THE SYMPTOM INVENTORIES
AN ANNOTATED BIBLIOGRAPHY
Kenneth D. Gadow, Ph.D., and Joyce Sprafkin, Ph.D.
Department of Psychiatry and Behavioral Science
State University of New York
Stony Brook, NY 11794-8790
The citation for this document is as follows:
Gadow, K.D., & Sprafkin, J. (2006). The Symptom Inventories: An annotated bibliography. Stony Brook, NY: Checkmate Plus.
YEAR: 2007 and In Press
07-1. Drabick, D. A. G., Gadow, K.D., & Loney, J. (2007). Source-specific ODD: Comorbidity and risk factors in referred elementary school boys. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 92-101.
Objective: To examine differences in risk factors and comorbid conditions for oppositional defiant disorder (ODD) symptom groups in a sample of 248 elementary school boys (ages 6-10) recruited from 1994-1996. Method: The boys and their mothers received multiple assessments of cognitive, behavioral, academic, and family functioning, including a clinic-based evaluation in Stony Brook, NY. ODD was defined using four different strategies for aggregating data from mother and teacher reports of DSM-IV symptoms from the Child Symptom Inventory-4. Results: Source-specific ODD symptom groups had better internal validity and were more differentiated than groups defined using the other strategies. The mother-defined ODD symptom group (ODD/M) had higher levels of maternal detachment than the teacher-defined symptom group (ODD/T), and the ODD/T group had more social problems than the ODD/M group. The classification agreement group (ODD/M+T) evidenced higher levels of sensation seeking, maternal control, and comorbid symptoms than the ODD/M and ODD/T groups. Controlling for co-occurring attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) symptoms altered some of the relations among ODD, comorbid symptoms, and psychosocial correlates. Conclusion: Patterns of co-occurring psychiatric symptoms and psychosocial correlates of ODD symptom groups varied depending on the rater(s) used to determine group membership. Results support continued research into source specificity for conceptualizing ODD.
07-2. DeVincent, C.J., Gadow, K.D., Delosh, D., & Geller, L. (2007). Sleep disturbance and its relation to DSM-IV psychiatric symptoms in preschool-aged children with pervasive developmental disorder and community controls. Journal of Child Neurology.
Objective: This study describes the relation between sleep problems and psychiatric symptoms in preschool-aged children (3 to 5 years) with Pervasive Developmental Disorder and a community-based sample of children attending early childhood programs. Method: Parents completed the Early Childhood Inventory-4, a DSM-IV-referenced rating scale for two samples: children with Pervasive Developmental Disorder (N=112) and nondisabled youngsters (N=497). Results: Although children with Pervasive Developmental Disorder had significantly greater number and severity of sleep problems than the community preschoolers, sleep disturbed children in both samples exhibited more severe behavioral difficulties—primarily symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder—than children without sleep problems. Conclusion: Sleep problems are an indicator of similar comorbid psychiatric symptoms in both children with and without Pervasive Developmental Disorder, which suggests commonalities in their etiology.
07-3. Gadow, K.D., Sprafkin, J., Schneider, J., Nolan, E.E., Weiss, M.D., & Schwartz, J. (in press). ODD, ADHD, versus ODD+ADHD in clinic and community adults. Journal of Attention Disorders,
Objective: To seek evidence for the validity of oppositional defiant disorder (ODD) as a behavioral syndrome in adults. Method: Two groups of adults, a mental health outpatient Clinic sample (N=490) and a non-referred Community sample (N=900) completed a DSM-IV-referenced rating scale, the Adult Self Report Inventory-4 (ASRI-4), and a brief questionnaire (social, educational, occupational, and treatment variables). Participants were separated into four groups on the basis of ASRI-4 scores: ODD, ADHD, ODD+ADHD, and NONE. Results: In general, the three symptom groups were more severe than the NONE group; the ODD+ADHD and NONE groups were the most and least severe, respectively; and there were clear differences between the ODD and ADHD groups. The pattern of group differences was generally similar in both samples. Conclusion: Findings support the distinction between ADHD and ODD symptom presentations in adults, and the notion that the co-morbid condition is a unique clinical entity, both of which are consistent with the child literature. Nevertheless, additional research with larger samples of patients will be necessary to establish ODD as a potential behavioral syndrome in adults.
07-4. Sprafkin, J., & Gadow, K.D. (2007). Is Item Randomization Necessary? A Comparison of the Psychometric Properties of Two ADHD Rating Scale Formats. Journal of Child and Adolescent Psychopharmacology.
Objective: Although behavior rating scales are generally considered de riguer for best clinical practices, they are often time consuming to score, especially if items are randomized. This study compares the reliability, validity, and clinical utility of two methods of ordering ADHD Symptom Checklist-4 (ADHD-SC4) rating scale items; namely, diagnostic-cluster versus randomized-order formats. Method: Participants were parents of 207 children between 5 and 17 years old referred to a child psychiatry outpatient service and who were diagnosed as having a variety of emotional and behavioral disorders. Children were assessed with a battery of standardized assessment instruments and clinical interviews. Half received the standard, diagnostic clusters version of the ADHD-SC4 and half a randomized order version. Results: Findings indicate comparable internal consistency, convergent/discriminant validity, and sensitivity for identifying children with ADHD and ODD. Conclusion: The findings of this study suggest that item arrangement has few apparent negative implications for clinical utility of the ADHD-SC4.
07-5 Sprafkin, J. , Gadow, K.D., Weiss, M.D., Schneider, J., & Nolan, E.E. (2007). Psychiatric comorbidity in ADHD symptom subtypes in clinic and community adults. Journal of Attention Disorders,
Objective: To compare psychiatric comorbidity between the three symptom subtypes of attention-deficit/hyperactivity disorder (ADHD), inattentive (I), hyperactive-impulsive (H), and combined (C), in adults. Methods: Two groups of adults, a mental health outpatient Clinic sample (N=487) and a nonreferred Community sample (N=900) completed the Adult Self Report Inventory-4 (ASRI-4), a DSM-IV-referenced rating scale and a brief questionnaire (social, educational, occupational, and treatment variables). Participants were assigned to one of four groups: ADHD:I, ADHD:H, ADHD:C, and NONE. Results: In general, all three ADHD symptom groups reported more severe comorbid symptoms than the NONE group; the ADHD:C and NONE groups were the most and least severe, respectively; and there were clear differences between the ADHD:I and ADHD:H groups. The pattern of group differences was generally similar in both samples. Conclusions: ADHD symptom subtypes in adults are associated with distinct clinical correlates, which is consistent with the research on child ADHD subtypes. The diversity of self-reported, co-occurring psychiatric symptoms in adults who meet symptom criteria for ADHD suggests that restricting diagnostic and treatment evaluations to ADHD behaviors is ill-advised.
07-6 Sullivan, K., Hooper, S., & Hatton, D. (2007). Behavioural equivalents of anxiety in children with fragile X syndrome: parent and teacher report. Journal of Intellectual Disability Research , 51, 54-65.
Background: Identifying many of the diagnostic criteria for anxiety and depression in individuals with intellectual disability (ID) can be challenging because they may be unable to recognize and communicate their emotional experiences accurately. The purpose of this study is to identify behavioural equivalents of anxiety in children with fragile X syndrome (FXS), the leading inherited cause of ID. Methods: Parents and teachers of 43 children (aged 6-14 years) with full mutation FXS completed two standardized questionnaires on children's problem behaviour and psychiatric symptoms, [one of which was the Child Symptom Inventory-4]. Items from the questionnaires thought to be possible behavioural equivalents of anxiety were identified and grouped into four domains: Avoidance Behaviours - Confrontational; Avoidance Behaviours - Non-confrontational; Anxiety Continuum Behaviours; and Behavioural Dysregulation. The mean rating for the four groups of items was used to predict the children's status for exhibiting significant problems with anxiety as defined by the Diagnostic and Statistical Manual of Mental Disorders-oriented Anxiety Subscale from the problem behaviour scale. Results: The predictor variables classified 81% (parent rating) and 86% (teacher rating) of the children correctly. Avoidance Behaviours - Confrontational and Avoidance Behaviours - Non-confrontational (teacher rating) and Anxiety Continuum Behaviours (parent and teacher rating) made unique contributions to the models. Conclusions: Children who are unable to identify and communicate that they worry about general day-to-day events may exhibit more observable behaviours resembling active and passive avoidance (e.g. arguing, avoiding difficult tasks, staring off) or have specific phobias and compulsions. These findings suggest that there are behavioural equivalents for anxiety disorder in children with FXS and, more generally, support the notion of behavioural equivalents in ID.
YEAR: 2006
06-1. Chervin, R.D., Ruzicka, D.L., Giordani, B.J., Weatherly, R.A., Dillon, J.E., Hodges, E.K., Marcus, C.L., & Guire, K.E. (2006). Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics, 17:769-778.
Objective: Most children with sleep-disordered breathing (SDB) have mild-to-moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically indicated adenotonsillectomy or unrelated surgical care. Method: We recorded sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old: 78 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 27 for unrelated surgical care. One year later, we repeated all assessments in 100 of these children. Results: Subjects who had an adenotonsillectomy, in comparison to controls, were more hyperactive on well-validated parent rating scales [including the Child Symptom Inventory-4], inattentive on cognitive testing, sleepy on the Multiple Sleep Latency Test, and likely to have attention-deficit/hyperactivity disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) as judged by a child psychiatrist. In contrast, 1 year later, the 2 groups showed no significant differences in the same measures. Subjects who had an adenotonsillectomy had improved substantially in all measures, and control subjects improved in none. However, polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness. Conclusion: Children scheduled for adenotonsillectomy often have mild-to-moderate SDB and significant neurobehavioral morbidity, including hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness, all of which tend to improve by 1 year after surgery. However, the lack of better correspondence between SDB measures and neurobehavioral outcomes suggests the need for better measures or improved understanding of underlying causal mechanisms.
06-2. Crowell, S.E., Beauchaine, T.P., Gatzke-Kopp, L., Sylvers, P., Mead, H., & Chipman-Chacon, J. (2006). Autonomic correlates of attention-deficit/hyperactivity disorder and oppositional defiant disorder in preschool children. Journal of Abnormal Psychology, 115, 174-178.
Objective: Numerous studies have revealed autonomic underarousal in conduct-disordered adolescents and antisocial adults. It is unknown, however, whether similar autonomic markers are present in at-risk preschoolers. Method: In this study, the authors compared autonomic profiles of 4- to 6-year-old children with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD; n = 18) with those of age-matched controls (n = 20). [Symptom groups were defined on the basis of scores on the parent-completed Child Symptom Inventory-4.] Results: Children with ADHD and ODD exhibited fewer electrodermal responses and lengthened cardiac preejection periods at baseline and during reward. Although group differences were not found in baseline respiratory sinus arrhythmia, heart rate changes among ADHD and ODD participants were mediated exclusively by parasympathetic withdrawal, with no independent sympathetic contribution. Heart rate changes among controls were mediated by both autonomic branches. Conclusion: These results suggest that at-risk preschoolers are autonomically similar to older externalizing children.
06-3. Drabick, D.A.G., Gadow, K.D., & Sprafkin, J. (2006). Co-occurrence of conduct disorder and depression in a clinic-based sample of boys with ADHD. Journal of Child Psychology and Psychiatry, 47, 766-774.
Background: Children with attention-deficit/hyperactivity disorder (ADHD) are at risk for the development of comorbid conduct disorder ( CD) and depression. The current study examined potential psychosocial risk factors for CD and depression in a clinic-based sample of 203 boys ( aged 6-10 years) with ADHD. Method: The boys and their mothers participated in an evaluation that involved assessments of cognitive, behavioral, academic, and family functioning and included the Child Symptom Inventory-4. Potential predictors of CD and depression involved four domains: parenting behaviors, family environment, academic/cognitive functioning, and peer relations. ADHD groups were defined using mother- and teacher-report of DSM-IV symptoms. Mother-ratings of DSM-IV symptoms were obtained for a subsample of 91 boys approximately 5 years after the initial assessment. Results: For both mother- and teacher-defined ADHD groups, social problems were related to depression symptoms; hostile, inconsistent, and detached parenting behaviors were related to CD symptoms; and family environment characterized by low cohesion, high conflict, and low marital satisfaction was related to CD and depression symptoms. For the teacher-defined ADHD group, parenting variables also predicted depression symptoms. Academic and cognitive variables did not predict CD or depression symptoms when parenting, family, and peer relationship variables were taken into account. Depression prospectively predicted CD, but not the reverse, and parental hostile control and familial conflict prospectively predicted CD for the teacher-defined ADHD group only. Conclusion: Source-specificity is a useful consideration when describing the relation of parenting and home environment with CD and depression symptoms in boys with ADHD. Intervention efforts that address these parenting, family, and peer relationship variables may aid in preventing the development of comorbid conditions.
06-4. Egger, H.L., & Angold, A. (2006). Common emotional and behavioral disorders in preschool children: Presentation, nosology, and epidemiology. Journal of Child Psychology and Psychiatry, 47, 313-337.
We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children. [The authors summarize research findings for the Early Childhood Inventory-4. They also note “that relatively stable psychopathological characteristics can be reliably identified in preschoolers, consider the encouraging psychometric properties of the CBCL 1½-5 (Achenbach & Rescorla, (2000) and the Early Childhood Inventory-4 (Gadow & Sprafkin, 1997)” p. 315.]
06-5. Gadow, K.D., DeVincent, C.J., & Pomeroy, J. (2006). ADHD symptom subtypes in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 36, 271-283.
Objective: This study describes and compares DSM-IV ADHD symptom subtypes in children with and without pervasive developmental disorder (PDD). Method: Parents and teachers completed Early Childhood Inventory-4 for 3-to-5 (N=182/135) and the Child Symptom Inventory-4 for 6-to-12 (N=301/191) year old children with PDD and clinic controls, respectively. Results: ADHD subtypes were clearly differentiated from the nonADHD group and showed a differential pattern of co-occurring psychiatric symptoms, which was more pronounced for teacher- than parent-defined subtypes and for older versus younger children. The combined (C) type was rated more oppositional and aggressive (ages 3-12) and as having more severe PDD symptoms (ages 6-12) than the inattentive (I) type and from less advantaged home environments than the I and hyperactive-impulsive (H) subtypes. The H group was the least impaired subtype. ADHD subtype differences were similar for both PDD and nonPDD children. Conclusion: Findings support the notion that ADHD may be a clinically meaningful syndrome in children with PDD.
06-6. Hooper, S.R., Ashley, T.A., Roberts, J.E., Zeisel, S.A., & Poe, M.D. (2006).The relationship of otitis media in early childhood to attention dimensions during the early elementary school years. Journal of Developmental and Behavioral Pediatrics, 27, 281-289.
Objective: This study examined the impact of otitis media with effusion (OME) and associated hearing loss between 6 and 48 months of age on attention dimensions (i.e., selective/focus, sustained) during the elementary school years. Method: A prospective cohort design in which 74 African American infants were recruited between ages 6 and 12 months. Ear examinations were done repeatedly using both otoscopy and tympanometry, and hearing was assessed using standard audiometric procedures between 6 and 48 months. Multiple measures of attention including direct assessment, behavioral observations, parent/teacher ratings [to include the Child Symptom Inventory-4] were administered from kindergarten through second grade to assess two theoretical dimensions of attention: selective/focused and sustained. The home environment was assessed annually. Results: Findings indicated that neither early childhood OME nor hearing loss showed significant correlations with any of the longitudinal or cross-sectional measures of selective/focused attention and sustained attention. In contrast, children with mothers who had fewer years of education and who lived in less responsive and supportive home environments scored higher on both parent and teacher ratings of sustained attention (i.e., hyperactivity) through the second grade of elementary school. For NEPSY Auditory Attention in second grade, a significant interaction between the Home Observation for Measurement of the Environment and hearing loss was uncovered. This interaction showed that children with hearing loss from poor home environments experienced greater difficulties on the NEPSY Auditory Attention task than those with hearing loss from good home environments. Conclusion: These findings do not support a direct linkage of a history of OME and associated hearing loss to difficulties in selective/focused attention or sustained attention in early elementary school children. Relationships between sociodemographic variables and attention-related functions appear stronger and should be considered as mediators in any examination of the linkages between early OME and subsequent attention functions.
06-7. Jane, M.C., Canals, J., Ballespi, S., Vinas, F., Esparo, G., & Domenech, E. (2006). Parents and teachers reports of DSM-IV psychopathological symptoms in preschool children. Social Psychiatry and Psychiatric Epidemiology, 41, 386-393.
Objective: This study used DSM-IV criteria to analyse reports from teachers and parents and to compare behavioural and emotional symptoms in Spanish preschool children from both urban and rural populations. Method: The field survey was conducted in two geographical areas in Catalonia (Spain). A sample of 1104 children (56.67% boys and 43.32% girls) aged 3-6 years participated in this study: 697 were from urban areas and 408 from rural ones. The Early Childhood Inventory-teachers' and parents' versions (ECI-4) [Gadow KD, Sprafkin J (1997)-was used as the screening instrument. Results: The teachers' and parents' reports assigned 32.7 and 46.7%, respectively, to one or more ECI-4 categories. Significant differences between sexes were found in teachers' reports. The whole disorders were significantly more prevalent in the urban sample than in the rural one (30.6 vs. 20.3%). The most prevalent disorders in both areas were Anxiety Disorders and Behavioural Problems, and the least prevalent were Mood Disorders and Autistic Disorders. Conclusion: The findings indicate that there are some differences in the prevalence rates of preschool psychopathological disorders between rural and urban Spanish areas.
06-8. Kandel, D.B., Schaffran, C., Griesler, P.C., Hu, M.C., Davies, M., & Benowitz, N. (2006). Salivary cotinine concentration versus self-reported cigarette smoking: Three patterns of inconsistency in adolescence. Nicotine & Tobacco Research, 8, 525-537.
Objective: The present study examined the extent and sources of discrepancies between self-reported cigarette smoking and salivary cotinine concentration among adolescents. Method: The data are from household interviews with a cohort of 1,024 adolescents from an urban school system. Histories of tobacco use in the last 7 days and saliva samples were obtained. Results: Logistic regressions identified correlates of three inconsistent patterns: ( a) Pattern 1-self-reported nonsmoking among adolescents with cotinine concentration above the 11.4 ng/mg cutpoint (n=176), (b) Pattern 2 - low cotinine concentration ( below cutpoint) among adolescents reporting having smoked within the last 3 days (n=155), and (c) Pattern 3-high cotinine concentration (above cutpoint) among adolescents reporting not having smoked within the last 3 days (n=869). Rates of inconsistency were high among smokers defined by cotinine levels or self-reports ( Pattern 1=49.1%; Pattern 2=42.0%). Controlling for other covariates, we found that reports of nonsmoking among those with high cotinine ( Pattern 1) were associated with younger age, having few friends smoking, little recent exposure to smokers, and being interviewed by the same interviewer as the parent and on the same day. Low cotinine concentration among self-reported smokers ( Pattern 2) was negatively associated with older age, being African American, number of cigarettes smoked, depth of inhalation, and exposure to passive smoke but positively associated with less recent smoking and depressive symptoms as assessed with the Youths Inventory-4 (YI-4). High cotinine concentrations among self-reported nonsmokers was positively associated with exposure to passive smoke ( Pattern 3). The data are consonant with laboratory findings regarding ethnic differences in nicotine metabolism rate. The inverse relationship of cotinine concentration with YI-4 depressive symptoms has not previously been reported. Depressed adolescent smokers may take in smaller doses of nicotine than nondepressed smokers; alternatively, depressed adolescents may metabolize nicotine more rapidly.
O6-9. Klassen, A.F., Miller, A., & Fine, S. (2006). Agreement between parent and child report of quality of life in children with attention-deficit/hyperactivity disorder. Child Care Health and Development, 32, 397-406.
Objective: There is little information in the research literature of agreement between parent and child in reports of child quality of life (QOL) for a sample of children diagnosed with attention-deficit/ hyperactivity disorder (ADHD). The aim of our study was to determine whether parent and child concordance is greater for physical domains of QOL than for psychosocial domains; whether parents rate their child's QOL better or poorer than their child's ratings; and whether concordance is related to demographic, socioeconomic or clinical factors. Method: The study was a questionnaire survey of children aged 10-17 referred to the ADHD clinic and diagnosed with ADHD in the province of British Columbia (Canada) between November 2001 and October 2002 and their parent. Results: Fifty-eight children diagnosed with ADHD and their parents completed our study questionnaire. The main outcome measure was the Child Health Questionnaire, which permitted comparisons on eight QOL domains and one single item. Intraclass correlation coefficients were moderate for five domains (range from 0.40 to 0.51), and good for three domains (range from 0.60 to 0.75). Children rated their QOL significantly better than their parents in four areas and poorer in one. Standardized Response Means indicated clinically important differences in mean scores for Behaviour and Self-esteem. Compared with population norms, across most domains, children with ADHD reported comparable health. Discrepancies between parent-child ratings were related to the presence of a comorbid oppositional/defiant disorder, a psychosocial stressor and increased ADHD symptoms. Conclusion: Although self-report is an important means of eliciting QOL data, in children with ADHD, given the discrepancies in this study between parent and child report, measuring both perspectives seems appropriate.
06-10. Leathers, S.J. (2006). Placement disruption and negative placement outcomes among adolescents in long-term foster care: The role of behavior problems. Child Abuse & Neglect, 30, 307-324.
Objective: This study examined risk of placement disruption and negative placement outcomes (e.g., residential treatment and incarceration) among adolescents placed in traditional family foster care for a year or longer. Method: The caseworkers and foster parents of 179 randomly selected 12-13-year-old adolescents placed in traditional foster care were interviewed by telephone. Interviews included standardized measures of externalizing behavioral problems [Oppositional Defiant Disorder and Conduct Disorder symptom categories of the Child Symptom Inventory-4] and several other variables that have been previously associated with placement movement. Disruption from the youth's foster home at the time of the interview was prospectively tracked for 5 years. Results: Over half of the youth experienced a disruption of their placement. Contrary to expectations, behavior problems as reported by caseworkers, but not foster parents, were predictive of placement disruption. However, the foster parent's report of behavior problems predicted risk of negative outcome after a period of 5 years. As hypothesized, integration in the foster home was highly predictive of placement stability and mediated the association between behavior problems and risk of disruption. Conclusion: Results suggest that integration in the foster home might be an important dimension of placement adaptation that should be considered during service planning for foster youth in long-term foster care. In addition, using standardized measures of behavior with both foster parents and caseworkers might be necessary to assess both long-term risk of negative outcomes and more immediate risk of placement disruption.
06-11. Loney, B.R., Butler, M.A., Lima, E.N., Counts, C.A., & Eckel, L.A . (2006). The relation between salivary cortisol, callous-unemotional traits, and conduct problems in an adolescent non-referred sample. Journal of Child Psychology and Psychiatry, 47, 30-36.
Objective: Background: Previous research has suggested that adult psychopathic behavior and child callous-unemotional (CU) traits are uniquely related to low emotional reactivity. Salivary cortisol is a promising biological measure of emotional reactivity that has been relatively overlooked in research on CU traits and antisocial behavior. The current study examined for gender differences in the relation between resting salivary cortisol levels and CU traits in a non-referred adolescent sample. Salivary testosterone levels were assessed to provide discriminant validity for cortisol analyses and were not expected to bear a relation to CU traits. Method: An extreme groups strategy was used to recruit 108 adolescents (53 male, 55 female) from a larger screening sample who exhibited various combinations of low and high scores on parent-report measures of CU traits and conduct problems. [The latter were assessed with the Adolescent Symptom Inventory-4]. Resting saliva samples were assayed for cortisol and testosterone levels using a radioimmunoassay procedure. Results: Consistent with prediction, male participants exhibiting elevated CU traits were uniquely characterized by low cortisol levels relative to male comparison groups (p <.05). Testosterone levels did not differentiate groups and no hormone effects were found for female participants. Conclusion: The current findings build upon recent research in suggesting that low cortisol may be a biological marker for male CU traits.
06-12. Loney, B.R., Lima, E.N., & Butler, M.A. (2006).Trait affectivity and nonreferred adolescent conduct problems. Journal of Clinical Child and Adolescent Psychology, 35, 329-336.
Objective: This study examined for profiles of positive trait affectivity (PA) and negative trait affectivity (NA) associated with adolescent conduct problems. Prior trait affectivity research has been relatively biased toward the assessment of adults and internalizing symptomatology. Consistent with recent developmental modeling of antisocial behavior, this study, proposed that conduct problems are uniquely associated with 2 PA-NA profiles (i.e., high PA-high NA and low PA-low NA). Method: A nonreferred sample of 109 adolescents ages 12 to 19 was recruited to assess the independent relations between rating scale measures of the PA-NA dimensions and conduct problems [sum of the Oppositional Defiant Disorder and Conduct Disorder symptom categories of the Adolescent Symptom Inventory-4], controlling for related internalizing (anxiety and depression) and externalizing (hyperactivity-impulsivity) symptomatology. Results: The results generally confirmed the proposed interaction between the PA-NA dimensions in the prediction of adolescent conduct problems. [Also reported are correlations between the ASI-4 and the CDI and the RCMAS.]
06-13. Scahill, L., McDougle, C.J., Williams, S.K., Dimitropoulos, A., Aman, M.G., McCracken, J.T., Tierney, E., Arnold, L.E., Cronin, P., Grados, M., Ghuman, J., Koenig, K., Lam, K.S.L., McGough, J., Posey, D.J., Ritz, L., Swiezy, N.B., & Vitiello, B. (2006). Children's Yale-Brown Obsessive Compulsive Scale modified for pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1114-1123.
Objective: To examine the psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scales (CYBOCS) modified for pervasive developmental disorders (PDDs). Method: Raters from five Research Units on Pediatric Psychopharmacology (RUPP) Autism Network were trained to reliability. The modified scale (CYBOCS-PDD), which contains only the five Compulsion severity items (range 0-20), was administered to 172 medication-free children (mean 8.2 +/- 2.6 years) with PDD (autistic disorder, n = 152; Asperger's disorder, n = 6; PDD not otherwise specified, n = 14) participating in RUPP clinical trials. Reliability was assessed by intraclass correlation coefficient (ICC) and internal consistency by Cronbach's alpha coefficient. Correlations with ratings of repetitive behavior and disruptive behavior were examined for validity. Results: Eleven raters showed excellent reliability (ICC = 0.97). The mean CYBOCS score was 14.4 +/- 3.86) with excellent internal consistency (alpha = .85). Correlations with other measures of repetitive behavior [including the Child Symptom Inventory-4 Compulsions and Tics scales] ranged from r = 0.11 to r = 0.28 and were similar to correlations with measures of irritability (r = 0.24) and hyperactivity (r = 0.25). Children with higher scores on the CYBOCS-PDD had higher levels of maladaptive behaviors and lower adaptive functioning. Conclusion: The five-item CYBOCS-PDD is reliable, distinct from other measures of repetitive behavior, and sensitive to change.
06-14. Weiss, M.D., Wasdell, M.B., Bomben, M.M., Rea, K.J., & Freeman, R.D. (2006). Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 512-519.
Objective: To evaluate the efficacy of sleep hygiene and melatonin treatment for initial insomnia in children with attention-deficit/hyperactivity disorder (ADHD). Method: Twenty-seven stimulant-treated children (6-14 years of age) with ADHD and initial insomnia (> 60 minutes) received sleep hygiene intervention. Nonresponders were randomized to a 30-day double-blind, placebo-controlled, crossover trial of 5-mg pharmaceutical-grade melatonin provided by the study's sponsor. [The ADHD symptom category of the parent-completed Child Symptom Inventory-4 was used as a screening device for possible inclusion in the study.] Results: Sleep hygiene reduced initial insomnia to < 60 minutes in 5 cases, with an overall effect size in the group as a whole of 0.67. Analysis of the trial data able to be evaluated showed a significant reduction in initial insomnia of 16 minutes with melatonin relative to placebo, with an effect size of 0.6. Adverse events were generally mild and not different from those recorded with placebo treatment. The effect size of the combined sleep hygiene and melatonin intervention from baseline to 90 days' posttrial was 1.7, with a mean decrease in initial insomnia of 60 minutes. Improved sleep had no demonstrable effect on ADHD symptoms. Conclusion: Combined sleep hygiene and melatonin was a safe and effective treatment for initial insomnia in children with ADHD taking stimulant medication.
YEAR: 2005
05-1. Aman, M.G., Buitelaar, J., DeSmedt, G., Wapenaar, R., & Binder, C. (2005). Pharmacotherapy of disruptive behavior and item changes on a standardized rating scale: Pooled analysis of risperidone effects in children with subaverage IQ. Journal of child and Adolescent Psychopharmacology, 15, 220-232.
The ADHD symptom category of the parent-completed Child Symptom Inventory-4 was used as a screening device for possible inclusion in the study.
05-2. Aman, M.G., Arnold, L.E., McDougle, C.J., Vitiello, B., Scahill, L., Davies, M., McCracken, J.T., Tierney, E., Nash, P.L., Posey, D.J., Chuang, S., Martin, A., Shah, B., Gonzalez, N.M., Swiezy, N.B., Ritz, L., Koenig, K., McGough, J., Ghuman, J.K., & Lindsay, R.L. (2005). Acute and long-term safety and tolerability of risperidone in children with autism. Journal of Child and Adolescent Psychopharmacology, 15, 869-884.
The ADHD symptom category of the parent-completed Child Symptom Inventory-4 was used as a screening device for possible inclusion in the study.
05-3. Croonenberghs, J., Fegert, J.M., Findling, R.L., De Smedt, G., Van Dongen, S., & Risperidone Disruptive Behavior Study Group. (2005). Risperidone in children with disruptive behavior disorders and subaverage intelligence: A 1-year, open-label study of 504 patients. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 64-72.
Objective: To determine the long-term safety and effectiveness of resperidone for severe disruptive behaviors in children. Method: A multisite, 1-year, open-label study of patients aged 5 to 14 years with disruptive behavior and subaverage intelligence was conducted. [The Child Symptom Inventory-4 was one of several measures used to make DSM-IV diagnoses.] Results: Seventy-three percent of the 504 patients enrolled completed the study. The mean ± SE dose of risperidone was 1.6±0.0 mg/day. The most common adverse events were somnolence (30%), rhinitis (27%), and headache (22%). The incidence of movement disorders was low, and mean Extrapyramidal Symptom Rating Scale scores decreased during risperidone treatment. No clinically significant changes in mean laboratory values were noted, except for transient increase in serum prolactin levels. Scores on the Nisonger Child Behavior Rating Form Conduct Problem Scale improved significantly as early as week 1, and improvement was maintained throughout the trial (p<.001 at each time point). Significant improvements were noted on positive social behavior and other Nisonger Rating Form subscales, Aberrant Behavior Checklist, Clinical Global Impressions scale, and tests of patients’ cognitive functioning (each p<.001). Conclusions: Risperidone was well tolerated and effective in the long-term treatment of disruptive behavior disorders in children with subaverage intelligence.
05-4. Crowell, S.E., Beauchaine, T.P., McCauley, E., Smith, C.J., Stevens, A.L., & Sylvers, P. (2005). Psychological, autonomic, and serotonergic correlates of parasuicide among adolescent girls. Development and Psychopathology, 17, 1105-1127.
Objective: Although parasuicidal behavior in adolescence is poorly understood, evidence suggests that it may be a developmental precursor of borderline personality disorder (BPD). Current theories of both parasuicide and BPD suggest that emotion dysregulation is the primary precipitant of self-injury, which serves to dampen overwhelmingly negative affect. To date, however, no studies have assessed endophenotypic markers of emotional responding among parasuicidal adolescents. Method: In the present study, we compare parasuicidal adolescent girls (n = 23) with age-matched controls (n = 23) on both psychological and physiological measures of emotion regulation and psychopathology. Adolescents, parents, and teachers completed questionnaires [including the Adolescent Symptom Inventory-4 and the Youth’s Inventory-4] assessing internalizing and externalizing psychopathology, substance use, trait affectivity, and histories of parasuicide. Psychophysiological measures including electrodermal responding (EDR), respiratory sinus arrhythmia, and cardiac pre-ejection period (PEP) were collected at baseline, during negative mood induction, and during recovery. Results: Compared with controls, parasuicidal adolescents exhibited reduced respiratory sinus arrhythmia (RSA) at baseline, greater RSA reactivity during negative mood induction, and attenuated peripheral serotonin levels. No between-group differences on measures of PEP or EDR were found. Conclusion: These results lend further support to theories of emotion dysregulation and impulsivity in parasuicidal teenage girls.
05-5 Frick, P.J., Stickle, T.R., Dandreaux, D.M., Farrell, J.M., & Kimonis, E.R. (2005). Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency. Journal of Abnormal Child Psychology, 33, 471-487.
Objective: The current study tests whether the presence of callous-unemotional (CU) traits designates a group of children with conduct problems who show an especially severe and chronic pattern of conduct problems and delinquency. Method: Ninety-eight children who were selected from a large community screening of school children in grades 3, 4, 6 and 7 were followed across four yearly assessments. Results: Children with conduct problems [determined on the basis of parent and teacher ratings of ODD and CD symptoms from the Child Symptom Inventory-4] who also showed CU traits exhibited the highest rates of conduct problems, self-reported delinquency, and police contacts across the four years of the study. In fact, this group accounted for at least half of all of the police contacts reported in the sample across the last three waves of data collection. In contrast, children with conduct problems who did not show CU traits continued to show higher rates of conduct problems across the follow-up assessments compared to non-conduct problem children. However, they did not show higher rates of self-reported delinquency than non-conduct problem children. In fact, the second highest rate of self-reported delinquency in the sample was found for the group of children who were high on CU traits but without conduct problems at the start of the study.
05-6. Gadow, K.D., & DeVincent, C.J.(2005). Clinical significance of tics and ADHD in children with pervasive developmental disorder. Journal of Child Neurology, 20, 481-488.
Objective: The goal of this study was to examine the clinical significance of co-occurring tics and attention-deficit/hyperactivity disorder (ADHD) as indicators of more complex symptomatology in children with and without pervasive developmental disorder (PDD). Method: Parents and teachers completed a DSM-IV-referenced rating scale for 3 to 5- (N=182/135) and 6 to 12- (N=301/191) year-old children with PDD and clinic controls, respectively. Results: The percentage of children with tic behaviors varied with age: preschoolers (25%, 44%) versus elementary school children (60%, 66%), parents and teachers, respectively. For many psychiatric symptoms, screening prevalence rates were highest for the ADHD+Tics group, and lowest for the NONE group, but the pattern of group differences varied by age group and informant. In general, there were few differences between the ADHD only and Tics only groups. The pattern of ADHD/Tic group differences was similar for both PDD and nonPDD children. Conclusion: We concluded that these findings support the notion that the co-occurrence of ADHD and tics is an indicator of more complex psychiatric symptomatology in children with PDD.
05-7. Gadow, K.D., DeVincent, C.J., Pomeroy, J. & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-aged children with PDD versus clinic and community samples. Autism, 9, 392-414.
Objective: This study describes and compares the severity and prevalence of DSM-IV symptoms in children (ages 6 to 12 years) with diagnosed pervasive developmental disorder (PDD), clinic controls, and two community-based samples. Method: Parents (/and teachers) completed the Child Symptom Inventory-4 (CSI-4) for four samples: PDD (N=284/284) and nonPDD psychiatric clinic referrals (N=189/181) and pupils in regular (N=385/404) and special (N=61/60) education classes. Results: In general, the PDD group received higher DSM-IV symptom severity ratings than the regular education group, but was similar to the nonPDD clinic sample. Screening prevalence rates were highest for ADHD, ODD, and generalized anxiety disorder. PDD subtypes exhibited differentially higher rates of psychiatric symptoms (Asperger's disorder > PDDNOS > Autistic disorder). The magnitude of rater and gender differences in symptom severity ratings was generally modest. Conclusion: Clinic-referred children with PDD exhibit a pattern of psychiatric symptoms that is highly similar to nonPDD clinic referrals. Although much additional research is needed to address the issue of comorbidity, these symptoms have important treatment implications.
05-8. Kandel, D., Schaffran, C., Griesler, P., Samuolis, J., Davies, M., & Galanti, R. (2005). On the measurement of nicotine dependence in adolescence: Comparisons of the mFTQ and a DSM-IV-based scale. Journal of Pediatric Psychology, 30, 319-332.
Objective: To compare nicotine-dependent smokers identified by the modified Fagerstrom Tolerance Questionnaire (mFTQ) and a scale based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), in a multiethnic adolescent sample. Method: A school survey was conducted on 6th to 10th-grade students (N=15,007) in a large urban public school system. Results: Two scales formed two distinct factors. The concordance between the two classifications of nicotine dependence was low. The DSM identified a much larger number of nicotine-dependent smokers than the mFTQ, mostly because smokers met dependence criteria at much lower levels of cigarettes consumed, especially when they were depressed [as assessed with the Depression symptom category of the Youth’s Inventory-4]. Rates of dependence were higher among whites than minority-group members, especially African Americans. Control for level of cigarette consumption attenuated or eliminated ethnic differences. Conclusion: This investigation provides some understanding of youths defined as dependent by each scale but cannot by itself indicate which scale better measures dependence. Differences in dependence rates among ethnic groups are accounted for mostly by quantity of cigarettes smoked.
05-9. Kronenberger, W.G., Mathews, V.R., Dunn, D.W., Wang, Y., Wood, E.A.., Giauque, A.L., Larsen, J.J., Rembusch, M.E., Lowe, M.J., & Li, T.Q. (2005), Media violence exposure and executive functioning in aggressive and control adolescents. Journal of Clinical Psychology, 61, 725-737.
Objective: The relationship between media violence exposure and executive functioning was investigated in samples of adolescents with no psychiatric diagnosis or with a history of aggressive-disruptive behavior. Method: Age-, gender-, and IQ-matched samples of adolescents who had no Diagnostic and Statistical Manual of Mental Disorders-fourth edition (DSM-IV: American Psychiatric Association, 19 94) diagnosis (N = 2 7) and of adolescents who had DSM-IV Disruptive Behavior Disorder diagnoses (N = 27) completed measures of media violence exposure and tests of executive functioning. Results: Moderate to strong relationships were found between higher amounts of media violence exposure and deficits in self-report, parent-report [ADHD Symptom Severity Score of the Adolescent Symptom Inventory-4], and laboratory-based measures of executive functioning. A significant diagnosis by media violence exposure interaction effect was found for Conners' Continuous Performance Test scores, such that the media violence exposure-executive functioning relationship was stronger for adolescents who had Disruptive Behavior Disorder diagnoses. Conclusion: Results indicate that media violence exposure is related to poorer executive functioning [ADHD Symptom Severity Score of the Adolescent Symptom Inventory-4], and this relationship may be stronger for adolescents who have a history of aggressive-disruptive behavior.
05-10. Leff, S.S., & Lakin, R. (2005). Playground-based observational systems: A review and implications for practitioners and researchers. School Psychology Review, 34, 475-489.
Behavioral observation systems allow for a relatively objective way to record important academic, behavioral, and/or interactional processes. Not surprisingly, the majority of school-based observational methods have been designed for and evaluated within the classroom setting. Although this is understandable, the playground context during recess provides an important unstructured school context in which to understand young children's peer relationships, play behaviors, and aggressive actions. This article provides a critical review of six playground-based observation systems [including the ADHD School Observation Code, ADHD-SOC] and discusses implications for use by practitioners and researchers. [The authors conclude that “the ADHD-SOC appears to be a well-established measure that has been evaluated extensively for its reliability and validity” (p. 481). They also note that “the ADHD SOC can be used to monitor the effectiveness of medication or psychosocial interventions with students with ADHD and comorbid externalizing disorders. Furthermore, the ADHD-SOC manual includes information on how to adapt coding sheets to fit one’s particular needs, which makes the ADHD-SOC a feasible system for use across classroom and playground/lunchroom settings” (p. 486).]
05-11. Mathews, V.P., Kronenberger, W.G., Wang, Y., Lurito, J.T., Lowe, M.J., & Dunn, D.W. (2005). Media violence exposure and frontal lobe activation measured by functional magnetic resonance imaging in aggressive and nonaggressive adolescents. Journal of Computer Assisted Tomography, 29, 287-292.
Objective: To understand better the relation between media violence exposure, brain functioning, and trait aggression, this study investigated the association between media violence exposure and brain activation as measured by functional magnetic resonance imaging (fMRI) in groups of normal adolescents and adolescents with disruptive behavior disorder (DBD) with aggressive features [assessed with the Adolescent Symptom Inventory-4]. Methods: Seventy-one participants underwent neuropsychologic evaluation and assessment of exposure to violent media. Subjects also were evaluated with fMRl while performing a counting Stroop (CS) task. Results: Frontal lobe activation was reduced in aggressive subjects compared with control subjects. In addition, differences in frontal lobe activation were associated with differences in media violence exposure. Specifically, activation during performance of the CS in control subjects with high media violence exposure resembled that seen in DBD subjects.
Conclusions: Our findings suggest that media violence exposure may be associated with alterations in brain functioning whether or not trait aggression is present.
05-12. McMahon, R.J., & Frick, P.J. (2005). Evidence-based assessment of conduct problems in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34, 477-505.
This article provides a summary of research in 4 areas that have direct and important implications for evidence-based assessment of children and adolescents with conduct problems (CP): (a) the heterogeneity in types and severity of CP, (b) common comorbid conditions, (c) multiple risk factors associated with CP, and (d) multiple developmental pathways to CP. For each of these domains, we discuss implications for evidence-based assessment, present examples of specific measures that can aid in such assessments [such as the Early Childhood Inventory-4 and the Child Symptom Inventory-4, which the authors note were the only measures in their review that contained DSM-IV-referenced oppositional defiant disorder and conduct disorder subscales], and provide recommendations for evidence-based assessment of CP in children and adolescents. We conclude that there is a need to (a) enhance the clinical utility of evidence-based measures for assessing CP; (b) increase attention to the sensitivity of such measures to change, for both treatment evaluation and monitoring; and (c) develop assessment methods that reliably and validly identify a child or adolescent’s placement and progress on the various developmental pathways to CP.
05-13. O’Driscoll, G.A., Depatie, L., Holahan, A.L.V., Savion-Lemieux, T., Barr, R.G., Jolicoeur, C., & Douglas, V.I. (2005). Executive functions and methylphenidate response in subtypes of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57, 1452-1460.
Objective: Oculomotor tasks are a well-established means of studying executive functions and frontal-striatal functioning in both nonhuman primates and humans. Attention-deficit/hyperactivity disorder (ADHD) is thought to implicate frontal-striatal circuitry. We used oculomotor tests to investigate executive functions and methylphenidate response in two subtypes of ADHD. Method: Subjects were boys, aged 11.5–14 years, with ADHD-combined (n = 10), ADHD-inattentive (n = 12), and control subjects (n = 10). [Diagnostic assessment instruments included the Child Symptom Inventory-4.] Executive functions assessed were motor planning (tapped with predictive saccades), response inhibition (antisaccades), and task switching (saccades-antisaccades mixed). Results: The ADHD-combined boys were impaired relative to control subjects in motor planning (p < .003) and response inhibition (p < .007) but not in task switching (p > .92). They were also significantly impaired relative to ADHD-inattentive boys, making fewer predictive saccades (p < .03) and having more subjects with antisaccade performance in the impaired range (p < .04). Methylphenidate significantly improved motor planning and response inhibition in both subtypes. Conclusions: ADHD-combined but not ADHD-inattentive boys showed impairments on motor planning and response inhibition. These deficits might be mediated by brain structures implicated specifically in the hyperactive/impulsive symptoms. Methylphenidate improved oculomotor performance in both subtypes; thus, it was effective even when initial performance was not impaired.
05-14. Pakalnis, A., Gibson, J., & Colvin, A. (2005). Comorbidity of psychiatric and behavioral disorders in pediatric migraine. Headache, 45, 590-596.
Objective: Recurrent migraine headaches are common in school-age children, and concurrent behavioral or psychiatric diagnoses could significantly impact headache frequency, severity, and response to treatment.
The present study determines whether behavioral and psychiatric disorders occur more frequently in school-age children with migraine headache and elucidates treatment response related to comorbid psychiatric or behavioral diagnosis. Method: Healthy children from 6 to 17 years of age presenting to our headache clinic with migraine headache according to International Headache Society (IHS) criteria were identified. Parents/guardians were asked to complete the Child Symptom Inventory-4 (CSI-4) after written informed consent. Children with positive rating scales underwent psychological interviews for confirmatory diagnosis. Results were compared to controls. Headache patients were assigned our usual treatment paradigm. Response regarding headache frequency was assessed at 3 months. Results: A total of 47 patients were diagnosed with migraine headaches. The mean age was 10.55 years. Thirty controls were identified. After completing the CSI-4 and confirmatory psychological interview, 14 of 47 headache patients fulfilled DSM-4 criteria for a psychiatric or behavioral disorder. Oppositional defiant disorder (ODD) was significantly represented among children with migraine compared to the control group of children. Headache patients improved significantly post-treatment regarding their headache frequencies regardless of comorbid psychiatric or behavioral disorder. No significant differences were noted between boys and girls regarding diagnoses or treatment outcome. Conclusion: ODD was a significant comorbidity in our headache population. Although families complained of significant behavioral symptomatology in their children, most of these symptoms did not qualify their children for a psychiatric diagnosis and may be related to the stressors of headache on social/school disruption.
05-15. Pelham, W.E., Fabiano, G.A., & Massetti, G.M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34, 449-476.
This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods [including the ADHD Symptom Checklist-4, Child Symptom Inventory-4]. It is concluded that symptom rating scales based on DSM-IV, empirically and rationally derived ADHD rating scales, structure interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teach