE related to VPA therapy.

The effect of lead exposure on behavior problems in preschool children

OBJECTIVES

Interpreting associations between lead exposure and child behavior problems is difficult because studies have not controlled for sociodemographic confounders or have used shed teeth to mark exposure. This study explored associations between blood lead and preschool behavior.

METHODS

Children from a smelter town and a non-lead-exposed town in Yugoslavia were followed up prospectively from pregnancy through age 3. The Child Behavior Checklist was used to assess behavior problems in 379 3-year-olds, controlling for sociodemographic factors and difficult infant temperament.

RESULTS

Multiple regression revealed the expected significant associations between checklist subscales and sociodemographic factors, which explained 7% to 18% of the variance on the subscales. Concurrent blood lead explained a significant 1% to 4% of the variance on the Destructive and Withdrawn subscales. Earlier difficult temperament explained an additional 2% to 5% of the checklist variance. Scores on the Destructive subscale were consistently associated with blood lead. As blood lead increased from 10 to 20 micrograms/dL, subscale scores increased by approximately 0.5 points.

CONCLUSIONS

Lead/behavior associations are significant but small compared with the effects of social factors.

Low-level lead exposure and behavior in early childhood

OBJECTIVE

To assess whether small elevations in blood lead level were associated with measurable behavioral changes in a group of poor children between 1 and 3 years old.

METHODS

The study population consisted of children presenting for routine well-child care to the pediatric clinic at Bellevue Hospital Center, a large urban public hospital. The following inclusion criteria were used for entry into the study: age 12 to 36 months; capillary lead screening result <1.21 micromol/L (25 microg/dL); no known prior history either of blood lead level >1.21 micromol/L (25 microg/dL) or lead exposure requiring chelation therapy; Latino or African-American; English or Spanish spoken in the home; biological mother as primary caretaker; child not presently attending day care; full-term, singleton gestation; birth weight at least 2500 g; no known neurologic or developmental disorder; and no severe chronic disease, including human immunodeficiency virus infection. Study enrollment was simultaneously stratified by capillary lead level and age. All children between 12 and 36 months attending the pediatric clinic during the study period received screening capillary blood measures of lead level following the recommendations of the Centers for Disease Control and Prevention and the American Academy of Pediatrics as part of routine primary care. During periods of enrollment, consecutive lead measurements performed in the pediatric clinic were reviewed by one of the researchers. For those children meeting entry criteria based on lead level and age, further eligibility based on the remainder of the inclusion criteria was determined through parental interview and review of the medical record. Lead exposure was assessed with a single capillary blood specimen, using atomic absorption spectrophotometry. Subjects were considered to be lead-exposed if their lead level was between 0.48 and 1.20 micromol/L (10 and 24.9 microg/dL) and nonexposed if their lead level was between 0 and 0.48 micromol/L (0 and 9.9 microg/dL). Behavior was assessed using the Behavior Rating Scale (BRS) of the Bayley Scales of Infant Development, second edition. The BRS in this age group consists of three components: an Emotional Regulation Factor that measures hyperactive/distractible/easy-frustration behaviors; an Orientation-Engagement Factor that measures fear/withdrawal/disinterest behaviors; and a Motor Quality Factor that assesses the appropriateness of movement and tone. The BRS is scored as a percentile; lower scores reflect more problematic behaviors. Researchers performing the BRS were blinded to capillary lead results. Information was collected concerning factors that might confound the relationship between lead and behavior. Demographic factors were collected, including: child's age, gender, and country of origin; mother's age, marital status, parity, country of origin, and primary language spoken; parental education, and occupation and receipt of public assistance. Socioeconomic status was determined using the Hollingshead Two-Factor Index of Social Position. Maternal verbal IQ was assessed using the Peabody Picture Vocabulary Test-Revised. Maternal depression was assessed using the Center for Epidemiologic Studies-Depression Scale. Cognitive stimulation provided in the home was assessed using a new office-based instrument, the StimQ, which measures the quantity and quality of play materials and parent-toddler activities in the child's home. To assess the child for iron deficiency, we performed a hematocrit and mean corpuscular volume at the time of the capillary lead evaluation. A presumptive diagnosis of iron deficiency was made if the child was either anemic (defined as a hematocrit <32) or had a mean corpuscular volume <72.

RESULTS

The study sample consisted of 72 children. Children in the lead-exposed group (n = 41) had a mean BRS behavior score that was 15.8 points lower than that of children in the nonexposed group (n = 31), which was significant by the Stu

Plasma GABA in children and adolescents with mood, behavior, and comorbid mood and behavior disorders: a preliminary study

Plasma GABA concentrations (pGABA) were measured in 115 inpatients (aged 7-17) with child psychiatric disorders. Group mean pGABAs were compared for 38 patients with mood disorders only (MOOD), 29 with behavior disorders only (BEH), 48 with comorbid mood and behavior disorders (MOOD + BEH), and 14 normal controls (CON, aged 14-17). The BEH group was characterized by (a) high mean pGABAs (157 vs. 133 pmol/ml), (b) lower mean pGABAs in BEH subjects who had been receiving pharmacotherapy with SSRIs or other medications (p < 0.026), and (c) decreased pGABA with increasing age (p = 0.019). These features were not found in controls or in groups of patients with mood disorders (MOOD or MOOD + BEH). Elevated mean pGABA in the BEH group appeared specifically in patients with comorbid CD and ADHD, not in patients with ADHD or CD alone (p = 0.004). No patient in BEH (or CON) had pGABA below 100 pmol/ml, but low pGABAs were found in 15% of MOOD patients (who had no behavior disorder) and in 16% of MOOD + BEH patients. Pharmacotherapy did not change pGABAs in the MOOD or the MOOD + BEH groups. No pGABA differences were found among the anxiety disorders, either alone or with mood or behavior comorbidity. The finding that plasma GABA levels are elevated in nonmedicated behavior disorders that present in the absence of mood disorders, and appear to lower following medication treatments, merits increased attention to the pharmacological study of nonaffective behavior disorders.

Basal plasma beta-endorphin in prepubertal sons of alcoholics and drug addicts: lack of association with problem behaviors

Several reports have speculated that variations in beta-endorphin functioning may actually proceed the development of alcoholism and other drug use disorders, and is consequently a genetic mechanism of some etiologic importance. The goal of this investigation was to determine whether differences in basal plasma beta-endorphin concentrations could be confirmed in prepubertal children naive to alcohol and drugs, yet at parental risk for alcoholism, or drug dependence. Consequently, we have examined fasting basal plasma beta-endorphin concentrations in a sample of prepubertal sons of alcoholic fathers and compared them to both our existing sample of sons of drug dependent fathers and normal control boys. In addition, we examined the relationship between plasma beta-endorphin concentrations and maternal reports of problem behaviors posited to be related to the liability for alcoholism or drug abuse. The results reveal no differences in fasting basal plasma beta-endorphin concentrations. Although the at-risk groups differ significantly from normal boys having elevated scale scores for internalizing and externalizing problem behaviors, no association between plasma beta-endorphin and these behavioral risk factors could be found. Overall, the results fail to support an inherited 'opioid deficiency hypothesis' for the development of alcoholism or drug dependence.

Neuroendocrine response to fenfluramine challenge in boys. Associations with aggressive behavior and adverse rearing

BACKGROUND

There is evidence of relationships among serotonin, aggressive behavior, and a childhood history of socially adverse-rearing conditions. This study examines the prolactin response to fenfluramine hydrochloride challenge in young boys who show clinically significant aggressive behavior or who are raised in a social environment that is conducive to the development of chronic aggression.

METHODS

A series of 34 younger brothers of convicted delinquents underwent standardized psychiatric and observation-based assessments of their social-rearing environments that were conducted during home visits. Approximately 2 years later, these boys underwent a reassessment of psychiatric status and an assessment of central serotonergic activity using the fenfluramine challenge procedure.

RESULTS

Increasing degrees of aggressive behavior at either assessment were positively correlated with the prolactin response to fenfluramine challenge. Furthermore, adverse-rearing circumstances that were conducive to the development of aggressive behavior also exhibited positive correlations with the prolactin response. This association between adverse rearing and the prolactin response was statistically independent of that between aggression and the prolactin response.

CONCLUSION

In young boys, aggressive behavior and social circumstances that are conducive to the development of aggressive behavior are positively correlated with a marker of central serotonergic activity.

Whole-blood serotonin in children and adolescents with mood and behavior disorders

Whole-blood serotonin (5-hydroxytryptamine, 5-HT) levels were measured in 118 children and adolescents with DSM-III-R mood disorders (n = 30) or behavior disorders (n = 27), a mixed group who met criteria for both mood and behavior disorders (n = 47), and a small sample of normal control subjects (n = 14). The patients were selected from consecutive admissions to an inpatient state hospital setting and the control subjects were recruited from a local high school. Levels of whole-blood 5-HT were significantly higher in the behavior disorder group (193 +/- 120) than in the mood disorder (122 +/- 83) or mixed mood and behavior (137 +/- 95) patient groups, but did not differ from control levels (170 +/- 48). A subsample of patients irrespective of diagnostic classification who had been on a selective serotonin reuptake inhibitor (SSRI) before admission had significantly lower whole-blood 5-HT concentrations (97.8 +/- 78.4) than those in patients who had been receiving some other type of psychotropic medication at admission (159.8 +/- 109.2) and from those in unmedicated patients (161.9 +/- 101.4). The 5-HT concentrations for patients receiving non-SSRI psychotropic medications did not differ from those of unmedicated patients. The frequency analysis of 5-HT concentration by psychiatric disorder group suggests that patients with mood disorders have the lowest values (below 100 ng/ml) and patients with behavior disorders have the highest values (above 300 ng/ml). Levels in the limited sample of normal subjects were all between 100 and 300 ng/ml. These findings were not accounted for by age, sex, gender, race, or season and lend support to accumulating research on simple neurobiological indicators in blood that help to distinguish these child/adolescent psychiatric disorders from each other and from individuals without these disorders.

Platelet dense granule secretion in adolescents with conduct disorder and substance abuse: preliminary evidence for variation in signal transduction

Platelet aggregation responses to agonists have been employed as peripheral indices of the physiological responsiveness and density of neurotransmitter receptors, and in investigations of membrane functioning in psychopathological conditions. In particular, there are mechanistic similarities between neuronal secretory and receptor dynamics, and those involved in platelet dense granule secretion. Consequently, we have explored the platelet dense granule secretory responses to various agonists in abstinent male adolescents who meet current psychiatric diagnostic criteria for Conduct Disorder and Psychoactive Substance. Use Disorder (CD+/PSUD+) in contrast to controls (CD-/PSUD-). The results showed a significant hyporesponsivity among experimental subjects to collagen, thrombin, adenosine diphosphate (ADP), ADP plus 0.2 microgram of serotonin, and ADP plus 1.0 microgram of serotonin. Only dense granule responses to arachidonic acid did not differentiate the groups. Taken together, the lack of agonist specificity suggests that a variation in signal transduction mechanisms could account for the observed reduction in dense granule secretion among CD+/PSUD+ adolescents. Association between dense granule secretory responses and substance use behavior, and comorbid psychiatric conditions are also examined.

Omega-3 fatty acids in boys with behavior, learning, and health problems

The purpose of the study reported here was to compare behavior, learning, and health problems in boys ages 6 to 12 with lower plasma phospholipid total omega-3 or total omega-6 fatty acid levels with those boys with higher levels of these fatty acids. A greater frequency of symptoms indicative of essential fatty acid deficiency was reported by the parents of subjects with lower plasma omega-3 or omega-6 fatty acid concentrations than those with higher levels. A greater number of behavior problems, assessed by the Conners' Rating Scale, temper tantrums, and sleep problems were reported in subjects with lower total omega-3 fatty acid concentrations. Additionally, more learning and health problems were found in subjects with lower total omega-3 fatty acid concentrations. (Only more colds and more antibiotic use were reported by those subjects with lower total omega-6 fatty acids). These findings are discussed in relation to recent findings for omega-3 experimentally deprived animals.

Biology, norms, and personality: a developmental perspective

The focus concerns psychobiological risk factors in the development of antisocial behavior among male and female subjects. Using longitudinal data, violent and nonviolent criminal offences were studied in relation to childhood vulnerability indicators, norm-breaking behavior in adolescence, and to personality traits and biochemical measures in adult age. Subsequently, levels of norm-breaking behavior in adolescence were studied as related to personality and biochemical measures in adult age. Data were obtained from a representative group of 82 male and 87 female subjects as (1) teacher ratings of behavior at age 13, assumed to differentially reflect vulnerability to externalizing and internalizing psychosocial disturbances; (2) self-ratings of norm-breaking behaviors at age 15; (3) Karolinska Scales of Personality scores and biochemical measures at age 26-27 years, and (4) records for criminal offences up to age 40. In both the male and female groups, criminal offences during the life span were associated with childhood externalizing and adolescent norm-breaking behavior. Furthermore, in the male group, criminal and violent offences were associated with adult psychopathy-related personality traits and a biochemical indicator of psychosocial vulnerability; platelet monoamine oxidase (MAO) activity. Among female subjects, criminal offenders displayed significantly lower MAO activity in comparison to noncriminals. High levels of norm-breaking behavior in adolescence were associated with adult high impulsiveness, low socialization, and low platelet MAO activity in both male and female subjects. The results of the analyses were used as a basis for some theoretical and methodological conclusions.

Untoward effects of lithium treatment in children aged four through six years

OBJECTIVE

To explore the relationship between lithium dose and serum lithium level on the occurrence of untoward or toxic effects of lithium in the treatment of 20 hospitalized aggressive and/or mood-disordered children aged 4 through 6 years.

METHOD

Clinical and research records of 20 children treated with lithium according to an established inpatient protocol were reviewed. Side effects as reported by psychiatric staff were categorized by organ system affected and severity.

RESULTS

During the initial 2 weeks of lithium treatment, 60% of the children manifested one or more types of side effects, most commonly central nervous system effects. Side effects were seen at doses of 25.6 to 52.1 mg/kg per day and at serum levels from 0.65 to 1.37 mEq/L. In general, adverse effects were associated with higher lithium doses and lithium levels and were most common during the first week of treatment. A potential interaction between concurrent infection and more severe side effects was seen.

CONCLUSIONS

Side effects occur frequently in children aged 6 years and younger during the initiation phase of lithium treatment; are related to higher milligram per kilogram doses, higher serum lithium levels, and phase of treatment; and may be related to concurrent medical illness.

[The effect of valproic acid monotherapy on behavior and cognitive performance of children with idiopathic generalized epilepsy]

Valproic acid (VPA) currently plays an important role in the treatment of several different types of epilepsy. Especially in children and adolescents, VPA is used because of a minimum of adverse effects and generally little impact on cognitive and psychomotor functions. However, reports in the literature regarding the influence of VPA on behavior and cognitive performance and on EEG parameters vary widely. We investigated the effect of VPA monotherapy on behavioral components (attention, concentration, inhibitory control), cognitive efficiency (motor reaction time, learning, retention) and evoked potentials in 19 children aged 6 to 14 years with idiopathic generalized epilepsy and compared the results with those of healthy controls matched for age. In addition, we analyzed the serum levels of VPA and some of the VPA metabolites in all of the children with epilepsy immediately before the psychophysiological assessments. Our results show marked differences between the children with epilepsy and the healthy controls in all types of behavior and cognitive performance assessed. Abnormal behavior (disturbances of attention and concentration, impulsive behavior patterns) and significant changes in evoked potentials appear to be correlated with serum levels of VPA and certain VPA metabolites.

Serum dopamine beta hydroxylase and maltreatment in psychiatrically hospitalized boys

Fifty boys, hospitalized on a school-age and an adolescent unit in an intermediate length psychiatric hospital, were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with different childhood maltreatment experiences. Childhood maltreatment was categorized according to onset (before 36 months old, between 36-72 months old and over 72 months old). Childhood maltreatment groups were compared with a group of psychiatrically hospitalized boys who had neither been abused nor neglected. Boys who were younger than 72 months at age of onset of maltreatment had significantly lower DBH activity than those who had experienced maltreatment later in childhood and those who had not been subjected to abuse or neglect. This difference appeared attributable to the DBH activity of school age (but not adolescent) boys who had been abused/neglected before 72 months. Boys with a principal diagnosis of conduct disorder solitary aggressive type had lower DBH activity than boys without this diagnosis regardless of whether or not they had been maltreated. Low serum DBH may be a biological sequela of maltreatment early in life that correlates with the development of conduct disorder solitary aggressive type in boys.

Attention deficit hyperactivity disorder and whole-blood serotonin levels: effects of comorbidity

Whole-blood serotonin (5-hydroxytryptamine, 5-HT) levels were measured in children with attention deficit hyperactivity disorder (ADHD) with and without comorbid conduct disorder (CD) or oppositional-defiant disorder (ODD). It was hypothesized that the whole-blood 5-HT levels of ADHD probands would be significantly correlated with the whole-blood 5-HT levels of their mothers. Fifty-two children who met DSM-III-R criteria for ADHD were selected consecutively from an ADHD clinic (47 males--35 Caucasians, 10 African-Americans, and 2 Hispanics; 10 females--all Caucasians). Whole-blood 5-HT was assayed by high performance liquid chromatography and compared between ADHD children with and without comorbid CD or ODD. The familiality of whole-blood 5-HT levels was studied by Spearman's rank-order correlation. There were no significant age, race, or sex effects. There was no significant difference in whole-blood 5-HT levels between children with ADHD only (n = 22; 190 +/- 45 ng/ml) and ADHD with CD or ODD (n = 30; 212 +/- 67). However, 7 out of 30 (23%) children with ADHD+CD/ODD had whole-blood 5-HT levels > 270 ng/ml, while none of the ADHD-only children had whole-blood 5-HT levels > 270 ng/ml, a statistically significant difference. Whole-blood 5-HT levels showed significant positive correlations between 36 children with disruptive behavior disorders and their biological mothers (rs = 0.47). There was no difference in mean levels of whole-blood 5-HT between subgroups of children with ADHD with or without comorbid CD or ODD.(ABSTRACT TRUNCATED AT 250 WORDS)

Seasonal rhythm of platelet [3H]imipramine binding in adolescents who attempted suicide

OBJECTIVE

This study was designed to determine the seasonality of serotonin functions among adolescents who attempt suicide.

METHOD

Platelet [3H]imipramine binding was assessed over a period of 18 months in 98 adolescents who attempted suicide and a comparison group of 23 never-suicidal youths with conduct disorder.

RESULTS

[3H]Imipramine (Bmax) was uncorrelated with age, but showed considerable seasonal variability over time in those who had attempted suicide.

CONCLUSIONS

[3H]Imipramine binding density in adolescents who attempted suicide exhibited significant seasonality, reaching a nadir in late winter/early spring.

Homovanillic acid and monoamine oxidase in sons of substance-abusing fathers: relationship to conduct disorder

OBJECTIVE

Children of substance-abusing (SA) fathers have been found to have increased rates of conduct disorder (CD). Substance abuse and antisocial behavior have been linked to alterations in dopaminergic regulation and to monoamine oxidase (MAO) in adults. This study assessed the relationship between homovanillic acid (HVA), the metabolite of dopamine (DA), and MAO, the enzyme facilitating the conversion of DA to HVA, with CD in boys of SA and non-SA fathers.

METHOD

Male youths (N = 65), between the ages of 6 and 15 years, admitted to a residential setting because of behavior problems, were studied through peripheral blood samples and structured interviews.

RESULTS

The findings indicated that MAO activity was significantly higher in boys of SA fathers with CD than (1) in boys of non-SA fathers with CD and (2) in boys of SA fathers without CD. HVA levels did not differ significantly among the groups.

CONCLUSIONS

In the context of previous studies, the findings support the concept of dopaminergic dysregulation in sons of SA fathers, manifested by alterations in MAO activity levels in those youths with CD.