2010

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. (2009). The Symptom Inventories:  An annotated bibliography.  Stony Brook, NY: Checkmate Plus.

© 2010 Checkmate Plus

YEAR: 2010 and In Press

10-1. Gadow, K.D., & Nolan, E.E. (2010). Methylphenidate and co-morbid anxiety disorder in children with both chronic multiple tic disorder and ADHD. Journal of Attention Disorders,   doi: 10.1177/1087054709356405

Objective:  To determine if co-morbid anxiety disorder is associated with differential response to immediate release methylphenidate (MPH-IR) in children with both attention-deficit/hyperactivity disorder (ADHD) and chronic multiple tic disorder (CMTD). Method: Children with (n=17) and without (n=37) diagnosed anxiety disorder (ANX) were evaluated in an 8-week, placebo-controlled trial with rating scales [including Child Symptom Inventory] and laboratory measures. Results: The +ANX group obtained more severe parent, teacher, and child ratings of anxiety and more severe parent ratings of depression, tics, oppositional defiant disorder (ODD), and peer aggression than the -ANX group. Treatment with short-term MPH-IR was associated with improvement in ADHD, ODD, and peer aggression in the +ANX group. When controlling for ODD severity, there were no apparent group differences in therapeutic response to MPH-IR in children ±ANX. There was little evidence that MPH-IR contributed to improvement in anxiety or depression symptoms in the +ANX group. There was some indication that children with co-morbid anxiety may differentially experience greater increase in systolic blood pressure (0.5 mg/kg of MPH-IR > placebo). Conclusion: Findings suggest that the co-occurrence of diagnosed CMTD+ADHD+ANX represents a particularly troublesome clinical phenotype, at least in the home setting.  Co-morbid anxiety disorder was not associated with a less favorable response to MPH-IR in children with ADHD+CMTD, but replication with larger samples is warranted before firm conclusions can be drawn about potential group differences.

10-2. Gadow, K.D., Chernoff, M., Williams, P.L., Brouwers, P., Morse, E., Heston, J., Hodge, J., Di Poalo, V., Deygoo, N.S., & Nachman, S. (2010). Co-Occurring psychiatric symptoms in children perinatally infected with HIV and peer comparison sample. Journal of Developmental and Behavioral Pediatrics, 31, 116-128.

Objective: To compare the rates of psychopathology in youths perinatally-infected with HIV (N=319) with a comparison sample of peers (N=256) either HIV-exposed or living in households with HIV-infected family members. Method:  Participants were randomly recruited from 29 sites in US and Puerto Rico and completed an extensive battery of measures including standardized DSM-IV-referenced ratings scales [Child and Adolescent Symptom Inventory-4R]. Results: The HIV+ group was relatively healthy (73% with CD4%> 25%), and 92% were actively receiving anti-retroviral therapy. Youths with HIV (17%) met symptom and impairment criteria for the following disorders: attention-deficit/hyperactivity disorder (12%), oppositional defiant disorder (5%), conduct disorder (1%), generalized anxiety disorder (2%), separation anxiety disorder (1%), depressive disorder (2%), or manic episode (1%). Many youths with HIV (27%) and peers (26%) were rated (either self- or caregiver report) as having psychiatric problems that interfered with academic or social functioning. With the exception of somatization disorder, the HIV+ group did not evidence higher rates or severity of psychopathology than peers although rates for both groups were higher than the general population. Nevertheless, self awareness of HIV infection in younger children was associated with more severe symptomatology, and youths with HIV had higher lifetime rates of special education (44% vs 32%), psychopharmacological (23% vs 12%), or behavioral (27% vs 17%) interventions. Youth-caregiver agreement was modest, and youths reported more impairment. Conclusion: HIV infection was not associated with differentially greater levels of current psychopathology; nevertheless, investigation of relations with developmental changes and specific illness parameters and treatments are ongoing. 

10-3. Gadow, K.D., Roohi, J., DeVincent, C.J., Kirsch, S., & Hatchwell, E. (2010). Brief Report: Glutamate transporter gene (SLC1A1) single nucleotide polymorphism (rs301430) and repetitive behaviors and anxiety in children with autism spectrum disorder. Journal of Autism and Developmental Disorders.  doi: 10.1007/s10803-010-0961-7

Investigated association of single nucleotide polymorphism (SNP) rs301430 in glutamate transporter gene (SLC1A1) with severity of repetitive behaviors (obsessive-compulsive behaviors, tics) and anxiety in children with autism spectrum disorder (ASD). Mothers and/or teachers completed a validated DSM-IV-referenced rating scale [Child Symptom Inventory-4] for 67 children with autism spectrum disorder. Although analyses were not significant for repetitive behaviors, youths homozygous for the high expressing C allele had more severe anxiety than carriers of the T allele. Allelic variation in SLC1A1 may be a biomarker for or modifier of anxiety symptom severity in children with ASD, but study findings are best conceptualized as tentative pending replication with larger independent samples.

10-4. Guttmann-Steinmetz, S., Gadow, K.D., DeVincent, C.J., & Crowell, J. (2010). Anxiety symptoms in boys with autism spectrum disorder, attention-deficit hyperactivity disorder, or chronic multiple tic disorder and community controls. Journal of Autism and Developmental Disorders.

We compared symptoms of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) in 5 groups of boys with neurobehavioral syndromes: attention-deficit/hyperactivity disorder (ADHD) plus autism spectrum disorder (ASD), ADHD plus chronic multiple tic disorder (CMTD), ASD only, ADHD only, and community Controls. Anxiety symptoms were assessed using parent and teacher versions of a DSM-IV-referenced rating scale [Child Symptom Inventory-4.] All three groups of boys with co-morbid ADHD evidenced more severe anxiety than Controls. Group differences in anxiety varied as a function of symptom, disorder, informant, and co-morbidity supporting the notion that co-morbid neurobehavioral syndromes differentially impact clinical features of co-occurring anxiety symptoms. Findings also suggest that GAD and SAD are phenomenologically unique, even in children with ASD. Implications for nosology are discussed.

10-5. New, J.J., Schultz, R.T., Wolf, J., Niehaus, J.L., Klin, A., German, T.C., & Scholl, B.J. (2010). The scope of social attention deficits in autism: Prioritized orienting to people and animals in static natural scenes. Neuropsychologia, 48, 51-59.  

A central feature of autism spectrum disorder (ASD) is an impairment in 'social attention'-the prioritized processing of socially relevant information, e.g. the eyes and face. Socially relevant stimuli are also preferentially attended in a broader categorical sense, however: observers orient preferentially to people and animals (compared to inanimate objects) in complex natural scenes. To measure the scope of social attention deficits in autism, observers viewed alternating versions of a natural scene on each trial, and had to 'spot the difference' between them-where the difference involved either an animate or inanimate object. Change detection performance was measured as an index of attentional prioritization. Individuals with ASD showed the same prioritized social attention for animate categories as did control [screened with the Child Symptom Inventory-4] participants. This could not be explained by lower level visual factors, since the effects disappeared when using blurred or inverted images. These results suggest that social attention - and its impairment in autism - may not be a unitary phenomenon: impairments in visual processing of specific social cues may occur despite intact categorical prioritization of social agents.

10-6. Pears, K.C., Bruce, J., Fisher, P. A., Kim, H.K. (2010). Indiscriminate friendliness in maltreated foster children. Child Maltreatment, 15, 64-75.

Indiscriminate friendliness is well documented in children adopted internationally following institutional rearing but is less studied in maltreated foster children. Precursors and correlates of indiscriminate friendliness were examined in 93 preschool-aged maltreated children residing in foster care and 60 age-matched, nonmaltreated children living with their biological parents. Measures included parent reports, official case record data, and standardized laboratory assessments. Foster children exhibited higher levels of indiscriminate friendliness than nonmaltreated children. Inhibitory control [assessed in part with the Early Childhood Inventory-4] was negatively associated with indiscriminate friendliness even after controlling for age and general cognitive ability. Additionally, the foster children who had experienced a greater number of foster caregivers had poorer inhibitory control, which was in turn associated with greater indiscriminate friendliness. The results indicate a greater prevalence of indiscriminate friendliness among foster children and suggest that indiscriminate friendliness is part of a larger pattern of dysregulation associated with inconsistency in caregiving.

10-7. Ruggero, C.J., Carlson, G.A., Kotov, R., & Bromet, E.J. (2010). Ten-year diagnostic consistency of bipolar disorder in a first-admission sample. Bipolar Disorders, 12, 21-31.  

Objectives: A number of reports have examined the stability of the diagnosis of schizophrenia, but fewer studies have considered the long-term consistency of a bipolar diagnosis or factors that influence the likelihood of a diagnostic change. The present study sought to estimate how consistently a bipolar diagnosis was made across a 10-year period and factors associated with consistency, particularly demographic and clinical characteristics, childhood-related factors, and illness course. Methods: The sample included 195 first-admission patients presenting with psychosis who were assessed soon after hospitalization and at 6-month, 2-year, and 10-year follow-up and diagnosed with bipolar disorder on at least one of these assessments. Diagnoses were made using best-estimate procedures and were blind to all previous consensus diagnoses. Respondents who were consistently diagnosed with bipolar disorder were compared to those whose diagnosis shifted across assessments. Results: Overall, 50.3% (n = 98) of the 195 respondents were diagnosed with bipolar disorder at every available assessment, but 49.7% (n = 97) had a diagnostic shift to a non-bipolar disorder at least once over the course of the 10-year study. Childhood psychopathology [assessed in part with the Child Symptom Inventory-4] and poorer illness course were among the few variables associated with increased odds of a change in diagnosis. Conclusions: Even with optimal assessment practices, misdiagnosis of bipolar disorder is common, with complex clinical presentations often making it difficult to consistently diagnose the disorder over the long term.

10-8. Schwartz, L., Serchuck, L., Williams, P.L., Gadow, K.D., Chernoff, M., Nachman, N.PACTG 1055 Team. (in press). Prevalence of pain and association with psychiatric symptom severity in perinatally HIV-infected children as compared to controls living in HIV-affected households. AIDS Care,

10-9. Sismanlar, S.G., Anik, Y., Coskun, A., Agaoglu, B., Karakaya, I., & Yavuz, C.I. (2010). The volumetric differences of the fronto-temporal region in young offspring of schizophrenic patients. European Child & Adolescent Psychiatry, 19, 151-157.  

The aim of this study is to examine the volumetric differences of the fronto-temporal region in the offspring of schizophrenic patients in comparison to normal. Twenty-six offspring of chronic schizophrenic patients aged between 8 and 15 years and 23 control children [evaluated with the Child Symptom Inventory-4] were matched with respect to cranial MRI. Chronic schizophrenic patients were reevaluated with SCID-I to confirm their diagnosis. Parents of children in the control group completed SCL-90-R and were evaluated by clinical interview to exclude any psychotic disorder. The diagnoses of psychiatric disorders in all of the children were established by DSM-IV-based clinical interviews with children and parents. They underwent IQ evaluation by WISC-R and evaluated with cranial MRI. Hippocampus, thalamus, amygdala, corpus callosum, frontal, and temporal lobe volumes were measured and compared by using MANCOVA. After covarying whole brain volume, age and gender, statistically significant decrease in the measurements of corpus callosum and hippocampi, and a non-significant trend toward smaller temporal lobes were observed in the high-risk children. The structure of hippocampal formation and corpus callosum were impaired in the children of the schizophrenic patients which suggests a neurodevelopmental abnormality in subjects with genetic high risk for schizophrenia.

10-10. Sprafkin, J., Mattison, R.E., Gadow, K.D., Schneider, J., &  Lavigne, J. (2010). A DSM-IV-referenced teacher rating scale for monitoring behavioral improvement. Journal of Attention Disorders.

Objective: To examine the psychometric properties of the 30-item teacher’s version of the Child and Adolescent Symptom Inventory Progress Monitor (CASI-PM-T), a DSM-IV-referenced rating scale for monitoring change in ADHD and co-occurring symptoms in youths receiving behavioral or pharmacological interventions. Method: Three separate studies were conducted to determine (a) which items from longer diagnostic instruments were most representative of ADHD and commonly occurring psychiatric syndromes in clinic-referred samples (N=406) ages 3-18 years, (b) the reliability and validity of the CASI-PM-T in students enrolled in full-time special education programs at the elementary and middle school levels (N = 169), and (c) the clinical utility of measuring behavioral change in a sample of outpatient ADHD children beginning treatment with stimulant medication. Results: Internal consistency reliabilities (.71 to .94), 2-week test-retest reliabilities (r = .70 to .90), and interrater agreement (r = .44 to .78) for the CASI-PM-T symptom categories were comparable to the full-length CASI-4. Convergence was also found between corresponding CASI-PM-T categories and consultant diagnoses of ADHD and ODD as well as school functioning measures of grade-point average and suspensions. The CASI-PM-T also demonstrated sensitivity to stimulant medication treatment effects. Conclusion: Findings provide preliminary support for the reliability, validity, and clinical utility of the CASI-PM-T.

10-11. Weisbrot, D.M., Ettinger, A.B., Gadow, K.D., Belman, A., MacAllister, W.S., Milazzo, M., Reed, M.L., Serrano, D., & Krupp, L.B. (2010). Psychiatric comorbidity in pediatric patients with demyelinating disorders. Journal of Child Neurology, 25, 192-202.  

Little is known about psychiatric aspects of pediatric demyelinating conditions. A total of 23 youths (6-17 years) with demyelinating conditions underwent semistructured psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Adolescents and parents completed the Child Symptom Inventory-4 and the Youth's Inventory-4. Fears and conceptions of their neurological problems were elicited. In all, 48% (n = 11) met criteria for current psychiatric diagnoses, including 27% (n = 3) with depressive disorders and 64% (n = 7) with anxiety disorders. Fears and conceptions of the illness were severe and diverse. Depressive and anxiety disorders are common in pediatric demyelinating disease. Clinicians should therefore screen for psychiatric comorbidity symptoms as part of the routine evaluation of such patients.

YEAR: 2009

09-1. Babio, N., Canals, J., Pietrobelli, A., Perez, S., & Arija, V. (2009). A two-phase population study: relationships between overweight, body composition and risk of eating disorders. Nutricion Hospitalaria, 24, 485-491.  

Background: Overweight and eating disorder (ED) are major public health problems in adolescents. Aims: To assess the association of overweight, body composition and anthropometric characteristics with the probability being at risk of ED. Methods: A two-phase study was used. 329 girls and 96 boys (aged 12-18 years) from an initial sample of 2967 adolescents were studied. The BMI, percentage of fat mass estimated by bioimpedance (FM(BIA)), waist circumference, waist-to-height ratio, and waist-to-hip ratio (WHipr) were calculated. The Eating Attitudes Test, Youth's Inventory-4 and a questionnaire to evaluate social influences were administered. Results: A total of 34.7% of girls and 53.6% of boys at risk of ED were overweight (including obesity). For girls, overweight frequency was significantly higher in risk ED group than in control group. Increases of one point in the BMI or FM(BIA) increased the probability of being at risk of ED by 12% (3.0-19.0) and 4% (0.0-8.0), respectively. An increase in Whipr was negatively associated with ED risk. Smoking and symptoms of dysthymia and  generalized anxiety disorder also increase the probability of being at risk of ED in adolescent girls. In adolescent boys, these relations were not observed. Conclusions: The higher BMI and the percentage of FM(BIA) are associated with greater risk of ED in adolescent girls, when psychological factors are present. Increases in the WHipr, characteristic of childhood body is negatively associated with that risk.

09-2. Barnes, M.E., Huss, E.A., Garrod, K.N., Van Raay, E., Dayyat, E., Gozal, D., & Molfese, D.L. (2009). Impairments in attention in occasionally snoring children: an event-related potential study. Developmental Neuropsychology, 34, 629-649.

To determine whether minimal snoring is benign in children. PROCEDURE: 22 rarely snoring children (mean age = 6.9 years, 11 females) and age- and sex-matched controls participated in an auditory oddball task wearing 128-electrode nets. Parents completed the Conners Parent Rating Scales-Revised Long (CPRS-R:L). [The Child Symptom Inventory-4 was used to screen children for significan behavioral disorders.] RESULTS: Snorers scored significantly higher on four CPRS-R:L subscales. Stepwise regression indicated that two ERP variables from a region of the ERP that peaked at 844 msec post-stimulus onset predicted CPRS-R:L Attention Deficit Hyperactivity Disorder (ADHD) Index scores. CONCLUSIONS: Occasional snorers, according to parental report, do exhibit ADHD-like behaviors. Basic sensory processing is longer than in controls, suggesting that delayed frontal activation requires more effort in snorers.

09-3. Bartgis, J., Lefler, E., Hartung, C.M., & Thomas, D.G. (2009). Contrast sensitivity in children with and without attention deficit hyperactivity disorder symptoms. Developmental Neuropsychology, 34, 663-682.   

Dopamine regulation may play a role in attention-deficit hyperactivity disorder (ADHD). Visual contrast sensitivity has been proposed as a measure of retinal dopamine that may predict frontal lobe dopamine levels. Individuals with disorders involving dopamine dysregulation (e.g., Parkinson's disease, Phenylketonuria) have shown poor contrast sensitivity. In this study, 110 6- to 13-year-old children with and without ADHD completed a task measuring visual contrast sensitivity. [ADHD was assessed with the Child Symptom Inventory-4.] As predicted, contrast sensitivity was significantly worse in children with ADHD-Combined Type than controls. Contrast sensitivity was significantly correlated with inattention and hyperactivity. However, unlike many neuropsychological studies of ADHD, only hyperactivity accounted for unique variance.

09-4. Bastiaens, L. (2009). A non-randomized, open study with Aripiprazole and Ziprasidone for the treatment of aggressive behavior in youth in a community clinic. Community Mental Health Journal, 45, 73-77.  

Forty-six patients (36 male, mean age 11.9 +/- 2.6) with a variety of diagnoses and with significant aggressive behavior were treated in an open, non-randomized fashion with Aripiprazole or Ziprasidone. Patients were diagnosed with the Mini International Neuropsychiatric Interview and the Child/Adolescent Symptom Inventory-4. The primary outcome measure was the Overt Aggression Scale (OAS). After 2 months, 34 patients were still in treatment. The average improvement of the OAS in these 34 patients was 63%. Clinical Global Impression-Improvement Scale was 2.1 +/- A 1.2. Neither at baseline, nor at 2 months, were there any statistically significant differences between the Aripiprazole and Ziprasidone groups. Sedation was the most common side effect.

09-5. Birmaher, B., Ehmann, M., Axelson, D.A., Goldstein, B.L., Monk, K., Kalas, C., Kupfer, D., Gill, M.K., Leibenluft, E., Bridge, J., Guyer, A., Egger, H.L., & Brent, D.A. (2009). Schedule for affective disorders and schizophrenia for school-age children (K-SADS-PL) for the assessment of preschool children - A preliminary psychometric study. Journal of Psychiatric Research, 43, 680-686.

Objective: To assess the psychometrics of the schedule for affective disorders and schizophrenia for school-age children present and lifetime version (K-SADS-PL) in diagnosing DSM-IV psychiatric disorders and subsyndromal symptomatology in preschool children. Method: Parents were interviewed about their children using the K-SADS-PL, and they completed the Early Childhood Inventory-4 (ECI-4) and child behavior checklist for ages 11/2-5 years (CBCL). Discriminant, divergent, and convergent validity of the K-SADS-PL were evaluated in 204 offspring ages 2-5 years old of parents from an ongoing study. Inter-rater reliability as well as predictive validity of intake diagnoses at second assessment approximately two years after intake were evaluated. Fourteen children were also assessed by the preschool age psychiatric assessment (PAPA). Results: Children who were diagnosed with oppositional defiant disorder, attention deficit hyperactivity disorder, anxiety, mood, or elimination disorders had significantly higher scores on the ECI-4 than children without these disorders. Significant correlations were found for all convergent CBCL scales. Divergent validity was acceptable for emotional disorders. Inter-rater kappa coefficients for all diagnoses were good. Above noted results were similar for children with at least one positive K-SADS-PL key screen symptom. A significantly higher percentage of children with an intake diagnosis had a diagnosis approximately two years after intake compared to those without an intake disorder. Overall, there was consistency between the PAPA and the K-SADS-PL. Conclusions: Pending further testing, the K-SADS-PL may prove useful for the assessment of psychopathology in preschoolers.

09-6. Boles, D.B., Adair, L.P., & Joubert, A.-M. (2009). A preliminary study of lateralized processing in attention-deficit/hyperactivity disorder. Journal of General Psychology, 136, 243-258.

Attention-deficit/hyperactivity disorder (ADHD) is associated with deficits in spatial and sustained attention processes normally linked to the right parietal and frontal lobes. However, data on lateralization changes in attention processes are sparse. Little research has addressed whether the problems may reflect a more widespread lateralization disorder or whether there are lateralization changes over time. To address these issues, the authors examined several tasks, each using a lateralized process largely localized to a particular lobe and 2 age ranges (11-14 and 18-26 years) of unmedicated ADHD participants and control participants. [Diagnoses were based on part on the Child Symptom Inventory-4 and the Adult Self Report Inventory-4.] ADHD children bisected lines significantly more rightward compared with control children, indicating an altered spatial attention process normally localized to the right parietal lobe. This problem was absent in young adults, suggesting a developmental resolution. The authors observed sustained attention decrements at both ages appearing earlier in the left hemisphere during a vigil. Finally, in these preliminary data, ADHD-related problems appeared specific to attention processes.

09-7. Bubier, J.L., Drabick, D.A.G., & Breiner, T. (2009). Autonomic functioning moderates the relations between contextual factors and externalizing behaviors among inner-city children. Journal of Family Psychology, 23, 500-510.

Although previous research has identified various child-specific and contextual risk factors associated with externalizing behaviors, there is a dearth of literature examining child X context interactions in the prospective prediction of externalizing behaviors. To address this gap, we examined autonomic functioning as a moderator of the relation between contextual factors (i.e., neighborhood cohesion and harsh parental behaviors) and externalizing behaviors [measured with the Child Symptom Inventory-4]. Participants were an ethnic minority, inner-city sample of first through fourth grade children (N = 57, 50% male) and their primary caregivers who participated in two assessments approximately 1 year apart. Results indicated that baseline sympathetic functioning moderated the relation between (a) neighborhood cohesion and externalizing behaviors and (b) harsh parental behaviors and externalizing behaviors. Post-hoc probing of these interactions revealed that higher levels of neighborhood cohesion prospectively predicted (a) higher levels of externalizing behaviors among children with heightened baseline sympathetic functioning, and (b) lower levels of externalizing behaviors among children with attenuated baseline sympathetic functioning. In addition, among children with heightened baseline sympathetic functioning, higher levels of harsh parental behaviors prospectively predicted higher levels of externalizing behaviors.

09-8. Chen, E.Y., McCloskey, M.S., & Keenan, K.E. (2009). Subtyping dietary restraint and negative affect in a longitudinal community sample of girls. International Journal of Eating Disorders, 42, 275-283.

Objective: This Study tests the validity of the "dietary-depressive" Subtype (typified by greater negative affect) and a "dietary" subtype (typified by dietary restraint only) using a diverse longitudinal community sample. Method: Girls at ages 10, 12, and 14 completed the Child Eating Attitudes Test, the Child Symptom Inventory-4, and Body Image Measure. Body Mass Index was assessed at each age. Results: Unlike previous studies, cluster analysis revealed an at-risk "dietary-depressive" (R+) subtype (18.7%, 100/534) and a not at-risk (R-) subtype, distinguished by few depressive symptoms and little dietary restraint (81.31%, 434/534), but no "dietary" subtype, When compared with the R- subtype, the R+ subtype had significantly greater eating disordered behavior and attitudes. The R+ subtype at age 10 was a risk factor for binge-eating but not obesity at ages 12 and 14. Discussion: Dietary restraint and depressive symptoms combined predict binge-eating. longitudinally in a diverse community sample of girls.

09-9. Chernoff, M., Nachman, S., Williams, P., Brouwers, P., Heston, J., Hodge, J., Di Poalo, V., Deygoo, N.S., Gadow, K.D., and the IMPAACT  P1055 Study Team. (2009). Mental health treatment patterns in perinatally HIV-Infected youth and controls. Pediatrics, 124, 627-636.

Background: Youths perinatally infected with HIV (HIV+) often receive psychotropic medication and behavioral treatment for emotional and behavioral symptoms. We describe patterns of intervention for HIV+ and controls in the United States. Methods: 319 HIV+ and 256 Controls, aged 6-17 years, enrolled in IMPAACT 1055, a prospective, 2 year observational study of psychiatric symptoms. 174 of Controls were perinatally HIV-exposed and 82 were uninfected children living in households with HIV+ members. Youths and their primary caregivers completed Youth’s (Self-Report) Inventory-4R and the Child and Adolescent Symptom Inventory-4R (CASI-4R), respectively. Children’s medication and behavioral psychiatric intervention histories were collected at entry.  We evaluated the association of past or current psychiatric treatment with HIV-status, baseline symptoms and impairment using multiple logistic regression, controlling for potential confounders. Results: HIV+ and controls had similar prevalence of psychiatric symptoms (61%) and impairment (14-15%).  104 (18%) participants received psychotropic medications: stimulants (14%), antidepressants (6%) and neuroleptics (4%) and 127 (22%) received behavioral treatment. More HIV+ than Controls received psychotropic medication (23% vs. 12%, p<0.001) and behavioral treatment (27% vs. 17%, p=0.01). After adjusting for symptom class and confounders, HIV+ children had twice the odds of controls to have received stimulants and over 4 times the odds to have received antidepressants. Caregiver-reported symptoms or impairment were associated with higher odds of intervention than reports by children alone. Conclusions: HIV+ children are more likely to receive mental health interventions than controls.  Pediatricians and caregivers should consider available mental health treatment options for all children living in families affected by HIV.

09-10. De Los Reyes, A., Henry, D.B., Tolan, P.H., & Wakschlag, L.S. (2009). Linking informant discrepancies to observed variations in young children's disruptive behavior. Journal of Abnormal Child Psychology, 37, 637-652.

Prior work has not tested the basic theoretical notion that informant discrepancies in reports of children's behavior exist, in part, because different informants observe children's behavior in different settings. We examined patterns of observed preschool disruptive behavior across varying social contexts in the laboratory and whether they related to parent-teacher rating discrepancies of disruptive behavior in a sample of 327 preschoolers. [Teacher ratings were obtained with the Early Childhood Inventory-4.]  Observed disruptive behavior was assessed with a lab-based developmentally sensitive diagnostic observation paradigm that assesses disruptive behavior across three interactions with the child with parent and examiner. Latent class analysis identified four patterns of disruptive behavior: (a) low across parent and examiner contexts, (b) high with parent only, (c) high with examiner only, and (d) high with parent and examiner. Observed disruptive behavior specific to the parent and examiner contexts were uniquely related to parent-identified and teacher-identified disruptive behavior, respectively. Further, observed disruptive behavior across both parent and examiner contexts was associated with disruptive behavior as identified by both informants. Links between observed behavior and informant discrepancies were not explained by child impairment or observed problematic parenting. Findings provide the first laboratory-based support for the Attribution Bias Context Model (De Los Reyes and Kazdin Psychological Bulletin 131:483-509, 2005), which posits that informant discrepancies are indicative of cross-contextual variability in children's behavior and informants' perspectives on this behavior. These findings have important implications for clinical assessment, treatment outcomes, and developmental psychopathology research.

09-11. DeVincent, C.J., & Gadow, K.D. (2009). Relative clinical utility of three Child Symptom Inventory-4 scoring algorithms for differentiating children with autism spectrum disorder vs. attention-deficit hyperactivity disorder. Autism Research, 2, 312-321.  

Objective: The present study compared three separate Child Symptom Inventory-4 (CSI-4) scoring algorithms for differentiating children with autism spectrum disorder (ASD) from youngsters with attention-deficit/hyperactivity disorder (ADHD). Method: Parents/teachers completed the CSI-4, a DSM-IV-referenced rating scale, for 6 to 12-year-old clinical referrals with ASD (N=186) and ADHD (N=251). Algorithms were based on either all CSI-4 items (forward logistic regressions) or the 12 DSM-IV symptoms of pervasive developmental disorder (PDD) included in the CSI-4. Results: ROC analyses indicated generally good to excellent values for area under the curve, sensitivity, specificity, and positive predictive power. Algorithms for parent ratings were superior to teacher ratings. The algorithm based solely on PDD symptoms evidenced the greatest generalizability. Conclusion: Although algorithms generated from regression analyses produced greater clinical utility for specific samples, the PDD-based algorithm resulted in greater stability across samples.

09-12. Domenech-Llaberia, E., Vinas, F., Pla, E., Claustre J.M., Mitjavila, M., Corbella, T., Canals, J. (2009). Prevalence of major depression in preschool children. European Child & Adolescent Psychiatry, 18, 597-604.   

The prevalence of preschool major depressive disorder (MDD) was studied in the community. The whole population of children between 3 and 6 years attending preschool nurseries in three areas (one urban, one rural and one suburban) in Spain (n = 1,427) were contacted. Selection was by a two-stage procedure. At stage I, the ESDM 3-6, a screening measure for preschool depression, was used to identify a sample for more intensive interviewing. Sensitivity and specificity of the cut-off point of the ESDM 3-6 had been previously tested in a pilot study (n = 229). [One of the assessment instruments was the Early Childhood Inventory-4.] During the first stage, 222 preschool children (15.6%) were found to be probable depressives, because they scored 27 or more, the cut-off used. At stage II, the children were interviewed and diagnosed by the consensus of two clinicians, blind to the ESDM 3-6 results. DSM-IV diagnostic criteria were used to define caseness. A total of 16 children (1.12%) met the MDD criteria. The prevalence by areas was urban 0.87%, rural 0.88%, suburban 1.43%. Sex distribution prevalence was 1:1. This study is a contribution to the scarce epidemiology of preschool depression in the community.

09-13. Dunn, D. W., Austin, J. K.., & Perkins, S.M. (2009). Prevalence of psychopathology in childhood epilepsy: categorical and dimensional measures. Developmental Medicine and Child Neurology, 51, 364-372.

Objective: Few studies have utilized both categorical and dimensional measures of psychopathology in children with epilepsy. Method: We evaluated 173 children (88 males, 85 females; mean age 11.7y [SD 1.8]; range 9-14y) who had epilepsy (generalized 36%, partial 61%) for at least 6 months. The primary caregiver completed a dimensional measure, the Child Behavior Checklist (CBCL), and a categorical measure, either the Child Symptom Inventory-4 (CSI-4) or the Adolescent Symptom Inventory-4 (ASI-4). Correlation coefficients were computed between the CBCL scores and CSI/ASI symptom scores. Results: For all children, diagnostic risk was higher than norms on CSI/ASI for attention-deficit-hyperactivity disorder (ADHD) inattentive type, ADHD combined type, oppositional defiant disorder, and dysthymic disorder. For children between 9 and 12 years, elevated scores were found on CBCL, total, internalizing, and attention problems, and on CSI, diagnostic risk for conduct disorder and Asperger syndrome. For children of 13 and 14 years, ASI diagnostic risk was higher for specific phobia, obsessions, posttraumatic stress disorder, motor tics, antisocial personality, panic attack, somatization disorder, and enuresis. CBCL and symptom scores on the CSI/ASI were significantly correlated. Conclusion: The conclusion was that children with epilepsy have high rates of behavioral difficulties on both dimensional and categorical measures. Concurrent validity for the CSI/ASI was supported.

09-14. Feng, X., Keenan, K., Hipwell, A.E, Henneberger, A.K., Rischall, M.S., Butch, J., Coyne, C., Boeldt, D., Hinze, A.K., & Babinski, D.E. (2009).  Longitudinal associations between emotion regulation and depression in preadolescent girls: Moderation by the caregiving environment. Developmental Psychology, 45, 798-808.

Identifying childhood precursors for depression has been challenging and yet important for understanding the rapid increase in the rate of depression among adolescent girls. This study examined the prospective relations of preadolescent girls' emotion regulation and parenting style with depressive symptoms. Participants were 225 children and their biological mothers recruited from a larger longitudinal community study. [The Child Symptom Inventory-4 was used as a screening tool for depressive symptoms.] Girls' observed positive and negative emotion during a conflict resolution task with mothers, their ability to regulate sadness and anger, and their perception of parental acceptance and psychological control were assessed at age 9. Depressive symptoms were assessed by self-report at ages 9 and 10. The results indicated interactions between child emotion characteristics and parenting in predicting later depression. Specifically, low levels of positive emotion expression predicted higher levels of depressive symptoms in the context of moderate to high parental psychological control. Low levels of sadness regulation were predictive of high levels of depressive symptoms in the context of low to moderate parental acceptance. Findings from this study support the hypothesis that the prospective association between vulnerabilities in emotion regulation and depression are moderated by the caregiving environment.

09-15. Gadow, K.D., DeVincent, C.J., & Schneider, J. (2009). Comparative study of children with ADHD Only, autism spectrum disorder+ADHD, and chronic multiple tic disorder+ADHD. Journal of Attention Disorders, 12, 474-485.

Objective: Children with diagnosed autism spectrum disorder (ASD) and chronic multiple tic disorder (CMTD) typically meet criteria for attention deficit/hyperactivity disorder (ADHD). The identification of similarities and differences in co-occurring psychiatric symptoms and mental health risk/protective factors among groups of children with ADHD only, ASD+ADHD, and CMTD+ADHD may eventually lead to a better understanding of these clinical phenotypes. Method: Children with ASD+ADHD (n=88), CMTD+ADHD (n=66), and ADHD Only (n=66) were evaluated using the parent- and teacher-completed Child Symptom Inventory-4, and a parent-completed questionnaire about medical, treatment, and family history. Results: All three groups were highly similar in severity of oppositional defiant disorder and conduct disorder symptoms.  With regard to the various types of anxiety examined in this study, the ASD+ADHD group generally exhibited the most severe symptoms, although the CMTD+ADHD group was rated as having the most generalized anxiety. The two co-morbid groups had the most involved medical histories and greatest likelihood of a family history of psychopathology. Conclusion: The three ADHD groups differed in clinically meaningful ways, and the apparent association between tics and anxiety may explain in part the elevated levels of anxiety in both ASD and CMTD groups.

09-16. Gadow, K.D., Roohi, J., DeVincent, C.J., & Kirsch, S., & Hatchwell, E. (2009). Association of COMT (Val158Met) and BDNF (Val66Met) gene polymorphisms with anxiety, ADHD and tics in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 1542-1551. DOI 10.1007/s10803-009-0794-4

Background: To examine rs4680 (COMT) and rs6265 (BDNF) as genetic markers of anxiety, ADHD, and tics. Methods: Parents and teachers completed a DSM-IV-referenced rating scale [Child Symptom Inventory-4] for a total sample of 67 children with autism spectrum disorder (ASD) Results: Both COMT (p=.06) and BDNF (p=.07) genotypes were marginally significant for teacher ratings of social anxiety (hp²=.06). Analyses also indicated associations of BDNF genotype with parent-rated ADHD (p=.01; hp²=.10) and teacher-rated tics (p=.04; hp²=.07). There was also evidence of a possible interaction (p=.02, hp²=.09) of BDNF genotype with DAT1 3’ VNTR with tic severity. Conclusion: BDNF and COMT may be biomarkers for phenotypic variation in ASD, but these preliminary findings remain tentative pending replication with larger, independent samples.

09-17. Gatzke-Kopp, L.M., Beauchaine, T.P., Shannon, K.E., Chipman, J., Fleming, A.P, Crowell, S., Liang, O., Johnson, L. C., & Aylward, E. (2009). neurological correlates of reward responding in adolescents with and without externalizing behavior disorders. Journal of Abnormal Psychology, 118, 203-213.

Opposing theories of striatal hyper- and hypodopaminergic functioning have been suggested in the pathophysiolopy of externalizing behavior disorders. [Potential participants were initially screened with the Adolescent Symptom Inventory-4.]To test these competing theories, the authors used functional MRI to evaluate neural activity during a simple reward task in 12- to 16-year-old boys with attention-deficit/hyperactivity disorder and/or conduct disorder (n = 19) and in controls with no psychiatric condition (n = 11). The task proceeded in blocks during which participants received either (a) monetary incentives for correct responses or (b) no rewards for correct responses. Controls exhibited striatal activation only during reward, shifting to anterior cingulate activation during nonreward. In contrast, externalizing adolescents exhibited striatal activation during both reward and nonreward. Externalizing psychopathology appears to be characterized by deficits in processing the omission of predicted reward, which may render behaviors that are acquired through environmental contingencies difficult to extinguish when those contingencies change.

09-18. Guttmann-Steinmetz, S., Gadow, K.D., & DeVincent, C.J. (2009). Oppositional defiant and conduct disorder behaviors in boys with autism spectrum disorder with and without attention-deficit hyperactivity disorder versus several comparison samples. Journal of Autism and Developmental Disorders, 39, 976-985.

We compared disruptive behaviors in boys with either autism spectrum disorder (ASD) plus ADHD (n=74), ADHD plus chronic tic disorder (CMTD) (n=47), ADHD Only (n=59), or ASD Only (n=107). Children were evaluated with parent and teacher versions of the Child Symptom Inventory-4 (CSI-4) including parent- (n=168) and teacher-rated (n=173) community Controls. Parents rated children in the three ADHD groups comparably for each symptom of oppositional defiant disorder (ODD) and conduct disorder (CD). Teacher ratings indicated that the ASD+ADHD group evidenced a unique pattern of ODD symptom severity, differentiating them from the other ADHD groups, and from the ASD Only group. The clinical features of ASD appear to influence co-morbid, DSM-IV-defined ODD, with implications for nosology.

09-19. Hack, M., Taylor, H.G., Schluchter, M., Andreias, L., Drotar, D., & Klein, N. (2009). Behavioral outcomes of extremely low birth weight children at age 8 years. Journal of Developmental and Behavioral Pediatrics, 30, 122-130.

Objective: To describe the prevalence of behavioral problems and symptomatology suggestive of Autism and Asperger's disorders at age 8 years among extremely low birth weight (ELBW, < 1 kg) children, born 1992 through 1995. Method: Parent reports of the behavior of 219 ELBW (mean birth weight, 810 g; gestational age 26 weeks) were compared with 176 normal birth weight children of similar maternal socio-demographic status, sex, and age. Behavior was assessed via the Child Symptom Inventory-4 that includes both Symptom Severity Scores and scores meeting DSM-IV criteria for disorders. Results: ELBW compared with normal birth weight children had significantly higher mean Symptom Severity Scores for the inattentive, hyperactive, and combined types of attention-deficit hyperactivity disorder (all p <.001) as well as higher scores for Generalized Anxiety (p <.01) and Autistic (p <.001) and Asperger's (p <.01) disorders. When DSM-IV criteria were considered, ELBW children also had significantly higher rates of attention-deficit hyperactivity disorder of the inattentive (100% vs 3%, p <.01) and combined (5% vs 0.6%, p <.05) types. Conclusions: Attention-deficit hyperactivity disorder, mainly the inattentive type is prevalent among ELBW children. Our findings of an increase in symptoms pertaining to Autistic and Asperger's disorders at school age agree with recent reports of others during early childhood. Early identification and intervention for these problems might improve child functioning and ameliorate parent and child distress.

09-20. Huang-Pollock, C. L., Mikami, A.Y., Pfiffner, L., & McBurnett, K. (2009). Can executive functions explain the relationship between attention deficit hyperactivity disorder and social adjustment? Journal of Abnormal Child Psychology, 37, 679-691.

This study examined the ability of executive functions (EF) to account for the relationship between Attention Deficit Hyperactivity Disorder (ADHD) status and social adjustment as indexed by parent and teacher report and by performance on a standardized observational "chat room" task. Children with the Combined subtype (ADHD-C; n=23), the Primarily Inattentive Subtype (ADHD-I; n=33), and non-ADHD controls (n=36) participated. [Potential participants were initially screened with the Child Symptom Inventory-4.] EF did not mediate the relationship between ADHD status and parent or teacher report of social adjustment. EF accounted for about 40-50% of the variance between ADHD status and the ability of children to detect subtle verbal cues as well as memory for the conversation in the chat room task, but did not mediate the relationship between ADHD and the number of prosocial, hostile, or on-topic statements that were made. Results are consistent with other recent reports, and suggest that the role of EF deficits in the production of social skill deficits in ADHD may not be as prominent as is typically assumed. The implications for the development of intervention programs designed to target core cognitive etiologic factors are discussed.

09-21. Keenan, K., Feng, X., Hipwell, A., & Klostermann, S. (2009).Depression begets depression: Comparing the predictive utility of depression and anxiety symptoms to later depression. Journal of Child Psychology and Psychiatry, 50, 1167-1175.

Background: The high comorbidity between depressive and anxiety disorders, especially among females, has called into question the independence of these two symptom groups. It is possible that childhood anxiety typically precedes depression in girls. Comparing of the predictive utility of symptoms of anxiety with the predictive utility of symptoms of depression from early childhood to early adolescence is needed to test this hypothesis. Methods: Data from a population-based sample of 2,451 girls were used to examine age-related changes and year-to-year stability within and across symptoms of major depression [assessed with the Child Symptom Inventory-4], separation anxiety, and generalized/social anxiety by maternal report from ages 6 to 12. In addition, the predictive utility of symptoms of major depression, separation anxiety, and generalized/social anxiety at ages 7-10 years of age to depressive disorders at ages 11-13 was tested. Results: Symptoms of separation anxiety demonstrated a linear decrease, depression symptoms a linear increase and symptoms of generalized/social anxiety an increase from 6-8, a plateau 8-10, followed by a decrease from 10-12 years. Year-to-year changes in symptoms of major depression were best predicted by depressive symptoms in the previous year, although a small amount of additional variance was accounted for by separation anxiety symptoms in early childhood and generalized/social anxiety symptoms in mid to later childhood. Age 8 was the earliest age from which depressive disorders in early adolescence could be predicted from symptoms of depression and generalized social anxiety. Conclusions: Homotypic continuity of depression and anxiety symptoms from early childhood to early adolescence is more common in girls than heterotypic continuity. Some additional information about year-to-year changes in depression symptoms and later depressive disorder is gained by assessing anxiety symptoms. Depressive symptoms themselves, however, appear to be the strongest and most reliable predictor of later depression.

09-22. Keenan, K., Hipwell, A.E., Hinze, A.E., & Babinski, D.E. (2009). The association of pain and depression in preadolescent girls: Moderation by race and pubertal stage. Journal of Pediatric Psychology, 34, 727-737.

Objective: To test whether an association between pain response and depression in females is present during preadolescence using a controlled pain stimulus and a clinically relevant assessment of depressive symptoms. Method: In a sample of 232 girls, pain threshold and tolerance were assessed at age 10 years using the cold pressor task, and a diagnostic interview was used to assess depression symptoms at 10 and 11 years of age. [The Child Symptom Inventory-4 was used as an initial screen for depression symptoms.]  Results: Response to pain at age 10 was associated with depressive symptoms at ages 10 and 11; race and pubertal stage moderated the association. Pain response and depression were more strongly associated among girls who had reached advanced stages of pubertal development and among European American girls. Conclusions: The results add to the existing literature on the co-occurrence of depression and pain by demonstrating modest but consistent concurrent and prospective associations between response to pain and depression among girls during preadolescence.

09-23. Keenan, K., Hipwell, A., Hinze, A., & Babinski, D. (2009). Equanimity to Excess: Inhibiting the Expression of Negative Emotion is Associated with Depression Symptoms in Girls. Journal of Abnormal Child Psychology, 37, 739-747.  

Emotion dysregulation is often invoked as an important construct for understanding risk for psychopathology, but specificity of domains of emotion regulation in clinically relevant research is often lacking. In the present study Gross' (2001) model of emotion regulation is used to generate hypotheses regarding the relative contribution of two specific types of deficits in emotion regulation, inhibited and disinhibited expression of negative emotion, to individual differences in depressive symptoms in preadolescent girls. A sample of 232 9-year-old girls was recruited from a community based study. [The Child Symptom Inventory-4 was used as an initial screen for depression symptoms.] Depression symptoms were assessed via diagnostic interview. The mother and interviewer rated the girl's level of impairment. Questionnaires and observations were used to assess inhibited and disinhibited expression of negative emotion. Differences in inhibited expression of negative emotion typically explained more variance in depressive symptoms and impairment across informants than did disinhibited expression of negative emotion. Although disinhibited expression of negative emotion is associated with depression and impairment, inhibited expression appeared to be a necessary ingredient, suggesting that inhibited expression may be a particularly relevant deficit in emotion regulation in the development of depression in females.

09-24. Kochanska, G., Barry, R.A., Jimenez, N.B., Hollatz, A., & Woodard, J. (2009). Guilt and effortful control: Two mechanisms that prevent disruptive developmental trajectories. Journal of Personality and Social Psychology, 97, 322-333. 

Children's guilt associated with transgressions and their capacity for effortful control are both powerful forces that inhibit disruptive conduct. The authors examined how guilt and effortful control, repeatedly observed from toddlerhood to preschool age, jointly predicted children's disruptive outcomes in 2 multimethod, multitrait longitudinal studies (Ns = 57 and 99). Disruptive outcomes were rated by mothers at 73 months (Study 1) and mothers, fathers, and teachers at 52 and 67 months (Study 2). [Disruptive behaviors were assessed in part with the Child Symptom Inventory-4.] In both studies, guilt moderated effects of effortful control: For highly guilt-prone children, variations in effortful control were unrelated to future disruptive outcomes. but for children who were less guilt prone, effortful control predicted such outcomes. Guilt may inhibit transgressions through an automatic response due to negative arousal triggered by memories of past wrongdoing, regardless of child capacity for deliberate inhibition. Effortful control that engages a deliberate restraint may offset risk for disruptive conduct conferred by low guilt.

09-25. Kochanska, G., Barry, R.A., Stellern, S.A., & O'Bleness, J.J. (2009). Early attachment organization moderates the parent-child mutually coercive pathway to children's antisocial conduct. Child Development, 80, 1288-1300.

This multimethod study of 101 mothers, fathers, and children elucidates poorly understood role of children's attachment security as moderating a common maladaptive trajectory: from parental power assertion, to child resentful opposition, to child antisocial conduct. [Disruptive behaviors were assessed in part with the Child Symptom Inventory-4.] Children's security was assessed at 15 months, parents' power assertion observed at 25 and 38 months, children's resentful opposition to parents observed at 52 months, and antisocial conduct rated by parents at 67 months. Moderated mediation analyses indicated that in insecure dyads, parental power assertion predicted children's resentful opposition, which then predicted antisocial conduct. This mechanism was absent in secure dyads. Early insecurity acts as a catalyst for a dyad embarking on mutually adversarial path toward antisocial outcomes, whereas early security defuses this maladaptive trajectory.

09-26. Lavigne, J.V., Cromley, T., Sprafkin, J., & Gadow, K.D. (2009). The Child and Adolescent Symptom Inventory Progress Monitor: A brief DSM-IV-referenced parent-report scale for children and adolescents. Journal of Child and Adolescent Psychopharmacology, 19, 241-252.

Because clinics generally serve children with a wide range of co-morbid disorders, and time constraints limit data collection needed to monitor symptom change, there is a strong need to develop assessment instruments that are brief but comprehensive, and can be administered repeatedly during clinical management. The Child and Adolescent Symptom Inventory-Progress Monitor-Parent Form (CASI-PM-P) is a 29-item rating scale designed to evaluate symptom change for commonly-referred child and adolescent disorders. Its intended applications include monitoring longer-term changes in clinical status and assessing intervention responsiveness. To enhance practicality, there is one version of the CASI-PM-P for all age groups with a common set of norms for both genders. Scoring procedures allow clinicians to assess whether observed symptom changes exceeded chance fluctuations.  Using a clinical sample of 2,693 children ages 3-17 years, the 29 symptom-related items were identified that had the best item-to-total minus item correlations on the three age-appropriates scales of the Symptom Inventories.  Item-to-total minus item correlations of similar magnitude were also obtained for those items with the standardization sample. In clinical samples, the CASI-PM-P scores had both high levels of internal consistency and test-retest reliability, and were sensitive to change in a treated sample. Collectively, the findings support the reliability and validity of the CASI-PM-P as a measure of behavioral change in clinical settings, while continued research will be necessary to improve clinical utility and provide better documentation of the scale’s strengths and weaknesses.

09-27. Lavigne, J.V., LeBailly, S.A., Hopkins, J., Gouze, K.R., & Binns, H. (2009). The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. Journal of Clinical Child and Adolescent Psychology, 38, 315-328.

Few studies have examined the epidemiology of preschoolers' psychopathology. This study included 796 4-year-old children recruited from schools and pediatric practices in a diverse, urban area. Psychiatric disorder was assessed by a structured interview adapted for preschool children and by questionnaire [including the Early Childhood Inventory-4]. The most common disorders were oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). Generalized anxiety disorder (GAD) and depressive disorders were reported in less than 1% of the sample. Race/ethnicity differences were not significant. Gender differences showed ADHD-inattentive type more common among boys, with no gender differences for GAD, major depressive disorder, dysthymia, separation anxiety disorder, or ODD at any level of impairment. The overall comorbidity rate was 6.4%. Approximately 3% of individuals receiving a diagnosis had received mental health services.

09-28. Ladouceur, C.D., Silk, J.S., Dahl, R.E., Ostapenko, L., Kronhaus, D.M., & Phillips, M.L. (2009). Fearful faces influence attentional control processes in anxious youth and adults. Emotion, 9, 855-864.

This study examined the effects of trait anxiety and age on performance on an emotional working memory task designed to investigate attentional control processes in the context of emotion. Participants included children, adolescents, and adults (8-30 years old). [Participants were evaluated with Adolescent Symptom Inventory-4 and the Child Symptom Inventory-4.] They performed the Emotional Face N-Back (EFNBACK) task, a modified n-back working memory task with four emotional distracter types (no picture, neutral, fearful, and happy) and two memory-load conditions (0-back and 2-back), and completed self-report trait anxiety measures. Results indicated that participants high in trait anxiety had slower reaction times on the fearful 2-back memory-load condition. A significant interaction with age indicated that this effect was greater in the younger participants. These findings suggest that anxious individuals, particularly younger ones, exhibit difficulty resisting interference from threat-related stimuli when greater attentional resources are being recruited.

09-29. Lecavalier, L., Gadow, K.D., DeVincent, C.J., & Edwards, M.C. (2009). Validation of DSM-IV model of psychiatric syndromes in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 278-289.

The objective of this study was to assess the internal construct validity of the DSM-IV as a conceptual model for characterizing behavioral syndromes in children with ASD. Parent and teachers completed the Child Symptom Inventory-4, a DSM-IV-referenced rating scale, for 6-to-12 year old clinic referrals with an ASD (N=498). Ratings were submitted to confirmatory factor analysis and models were assessed for fit. Results were also compared to those obtained for a sample of non-ASD psychiatric outpatient school-age children. Fit indices ranged from acceptable to good for the ASD samples and compared well to those obtained in typically-developing children. Findings lend support to the notion that DSM-IV syndromes may be an appropriate conceptual model for characterizing behavioral phenotypes in ASD.

09-30. Lecavalier, L., Gadow, K.D., DeVincent, C.J., Houts, C., & Edwards, M.C. (2009). Deconstructing the PDD clinical phenotype: internal validity of the DSM-IV. Journal of Child Psychology and Psychiatry, 50, 1246-1254.

Background: Empirical studies of the structure of autism symptoms have challenged the three-domain model of impairment currently characterizing pervasive developmental disorders (PDD). The objective of this study was to assess the internal validity of the DSM as a conceptual model for describing PDD, while paying particular attention to certain subject characteristics. Methods: Parents and teachers completed a DSM-IV-referenced rating scale [Early Childhood Inventory-4, Child Symptom Inventory-4] for 3- to 12-year-old clinic referrals with a PDD (n=730). Ratings were submitted to confirmatory factor analysis and different models were assessed for fit. Results: Measures of fit indicated that the three-factor solution based on the DSM was superior to other models. Most indices of fit were acceptable, but showed room for improvement. Fit indices varied according to the rater (parent or teacher), child's age (preschool versus school aged), PDD subtype (autism, Asperger's, pervasive developmental disorder not otherwise specified (PDDNOS)), and IQ. Conclusions: More research needs to be done before discarding current classification systems. Subject characteristics, modality of assessment, and procedural variations in statistical analyses impact conclusions about the structure of PDD symptoms.

09-31. Loeber, R., Hipwell, A., Battista, D., Sembower, M., & Stouthamer-Loeber, M. (2009). Intergenerational transmission of multiple problem behaviors: Prospective relationships between mothers and daughters. Journal of Abnormal Child Psychology, 37, 1035-1048.

Much of the research examining intergenerational continuity of problems from mother to offspring has focused on homotypic continuity (e. g., depression), despite the fact that different types of mental health problems tend to cluster in both adults and children. It remains unclear whether mothers with multiple mental health problems compared to mothers with fewer or no problems are more likely to have daughters with multiple mental health problems during middle childhood (ages 7 to 11). Six waves of maternal and child data from the Pittsburgh Girls Study (n = 2,451) were used to examine the specificity of effects of maternal psychopathology on child adjustment. Child multiple mental health problems comprised disruptive behavior, ADHD symptoms [assessed with the Child Symptom Inventory-4], depressed mood, anxiety symptoms and somatic complaints, while maternal multiple mental health problems consisted of depression, prior conduct problems and somatic complaints. Generalized Estimating Equations (GEE) was used to examine the prospective relationships between mother's single and multiple mental health problems and their daughter's single and multiple mental health problems across the elementary school-aged period (ages 7-11 years). The results show that multiple mental health problems in the mothers predicted multiple mental health problems in the daughters even when earlier mental health problem of the daughters, demographic factors, and childrearing practices were controlled. Maternal low parental warmth and harsh punishment independently contributed to the prediction of multiple mental health problems in their daughter, but mediation analyses showed that the contribution of parenting behaviors to the explanation of girls' mental health problems was small.

09-32. Loeber, R., Pardini, D., Hipwell, A., Stouthamer-Loeber, M., Keenan, K., Sembower, M.A. (2009). Are there stable factors in preadolescent girls' externalizing behaviors? Journal of Abnormal Child Psychology, 37, 777-791.    

Relatively little is known about the factor structure of disruptive behavior among preadolescent girls. The present study reports on exploratory and confirmatory factor analyses of disruptive girl behavior over four successive data waves as rated by parents and teachers in a large, representative community sample of girls (N = 2,451). Five factors were identified from parent ratings (oppositional behavior/conduct problems, inattention, hyperactivity/impulsivity, relational aggression, and callous-unemotional behaviors), and four factors were identified derived from teacher ratings (oppositional behavior/conduct problems/callous-unemotional behaviors, inattention, hyperactivity/impulsivity, and relational aggression). [Disruptive behaviors were assessed in part with the Child Symptom Inventory-4.] There was a high degree of consistency of items loading on equivalent factors across parent and teacher ratings. Year-to-year stability of factors between ages five and 12 was high for parent ratings (ICC = 0.70 to 0.88), and slightly lower for teacher ratings (ICC = 0.56 to 0.83). These findings are discussed in terms of possible adjustment to the criteria for children's disruptive behavior disorders found in the Diagnostic and Statistical Manual for Mental Disorders.

09-33. Martényi, F., Treuer, T.,  Gau, S. S.-F., Hong, S.D., Palaczky, M., Šuba, J., Tiberiu, M., Uhlíková, P., Xu, T., Zoroğlu, S., Gadow, K.D.,  Walton, R., & Harrison, G. (2009).  Attention-deficit/hyperactivity disorder diagnosis, co-morbidities, treatment patterns and quality of life in a paediatric population in Central and Eastern Europe and Asia. Journal of Child and Adolescent Psychopharmacology, 19, 363-376.

Attention deficit/hyperactivity disorder (ADHD) is often poorly understood, and treatment practices are variable. This 12-month, prospective, observational study provides information about the diagnosis, co-morbidities, treatment patterns, and quality of life (QOL) of patients aged 6-17 years with ADHD symptoms from eastern Asia and central and eastern Europe. Here, we present baseline data for the 1068 enrolled and eligible patients in the study (median age 8 years, 82.2% male). Patients were grouped into two cohorts based on whether they were prescribed psycho-and/or pharmacotherapy (n = 794) or not (n = 274) at study entry. On average, patients receiving treatment were significantly older (9.1 vs. 8.4 years, p<0.001), more severely ill (Clinical Global Impressions [CGI]-ADHD-S, 4.6 vs. 4.2, p<0.001; Child Symptom Inventory-4 Parent Checklist (CSI-4) ADHD: C, 35.2 vs. 31.9, p<0.001), and had significantly higher CSI-4 symptom severity scores relating to various co-morbidities than patients not receiving treatment. At study initiation, patient's health-related QOL was significantly impaired as measured on the Child Health and Illness Profile-Child Edition (CHIP-CE) rating scale, with significantly more impairment in the treated group of patients for the Comfort, Risks Avoidance, and Achievement domains. These results provide a description of ADHD and treatment practices in these regions and establish a baseline for gauging changes over time in the study sample.

09-34. McCabe, K., & Yeh, M. (2009). Parent-child interaction therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child and Adolescent Psychology, 38, 753-759. 

This study compared the effectiveness of a culturally modified version of Parent-Child Interaction Therapy (PCIT), called Guiando a Ninos Activos (GANA), to the effectiveness of standard PCIT and Treatment as Usual (TAU) for young Mexican American children with behavior problems. Fifty-eight Mexican American families whose 3- to 7-year-old child had a clinically significant behavior problems [assessed in part with the Early Childhood Inventory-4] were randomly assigned to GANA, standard PCIT, or TAU. All three treatment approaches produced significant pre-post improvement in conduct problems across a wide variety of parent-report measures. GANA produced results that were significantly superior to TAU across a wide variety of both parent report and observational indices; however, GANA and PCIT did not differ significantly from one another. PCIT was superior to TAU on two of the parent report indices and almost all of the observational indices. There were no significant differences between the three groups on treatment dropout, and families were more satisfied with both GANA and PCIT than with TAU.

09-35. Miranda, A., Grau, D., Rosel, J., & Melia, A. (2009). Understanding discipline in families of children with attention-deficit/hyperactivity disorder: a structural equation model. Spanish Journal of Psychology, 12, 496-505.

One hundred and fifty-five mothers of children with attention deficit/hyperactivity disorder (ADHD) completed a semi-structured interview, the Parenting Stress Index Questionnaire (Abidin, 1990), to evaluate parenting stress. The Parenting Scale (Arnold, O'Leary, Wolff & Acker, 1993) was also administered to measure dysfunctional discipline strategies. Structural equation modeling was used to test a model in which the independent variables were the Child's Characteristics and the Socio-Educational Status of his or her family; intermediate variables were Parenting Stress concerning the Child Domain and concerning the Parent Domain; and the dependent variable was Parental Discipline. The results confirm our hypotheses. Interventions in these families should therefore incorporate a component focused on Parenting Stress (in both the Child Domain and the Parent Domain), as a determinant of Parental Discipline.

09-36. Pakalnis, A., Splaingard, M., Splaingard, D., Kring, D., & Colvin, A. (2009). Serotonin effects on sleep and emotional disorders in adolescent migraine source. Headache, 49, 1486-1492.

Objectives: To determine frequency of emotional disorders and sleep disturbances in adolescent migraineurs with episodic and chronic headaches. To determine the relationship of whole blood serotonin, caffeine consumption, and frequency of sleep and mood disorders. Background: The neurotransmitter serotonin has been implicated to play a role in the initiation and maintenance of sleep and in modulating mood. A putative role in migraine pathophysiology is also known. Methods: Adolescents from 13 to 17 years of age were identified from our headache clinic with episodic or chronic migraine (according to International Classification of Headache Disorders-Second Edition criteria) and healthy controls enrolled. Psychological rating scales were completed, including Adolescent Symptom Inventory-4 and Child Depression Inventory. Sleep questionnaires (Pediatric Sleep Questionnaire and Child Sleep Habit Questionnaire) were completed by the teenager's parents/guardian. Whole blood serotonin levels were drawn and analyzed and caffeine consumption obtained by history. Results: A total of 18 controls (8 girls) and 15 patients each with episodic migraines (9 girls) and chronic migraine (10 girls) were studied. Patients with headache had significantly more sleep problems than controls. Patients with chronic migraines had increased daytime sleepiness and dysthymia compared with teenagers with episodic migraines. Serotonin levels were not significantly different, and no association was noted between serotonin levels and sleep abnormalities or emotional rating scales. Increased caffeine intake was related to sleep and depressive complaints. Conclusions: Sleep and emotional disorders were common in adolescents with migraine. Sleep disorders and dysthymia were more prevalent with increased headache frequency. No correlation was noted with whole blood serotonin levels.

09-37. Rapport, M.D., Bolden, J., Kofler, M. J., Sarver, D.E., Raiker, J.S., & Alderson, R. M. (2009). Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): A ubiquitous core symptom or manifestation of working memory deficits? Journal of Abnormal Child Psychology, 37, 521-534.

Hyperactivity is currently considered a core and ubiquitous feature of attention-deficit/hyperactivity disorder (ADHD); however, an alternative model challenges this premise and hypothesizes a functional relationship between working memory (WM) and activity level. The current study investigated whether children's activity level is functionally related to WM demands associated with the domain-general central executive and subsidiary storage/rehearsal components using tasks based on Baddeley's (Working memory, thought, and action. New York: Oxford University Press 2007) WM model. Activity level was objectively measured 16 times per second using wrist- and ankle-worn actigraphs while 23 boys between 8 and 12 years of age completed control tasks and visuospatial/phonological WM tasks of increasing memory demands. [Assessment instruments included the Child Symptom Inventory-4.] All children exhibited significantly higher activity rates under all WM relative to control conditions, and children with ADHD (n = 12) moved significantly more than typically developing children (n=11) under all conditions. Activity level in all children was associated with central executive but not storage/rehearsal functioning, and higher activity rates exhibited by children with ADHD under control conditions were fully attenuated by removing variance directly related to central executive processes.

09-38. Roohi, J., DeVincent, C.J., Hatchwell, E., & Gadow, K.D. (2009). Association of a monoamine oxidase-A gene promoter polymorphism with ADHD and anxiety in boys with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 67-74.

The aim of the present study was to examine the association between a variable number tandem repeat (VNTR) functional polymorphism in the promoter region of the MAO-A gene and severity of ADHD and anxiety in boys with ASD. Parents and teachers completed a DSM-IV-referenced rating scale [Child Symptom Inventory-4] for 5 -to-14 year old boys with ASD (n=43). Planned comparisons indicated that children with the 4- versus 3-repeat allele had significantly (p<.05) more severe parent-rated ADHD inattention and impulsivity, and more severe teacher-rated symptoms of generalized anxiety. Our results support a growing body of research indicating that concomitant behavioral disturbances in children with ASD warrant consideration as clinical phenotypes, but replication with independent samples is necessary to confirm this preliminary finding.

09-39. Schneider, J., Gadow, K.D., Crowell, J.A., & Sprafkin, J. (2009). Anxiety in boys with attention-deficit/hyperactivity disorder with and without chronic multiple tic disorder. Journal of Child and Adolescent Psychopharmacology, 19, 737-748.  

Objective: This study examined the psychosocial and behavioral concomitants of anxiety in clinic-referred boys with attention-deficit/hyperactivity disorder (ADHD) with and without chronic multiple tic disorder (CMTD). Method: ADHD boys with (n=65) and without (n=94) CMTD were evaluated with measures of psychiatric symptoms [including the Child Symptom Inventory-4], mental health risk factors, and academic and social performance. Results: Boys with CMTD evidenced more severe anxiety and less social competence and were more likely to be living with only one biological parent than the ADHD Only group, but the magnitude of group differences was generally small. The severity of generalized anxiety, separation anxiety, social phobia, and obsessive-compulsive symptoms were uniquely associated with a different pattern of risk factors, and there was some evidence that these patterns differed for the two groups of boys. Conclusion: Boys with CMTD had a relatively more severe and complex pattern of anxiety that was associated with different clinical features, all of which suggests that ADHD plus CMTD might better be conceptualized as a distinct clinical entity from ADHD Only. However, findings from the extant literature are mixed, and therefore this remains a topic for further study.

09-40. Shannon, K.E., Sauder, C., Beauchaine, T.P., & Gatzke-Kopp, L.M. (2009). Disrupted effective connectivity between the medial frontal cortex and the caudate in adolescent boys with externalizing behavior disorders. Criminal Justice and Behavior, 36, 1141-1157.   

Studies addressing the neural correlates of criminal behavior have focused primarily on the prefrontal cortex and the amygdala. However, few studies have examined dopaminergic inputs to these or other brain regions, despite the fact that central dopamine (DA) dysfunction is associated with both trait impulsivity and novelty seeking. Given long-standing associations between both of these personality traits and externalizing psychopathology, the authors examined effective connectivity between the caudate nucleus and the anterior cingulate cortex, two areas that rely on DA input to facilitate associative learning and goal directed behavior. [Potential participants were initially evaluated with the Child Symptom Inventory-4 or the Adolescent Symptom Inventory-4.] Dysfunction in top-down and bottom-up processing within this dopaminergically mediated frontostriatal circuit may be an important biological vulnerability that increases one's likelihood of engaging in delinquent and criminal behavior. When compared with controls, reduced effective connectivity between these regions among adolescents with externalizing psychopathology was found, suggesting deficiencies in frontostriatal circuitry.

09-41. Silk, J.S., Siegle, G.J., Whalen, D.J., Ostapenko, L.J., Ladoucer, C.D., & Dahl, R.E. (2009). Pubertal changes in emotional information processing: Pupillary, behavioral, and subjective evidence during emotional word verification. Development and Psychopathology, 21, 7-26. 

This study investigated pupillary and behavioral responses to an emotional word valence identification paradigm among 32 pre-/early pubertal and 34 mid-/late pubertal typically developing children and adolescents [pre-screened on either the Child Symptom Inventory-4 or Adolescent Symptom Inventory-4]. Participants were asked to identify the valence of positive, negative, and neutral words while pupil dilation was assessed using an eyetracker. Mid-/late pubertal children showed greater peak pupillary reactivity to words presented during the emotional word identification task than pre-/early pubertal children, regardless of word valence. Mid-/late pubertal children also showed smaller sustained pupil dilation than pre-/early pubertal children after the word was no longer on screen. These findings were replicated controlling for participants' age. In addition, mid-/late pubertal children had faster reaction times to all words, and rated themselves as mote emotional during their laboratory visit compared to pre-/early pubertal children, Greater recall of emotional words following the task was associated with mid-/late pubertal Status, and greater recall of emotional words was also associated with higher peak pupil dilation. These results provide physiological, behavioral, and subjective evidence consistent with a model of puberty-specific changes in neurobehavioral systems underpinning emotional reactivity.

09-42. Volpe, R. J., Gadow, K.D., Blom-Hoffman, J., & Feinberg, A.B. (2009). Factor-analytic and individualized approaches to constructing brief measures of ADHD behaviors. Journal of Emotional and Behavioral Disorders, 17, 118-128.   

Two studies were performed to examine a factor-analytic and an individualized approach to creating short progress-monitoring measures from the longer ADHD-Symptom Checklist-4 (ADHD-SC4). In study 1, teacher ratings on items of the ADHD: Inattentive (IA) and ADHD:Hyperactive-Impulsive (HI) scales of the ADHD-SC4 were factor analyzed in a normative data sample of 493 students aged 5 to 12 years. Items with the highest factor loadings were then selected to create abbreviated IA and HI scales for study 2. In study 2, the psychometric characteristics of two shortened progress-monitoring measures (factor derived and individualized) and the original IA and HI scales of the ADHD-SC4 were examined in a sample of 26 students aged 4 to 17 years in a medication titration study involving baseline and three doses of methylphenidate. The results indicated comparable psychometric properties across the original and abbreviated versions of the IA and HI scales.

09-43. Wang, Y., Mathews, V.P., Kalnin, A.J., Mosier, K.M., Dunn, D.W., Saykin, A.J., & Kronenberger, W.G. (2009).

Short term exposure to a violent video game induces changes in frontolimbic circuitry in adolescents. Brain Imaging and Behavior, 3, 38-50. 

Despite evidence of effects of violent video game play on behavior, the underlying neuronal mechanisms involved in these effects remain poorly understood. We report a functional MRI (fMRI) study during two modified Stroop tasks performed immediately after playing a violent or nonviolent video game. [Youths were screened for psychopathology with the Adolescent Symptoms Inventory-4.] Compared with the violent video game group, the nonviolent video game group demonstrated more activation in some regions of the prefrontal cortex during the Counting Stroop task. In contrast to the violent video game group, significantly stronger functional connectivity between left dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) was identified in the nonviolent video game group. During an Emotional Stroop task, the violent video game group showed more activity in the right amygdala and less activation in regions of the medial prefrontal cortex (MPFC). Furthermore, functional connectivity analysis revealed the negative coupling between right amygdala and MPFC in the nonviolent video game group. By contrast, no significant functional connectivity between right amygdala and MPFC was found in the violent video game group. These results suggest differential engagement of neural circuitry in response to short term exposure to a violent video game as compared to a nonviolent video game.

09-44. White, S.W., Ollendick, T., Scahill, L., Oswald, D., & Albano, A.M. (2009). Preliminary efficacy of a cognitive-behavioral treatment program for anxious youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1652-1662.

Anxiety is a commonly occurring psychiatric concern in adolescents with autism spectrum disorders (ASD). This pilot study examined the preliminary efficacy of a manual-based intervention targeting anxiety and social competence in four adolescents with high-functioning ASD. Anxiety and social functioning were assessed at baseline, midpoint, endpoint, and 6 months following treatment. [Anxiety was assessed with the 20-item Child and Adolescent Symptom Inventory-4 Autism Spectrum Disorder Anxiety Scale (CASI-Anx).] Treatment consisted of cognitive-behavioral therapy, supplemented with parent education and group social skills training. The treatment program was effective in reducing anxiety in three of the four subjects and improving the social skills in all four subjects. Recommendations for the assessment and treatment of anxiety youth with ASD such as use of self-report measures to complement clinician and parent-reports and adaptations to traditional child-based CBT, are offered.

YEAR: 2008

08-1. Abikoff, H.B., Vitiello, B., Riddle, M.A., Cunningham, C., Greenhill, L.L., Swanson, J.M., Chuang, S.Z., Davies, M.,  Kastelic, E., Wigal, S.B., Evans, L., Ghuman, J.K., Kollins, S.H., McCracken, J.T., McGough, J.J., Murray, D.W., Posner, K., Skrobala, A.M., & Wigal, T. (2008). Methylphenidate effects on functional outcomes in the preschoolers with attention-deficit/hyperactivity disorder treatment study (PATS). Journal of Child and Adolescent Psychopharmacology, 17, 581-592.

Objective: The purpose of this study was to examine the effects of methylphenidate (MPH) on functional outcomes, including children's social skills, classroom behavior, emotional status, and parenting stress, during the 4-week, double-blind placebo controlled phase of the Preschoolers with Attention Deficit/ Hyperactivity Disorder (ADHD) Treatment Study (PATS). Methods: A total of 114 preschoolers who had improved with acute MPH treatment, were randomized to their best MPH dose (M=4.22 mg/day; n=63) or placebo (PL; n=51). Assessments included the Clinical Global Impression-Severity (CGI-S), parent and teacher versions of the Strengths and Weaknesses of ADHD-Symptoms and Normal Behaviors (SWAN), Social Competence Scale (SCS), Social Skills Rating System (SSRS), and Early Childhood Inventory-4 (ECI-4), and Parenting Stress Index (PSI). Results: Medication effects varied by informant and outcome measure. Parent measures and teacher SWAN scores did not differentially improve with MPH. Parent-rated depression (p=0.02) and dysthymia (p=0.001) on the ECI worsened with MPH, but scores were not in the clinical range. Significant medication effects were found on clinician CGI-S (p=0.0001) and teacher social competence ratings (SCS, p=0.03).Conclusions: Preschoolers with ADHD treated with MPH for 4 weeks improve in some aspects of functioning. Additional improvements might require longer treatment, higher doses, and/or intensive behavioral treatment in combination with medication.

08-2. Alderson, R.M., Rapport, M.D., Sarver, D.E., & Kofler, M.J. (2008). ADHD and behavioral inhibition: A re-examination of the stop-signal task. Journal of Abnormal Child Psychology, 36, 989-998. 

The current study investigates two recently identified threats to the construct validity of behavioral inhibition as a core deficit of attention-deficit/hyperactivity disorder (ADHD) based on the stop-signal task: calculation of mean reaction time from go-trials presented adjacent to intermittent stop-trials, and non-reporting of the stop-signal delay metric. [One of the diagnostic measures was the Child Symptom Inventory-4.] Children with ADHD (n = 12) and typically developing (TD) children (n = 11) were administered the standard stop-signal task and three variant stop-signal conditions. These included a no-tone condition administered without the presentation of an auditory tone; an ignore-tone condition that presented a neutral (i.e., not associated with stopping) auditory tone; and a second ignore-tone condition that presented a neutral auditory tone after the tone had been previously paired with stopping. Children with ADHD exhibited significantly slower and more variable reaction times to go-stimuli, and slower stop-signal reaction times relative to TD controls. Stop-signal delay was not significantly different between groups, and both groups' go-trial reaction times slowed following meaningful tones. Collectively, these findings corroborate recent meta-analyses and indicate that previous findings of stop-signal performance deficits in ADHD reflect slower and more variable responding to visually presented stimuli and concurrent processing of a second stimulus, rather than deficits of motor behavioral inhibition.

08-3. Barry, J.J., Ettinger, A.B., Friel, P., Gilliam, F.G., Harden, C.L., Hermann, B., Kanner, A.M., Caplan, R., Plioplys, S., Salpekar, J., Dunn, D., Austin, J., & Jones, J. (2008). Consensus statement: The evaluation and treatment of people with epilepsy and affective disorders. Epilepsy & Behavior, 13(Suppl.1), S1-S29.

Affective disorders in people with epilepsy (PWE) have become increasingly recognized as a primary factor in the morbidity and mortality of epilepsy. To improve the recognition and treatment of affective disorders in PWE, an expert panel comprising members from the Epilepsy Foundation's Mood Disorders Initiative have composed a Consensus Statement. This document focuses on depressive disorders in particular and reviews the appearance and treatment of the disorder in children, adolescents, and adults. Idiosyncratic aspects of the appearance of depression in this population, along with physiological and cognitive issues and barriers to treatment, are reviewed. Finally, a suggested approach to the diagnosis of affective disorders in PWE is presented in detail. This includes the use of psychometric tools for diagnosis [Child Symptom Inventory-4 and Youth’s Inventory-4 are two of several measures noted] and a stepwise algorithmic approach to treatment. Recommendations are based on the general depression literature as well as epilepsy-specific studies. It is hoped that this document will improve the overall detection and subsequent treatment of affective illnesses in PWE.

08-4. Bastiaens, L. (2008). Both atomoxetine and stimulants improve quality of life in an ADHD population treated in a community clinic. Psychiatric Quarterly, 79, 133-137.

Objective: To evaluate change in quality of life in a community clinic ADHD population treated with atomoxetine or stimulants. No direct comparisons between atomoxetine and stimulants to improve quality of life in ADHD are available. Methods: A prospective, nonrandomized comparison between ADHD patients treated with atomoxetine or stimulants in one clinic. Structured diagnostic assessment tools [including the Child Symptom Inventory-4 and the Adolescent Symptom Inventory-4] and a specific quality of life measure were used. Results: 84 patients (atomoxetine n = 39/stimulants n = 45), between the ages of 5 and 18, were treated for approximately 8 months. At end point, there were no significant differences in improvements of quality of life between the two groups. Age, participation in psychotherapy, and parental disability were not correlated with quality of life changes. Patients with lower baseline scores improved most. Conclusions: Both atomoxetine and stimulants led to a modest increase in quality of life in this community clinic ADHD population.

08-5. Beauchaine, T.P., Hong, J., & Marsh, P. (2008). Sex differences in autonomic correlates of conduct problems and aggression. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 788-796.

Objective: To examine sex differences in autonomic nervous system functioning in children and adolescents with conduct problems and to evaluate the role of aggression in predicting autonomic nervous system functioning, over and above the effects of disruptive behavior. Although deficiencies in autonomic responding among boys with oppositional defiant disorder and/or conduct disorder are well documented, it remains unclear whether such findings extend to girls or apply only to children with aggressive forms of conduct problems. Method: Electrodermal responding, cardiac pre-ejection period, and respiratory sinus arrhythmia were recorded while boys (n = 110; 53 with conduct problems, 57 controls) and girls (n = 65; 33 with conduct problems, 32 controls) between the ages of 8 and 12 sat for an extended baseline, then played a game with conditions of reward and frustrative nonreward. [Aggressive behavior was assessed with the Child Symptom Inventory-4.] Results: Both sex effects and aggression effects were found. Aggressive boys with conduct problems demonstrated reduced autonomic functioning, consistent with previous research. In contrast, aggressive girls with conduct problems exhibited greater electrodermal responding than controls, with no differences in cardiovascular reactivity to incentives. Conclusions: Observed sex differences in the autonomic correlates of conduct problems and aggression may suggest different etiological mechanisms of externalizing psychopathology for girls compared with boys.

08-6. Bubier, J.L., & Drabick, D.A.G. (2008). Affective decision-making and externalizing behaviors: The role of autonomic activity Journal of Abnormal Child Psychology, 36, 941-953.

We tested a conceptual model involving the inter-relations among affective decision-making (indexed by a gambling task), autonomic nervous system (ANS) activity, and attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms in a largely impoverished, inner city sample of first through third grade children (N=63, 54% male). The present study hypothesized that impaired affective decision-making and decreased sympathetic and parasympathetic activation would be associated with higher levels of ADHD and ODD symptoms [assessed with the Child Symptom Inventory-4] , and that low sympathetic and parasympathetic activation during an emotion-inducing task would mediate the relation between affective decision-making and child externalizing symptoms. In support of our model, disadvantageous decision-making on a gambling task was associated with ADHD hyperactivity/impulsivity symptoms among boys, and attenuated sympathetic activation during an emotion-inducing task mediated this relation. Support for the model was not found among girls.

08-7. Cromley, T., & Lavigne, J.V. (2008). Predictors and consequences of early gains in child psychotherapy. Psychotherapy, 45, 42-60.

This study examined the predictors and consequences of early gains among children (n=130) receiving psychotherapeutic treatment as usual for a variety of disorders. Classification tree analysis showed that not receiving Medicaid, plus receiving a medication consult, were associated with any early gain (i.e., reliable change on one or more clinical scales of the Child Symptom Inventory-4, with the early gain either remaining in the clinical range or moving to a subclinical level) within the first eight treatment sessions, but only Medicaid status predicted subclinical gains. Overall, patients showing a subclinical early gain showed better long-term improvement in treatment than those with no subclinical gain; patterns of change for those with and without any early gain were similar but with smaller differences between groups.

08-8. Crowell, S.E., Beauchaine, T.P., McCauley, E., Smith, C.J., Vasilev, C.A., & Stevens, A.L. (2008). Parent-child interactions, peripheral serotonin, and self-inflicted injury in adolescents. Journal of Consulting and Clinical Psychology, 76, 15-21

Self-inflicted injury in adolescence indicates significant emotional and psychological suffering. Although data on the etiology of self-injury are limited, current theories suggest that the emotional lability observed among self-injuring adolescents results from complex interactions between individual biological vulnerabilities and environmental risk. For example, deficiencies in serotonergic functioning, in conjunction with certain family interaction patterns, may contribute to the development of emotional lability and risk for self-injury. The authors explored the relation between peripheral serotonin levels and mother-child interaction patterns among typical (n = 21) and self-injuring (n = 20) adolescents. [Measures of psychopathology included the Adolescent Symptom Inventory-4 and the Youth’s Inventory-4.] Findings revealed higher levels of negative affect and lower levels of both positive affect and cohesiveness among families of self-injuring participants. Peripheral serotonin was also correlated with the expression of positive affect within dyads. Furthermore, adolescents' serotonin levels interacted with negativity and conflict within dyads to explain 64% of the variance in self-injury. These findings underscore the importance of considering both biological and environmental risk factors in understanding and treating self-injuring adolescents.

08-9. DeVincent, C., Gadow, K.D., Strong, G., Schwartz, J., & Cuva, S. (2008). Screening for autism spectrum disorder with the Early Childhood Inventory-4. Journal of Developmental and Behavioral Pediatrics, 29, 1-10.

Objective: The early identification of children with Autism Spectrum Disorders (ASD) is critical for the remediation of developmental deficits. This study examined the clinical utility of ASD scoring algorithms for the Early Childhood Inventory-4 (ECI-4), a DSM-IV-referenced rating scale, as a practical solution for screening 3-to-5 year old children for ASD in medical and public school settings. Methods: Parents/teachers completed the ECI-4 for 3-to-5 year old clinic referrals with an ASD (N=196) or nonASD psychiatric (N=135) diagnosis. Children attending early childhood (i.e., day care, preschool, Head Start) programs were also rated by their parents (N=507) and teachers (N=407). Results: Stepwise logistic regression was used to generate ASD scoring algorithms for the ECI-4. ROC analyses generally indicated high levels of sensitivity/specificity for recommended ASD cutoff scores for parent (clinic: .96/.80; preschool: .92/.96) and teacher (clinic: .81/.79; preschool: .97/.92) ratings. Conclusion: Findings indicate that the ECI-4 shows promise as a clinically useful screening measure for ASD in clinic-referred and preschool children. Further research is clearly warranted.

08-10. Domenech-Llaberia, E., Jane, M.C. , Corbella, T., Ballespi, S., & Mitjavila, M., & Canals, J. (2008) Teacher reports of peer aggression in preschool: its relationship to DSM-IV externalizing symptoms Spanish Journal of Psychology, 11, 433-442.

Objective: to establish the prevalence and associations of peer aggression as manifested in preschool children, in community-based populations and to study links with DSM-IV externalizing diagnoses. Method: Subjects were 1.104 children, 3-to-5-year-olds attending rural and urban pre-schools classes. Teachers, completed the Peer Conflict Scale (PCs) to inform about direct physical and verbal aggression, object aggression and symbolic aggression and the questionnaire on psychopathology, Early Childhood Inventory-4. Results: 6.6% (n = 73) had at least one positive item on the PCS. This percentage dropped to 2.6% (n = 29) if we take into account a minimum of three positive items. Physical direct aggression was the more prevalent type of aggressive behavior, followed by verbal aggression, object aggression and symbolic aggression. Significant differences by gender and age were found. Peer aggression was associated with male gender from three years of age. Physical, object and verbal aggressive behavior was linked with externalizing disorders. This association was very strong with oppositional disorder. Conclusions: The present research with a Spanish population confirms the existence of peer aggression in preschoolers and the gender differences. Our chief contribution is about the age of emergence of sex differences and gender differences in different types of peer aggression

08-11. Drabick, D.A.G., Gadow, K.D., & Loney, J. (2008). Co-occurring ODD and GAD symptom groups: Source-specific syndromes and cross-informant comorbidity. Journal of Clinical Child and Adolescent Psychology, 37, 314-326.

Objective: Despite important clinical and nosological implications, the comorbidity of oppositional defiant disorder (ODD) and generalized anxiety disorder (GAD) has received little attention. Method: A clinic-based sample of 243 boys (aged 6-10 years), their parents, and teachers participated in an evaluation that involved assessments of behavioral, academic, and family functioning. ODD and GAD symptom groups were defined using various combinations of mother- and teacher-reports using the Child Symptom Inventory-4. Results: ODD symptom groups were associated with CD symptoms, and GAD symptom groups with MDD symptoms, regardless of rater. ADHD symptoms were associated with ODD and GAD symptom groups; however, covarying ADHD symptoms altered few findings. The ODD+GAD symptom groups were associated with higher rates of co-occurring symptoms and risk factors within (source-specific syndromes) and across (cross-informant comorbidity) informants.

08-12. Gadow, K.D., DeVincent, C.J., & Drabick, D.A.G. (2008). Oppositional defiant disorder as a clinical phenotype in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 38, 1302-1310.

Objective: To examine the validity of oppositional defiant disorder (ODD) as a clinical phenotype distinct from attention-deficit hyperactivity disorder (ADHD), parents and teachers completed either the Early Childhood Inventory-4 or the Child Symptom Inventory-4, DSM-IV-referenced rating scales and a background questionnaire for 608 children (ages 3-12 years) with autism spectrum disorder (ASD). Method: The ASD sample was separated into four groups: ODD, ADHD, ODD+ADHD, and neither (NONE). Comparison samples were nonASD clinic (n=326) and community (n>800) controls. Results: In the ASD sample, all three ODD/ADHD groups were clearly differentiated from the NONE group, and the ODD+ADHD group had the most severe co-occurring symptoms, medication use, and environmental disadvantage. There were few differences between ASD+ODD and ASD+ADHD groups. Conclusion: Findings for ASD and control samples were similar, supporting overlapping mechanisms in the pathogenesis of ODD.

08-13. Fastenau, P.S., Shen, J.Z., Dunn, D.W., & Austin, J.K. (2008). Academic underachievement among children with epilepsy proportion exceeding psychometric criteria for learning disability and associated risk factors. Journal of Learning Disabilities, 41, 195-207.  

This study assessed rates of learning disabilities (LD) by several psychometric definitions in children with epilepsy and identified risk factors. Participants (N = 173, ages 8-15 years) completed IQ screening, academic achievement testing, and structured interviews. Children with significant head injury, chronic physical conditions, or mental retardation were excluded. Using an IQ-achievement discrepancy definition, 48% exceeded the cutoff for LD in at least one academic area; using low-achievement definitions, 41% to 62% exceeded cutoffs in at least one academic area. Younger children with generalized nonabsence seizures were at increased risk for math LD using the IQ-achievement discrepancy definition; age of seizure onset and attention-deficit/hyperactivity disorder (ADHD) [assessed with the Child Symptom Inventory-4, Adolescent Symptom Inventory-4] were risk factors for reading and math LD using low-achievement definitions. Writing was the most common domain affected, but neither ADHD nor seizure variables reliably identified children at risk for writing LD. Although children with earlier seizure onset, generalized nonabsence seizures, and comorbid ADHD appear to be at increased risk for some types of LD by some definitions, these findings largely suggest that all children with epilepsy should be considered vulnerable to LD. A diagnosis of epilepsy (even with controlled seizures and less severe seizure types) should provide sufficient cause to screen school-age children for LD and comorbid ADHD.

08-14. Gadow, K.D., DeVincent, C., & Schneider, J. (2008). Predictors of psychiatric symptoms in children with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 38, 1710-1720.

Objective: This study examined mental health risk/protective factors for DSM-IV psychiatric symptoms in children with an autism spectrum disorder (ASD) and their contribution to functioning separate from ASD symptom severity. Method: Mothers/teachers completed the Child Symptom Inventory-4 and measures of risk/protection and social, adaptive, and school functioning in 6-to-12 year olds with a diagnosed ASD (N=238). Results: Bivariate correlations and simultaneous regression analyses indicated a unique pattern of predictors for attention-deficit/hyperactivity disorder, aggression, anxiety, and depression symptoms. Moreover, psychiatric symptoms differentially predicted social and school performance. Conclusion: Findings indicate that co-occurring psychiatric symptoms and their associated mental health risk/protective factors may have important clinical implications and generally support a biopsychosocial model of psychopathology in children with an ASD that appears to share many similarities with models for nonASD children.

08-15. Gadow, K.D., Nolan, E.E., Sverd, J., Sprafkin, J., & Schneider, J. (2008). Methylphenidate in children with oppositional defiant disorder and both co-morbid chronic multiple tic disorder and ADHD. Journal of Child Neurology, 23, 981-990.

Objective: Our primary objective was to determine if immediate-release methylphenidate is an effective treatment for oppositional defiant disorder diagnosed from mother’s report in children with both chronic multiple tic disorder and attention-deficit hyperactivity disorder (ADHD). Method: Children (N=31) ages 6 to 12 years received placebo and three doses of methylphenidate twice daily for 2 weeks each, under double-blind conditions and were assessed with ratings scales and laboratory measures. [Diagnostic measures included the Child Symptom Inventory-4.]  Results: Results indicated significant improvement in both oppositional and ADHD behaviors with medication; however, magnitude of treatment effect varied considerably as a function of disorder (ADHD>oppositional behaviors), informant (teacher>mother), assessment instrument, and specific oppositional behavior (rebellious>disobeys rules). Drug response was comparable to children (N=26) who did not have diagnosed oppositional defiant disorder, but co-morbidity appeared to alter the perceived benefits for ADHD according to mother’s report. Conclusion: Methylphenidate is an effective short-term treatment for oppositional behavior in children with co-morbid ADHD and chronic multiple tic disorder.

08-16. Gadow, K.D., Roohi, J., DeVincent, C.J., & Hatchwell, E. (2008). Association of ADHD, tics, and anxiety with dopamine transporter (DAT1) genotype in autism spectrum disorder. Journal of Child Psychology and Psychiatry, 49, 1331-1338.

Background: Autism spectrum disorder (ASD) is associated with high rates of psychiatric disturbance to include attention-deficit/hyperactivity disorder (ADHD), tic disorder, and anxiety disorders. The aim of the present study was to examine the association between a variable number tandem repeat (VNTR) functional polymorphism located in the 3’-untranslated region of the dopamine transporter gene (DAT1) and the severity of these symptoms as well as the association between the DAT1 DdeI polymorphism and severity of tics. Methods: Parents (n=62) and teachers (n=57) completed [the Child Symptom Inventory-4] a DSM-IV-referenced rating scale for 67 children with ASD. Results: According to parent ratings, children with the 10-10 repeat allele (versus a combined group of all other genotypes) exhibited less severe symptoms of hyperactivity and impulsivity as well as less severe language deficits. Teacher ratings indicated that social anxiety and tic symptoms were more severe for children with the 10-10 genotype versus all others. Exploratory analyses provided preliminary support for the notion that heterozygosity (9-10 repeat genotype) may be a risk/protective factor. There were no associations of tic severity with the DAT1 DdeI polymorphism. Conclusion: Collectively, these results suggest that the extraordinary variability in ASD clinical phenotypes may be explained in part by the same genes that are implicated in a host of other psychiatric disorders in nonASD populations. Nevertheless, replication with independent samples is necessary to confirm this preliminary finding.

08-17. Gadow, K.D., Schwartz, J., DeVincent, C., Strong, G., & Cuva, S. (2008). Clinical utility of autism spectrum disorder scoring algorithms for the Child Symptom Inventory. Journal of Autism and Developmental Disorders, 38, 419-427.

Objective: Few studies examine the clinical utility of autism spectrum disorder (ASD) rating scales for screening referrals to child psychiatry clinics. Method: Parents/teachers from Long Island, NY, completed the Child Symptom Incentory-4, a DSM-IV-referenced rating scale for 6-to-12 year old clinical referrals with an ASD (N=317) or nonASD psychiatric (N=191) diagnosis. Two separate groups of children attending public school, regular education classes in the same geographic area were also rated by their parents (N=446) and teachers (N=464). Results: Stepwise forward regression generated a scoring algorithm based on a subset of all CSI-4 items that best differentiated ASD from nonASD children. ROC analyses indicated high levels of sensitivity/specificity for recommended ASD cutoff scores for parent and teacher ratings.

08-18. Ghanizadeh, A.A. (2008). A preliminary study on screening prevalence of pervasive developmental disorder in schoolchildren in Iran Journal of Autism and Developmental Disorders, 38, 759-763.  

To study prevalence rates of pervasive developmental disorder (PDD) symptoms and differences between subtypes in school age Iranian children. A random sample of 2,000 school age children from both genders was selected. A parent-completed, DSM-IV-referenced rating scale of PDD symptoms [Child Symptom Inventory-4] was used. About 1.9% of the sample obtained screening cutoff scores for probable autistic disorder and 0.5 for probable asperger's disorder. The rate of probable PDD was not more in girls than the boys. The rate of suspected cases of PDD in Iran is very high and probable autistic disorder is not gender related. It shows the need for more consideration of PDD in the mental health programs planning.

08-19. Gouze, K.R., & Wendel, R. (2008). Integrative Module-Based Family Therapy: Application and training. Journal of Marital and Family Therapy, 34, 269-286. 

The field of marriage and family therapy is currently at a crossroads. The challenge for contemporary therapists is how to incorporate the wisdom of previous models with the accountability that comes from evidence-based practice. The Integrative Module-Based Family Therapy treatment model provides a formalized series of steps that clinicians can use in their case planning and implementation. It is based on nine clinically relevant modules for assessment [such as the Child Symptom Inventory-4] and intervention that are consistent with current best practices and empirically supported treatments. It thus meets the need for a structured family therapy practice and training approach that is respectful of the "art" of family therapy while still adhering to the principles of the "science" of evidence-based treatment.  CSI-4

08-20. Griesler, P.C., Kandel, D.B., Schaffran, C., Hu, M.C., & Davies, M. (2008). Adolescents' inconsistency in self-reported smoking - A comparison of reports in school and in household settings. Public Opinion Quarterly, 72, 260-290.

Extent and sources of inconsistency in self-reported cigarette smoking between self-administered school surveys and household interviews was examined in two longitudinal multiethnic adolescent samples, the urban Transition to Nicotine Dependence in Adolescence (TND) (N = 832) and the National Longitudinal Study of Adolescent Health (Add Health) (N = 4,414). Inconsistency was defined as a positive report of smoking in school followed by a negative report in the household. Smoking questions were ascertained with paper-and-pencil instruments (PAPI-SAQ) in school in both studies, and computer-assisted personal interviewing (CAPI) in TND but audio computer-assisted self-interviewing (ACASI) in Add Health in the household. [The Youth’s Inventory-4 was used to assess depression.] In TND, 23.5 percent of youths who reported smoking lifetime and 20.4 percent of those who reported smoking the last 12 months in the school survey reported in the household never having smoked; in Add Health, the latter was 8.6 percent. Logistic regressions identified five common correlates of inconsistency across the two studies: younger age, ethnic minority status, lesser involvement in deviant activities, having nonsmoking parents and friends. In TND, interviewing of youth and parent by the same interviewer increased inconsistent reporting. Matching the definition of inconsistent reporting and the age, gender and race/ethnic distributions of TND on an urban Add Health subsample reduced the predicted rate of inconsistency in TND. The estimated bias attributable to CAPI compared with ACASI methodology did not reach significance in the aggregated matched samples suggesting that irrespective of administration mode, household interviews decrease reporting of smoking, especially among younger, minority and more conventional youths embedded in a social network of nonsmokers.

08-21. Hartley, S.L., Sikora, D.M., & Mccoy, R. (2008). Prevalence and risk factors of maladaptive behaviour in young children with Autistic Disorder. Journal of Intellectual Disability Research, 52, 819-829.  

Background: Children with Autistic Disorder (AD) evidence more co-occurring maladaptive behaviours than their typically developing peers and peers with intellectual disability because of other aetiologies. The present study investigated the prevalence of Clinically Significant maladaptive behaviours during early childhood and identified at-risk subgroups of young children with AD. Method: Parents rated their child's maladaptive behaviours on the Child Behaviour Checklist (CBCL) in 169 children with AD aged 1.5 to 5.8 years. Results: One-third of young children with AD had a CBCL Total Problems score in the Clinically Significant range. The highest percentage of Clinically Significant scores were in the Withdrawal, Attention, and Aggression CBCL syndrome scales. There was a high degree of co-morbidity of Clinically Significant maladaptive behaviours. Several subject characteristic risk factors for maladaptive behaviours were identified. Conclusions: Findings highlight the need to include behavioural management strategies aimed at increasing social engagement, sustained attention and decreasing aggressive behaviour in comprehensive intervention programmes for young children with AD.

08-22. Hu, M.C., Muthen, B., Schaffran, C., Griesler, P.C., & Kandel, D.B. (2008).Developmental trajectories of criteria of nicotine dependence in adolescence. Drug and Alcohol Dependence, 98, 94-104.  

We describe the nature and predictors of developmental trajectories of symptoms of DSM-IV nicotine dependence in adolescence following smoking initiation. Data are front a longitudinal cohort of 324 new smokers from grades 6-10 in the Chicago Public Schools interviewed 5 times at 6-month intervals. Monthly data on DSM-IV symptoms of nicotine dependence were available for 36 months. [Depression symptoms were assessed with the Youth’s (Self Report) Inventory-4.] Growth Mixture modeling was applied to the monthly histories to identify trajectories of DSM-IV criteria of nicotine dependence. A four-class Solution best fitted the data: no DSM criterion (47.7%): early onset/chronic course (19.8%): early onset/remission (17.3%): late onset (15.2%). Blunt use prior to cigarette use was associated with the three symptomatic trajectories. Conduct disorder and prior heavy smoking were associated with Class 2 (chronic). Conduct disorder differentiated Class 2 front Class 4 (late onset). while pleasant initial sensitivity to the first tobacco experience was associated with Classes 2 and 3 (remit) and differentiated Class 2 front Class 4. Novelty seeking characterized Class 3. Parental dependence differentiated chronicity (Class 2) front remission (Class 3) among those who developed symptoms early. Being Hispanic reduced membership in Classes 3 and 4. and being male for Class 3. The data highlight the importance of parental nicotine dependence as a risk factor for early and sustained nicotine dependence by the offspring. Pleasant initial sensitivity and Conduct disorder for early onset of dependence and blunt use prior to smoking for all trajectories. The factors important for onset of dependence are not necessarily the same as those for Sustained Course.

08-23. Keenan, K., Hipwell, A., Feng, X., Babinski, D., Hinze, A., Rischall, M., Henneberger, A., (2008). Subthreshold symptoms of depression in preadolescent girls are stable and predictive of depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1433-1442.  

Objective: Given the risk for adolescent depression in girls to lead to a chronic course of mental illness, prevention of initial onset could have a large impact on reducing chronicity. If symptoms of depression that emerge during childhood were stable and predictive of later depressive disorders and impairment, then secondary prevention of initial onset of depressive disorders would be possible. Method: Drawing from the Pittsburgh Girls Study, an existing longitudinal study, 232 nine-year-old girls were recruited for the present study, half of whom screened high on a measure of depression [which included the Child Symptom Inventory-4] at age 8 years. Girls were interviewed about depressive symptoms using a diagnostic interview at ages 9, 10, and 11 years. Caregivers and interviewers rated impairment in each year. Results: The stability coefficients for DSM-IV symptom counts for a 1- to 2-year interval were in the moderate range (i.e., intraclass coefficients of 0.40-0.59 for continuous symptom counts and Kendall taub coefficients of 0.34-0.39 for symptom level stability). Depressive disorders were also relatively stable at this age. Poverty moderated the stability, but race and pubertal stage did not. Among the girls who did not meet criteria for a depressive disorder at age 9 years, the odds of meeting criteria for depressive disorders and for demonstrating impairment at age 10 or 11 years increased by 1.9 and 1.7, respectively, for every increase in the number of depression symptoms. Conclusions: Early-emerging symptoms of depression in girls are stable and predictive of depressive disorders and impairment. The results suggest that secondary prevention of depression in girls may be accomplished by targeting subthreshold symptoms manifest during childhood.

08-24. Kochanska, G., Barry, R.A., Aksan, N., & Boldt, L.J. (2008). A developmental model of maternal and child contributions to disruptive conduct: the first six years. Journal of Child Psychology and Psychiatry, 49, 1220-1227.

Background: The parent-child relationship is considered important for children's future conscience, and conscience is seen as protecting them from disruptive behavior problems, but specific mechanisms of this developmental process are rarely studied. Methods: This multi-trait multi-method study examined, in a longitudinal design, paths linking early maternal responsiveness to the child with the child's future conscience and disruptive behavior in 102 mother-child dyads. We tested a conceptual model where maternal responsiveness to the child, observed at 7 and 15 months, engenders a responsive stance in the child, observed at 25 and 38 months; that stance, in turn, becomes enduring and generalized, promoting multiple aspects of the child's conscience, observed at 52 months. In turn, conscience serves as a protective factor from disruptive behavior problems, rated by mothers and fathers at 67 months [Child Symptom Inventory-4]. Results: The postulated paths were examined using sequential regressions and mediation effects were tested using bootstrapping analyses. Child responsive stance at 25-38 months fully mediated the link between maternal responsiveness in infancy and conscience at 52 months, and conscience fully mediated the link between child responsive stance and future disruptive behavior at 67 months. Conclusions: Examination of developmental links among early maternal behavior, the child's responsive stance toward the mother, conscience, and disruptive behavior is a promising step toward elucidating mechanisms of children's adaptive and maladaptive trajectories.

08-25. Krull, K.R., Brouwers, P.,  Jain, N. , Zhang, L. , Bomgaars, L., Dreyer, Z., Mahoney, D., Bottomley, S., & Okcu, M.F. (2008). Folate pathway genetic polymorphisms are related to attention disorders in childhood leukemia survivors. Journal of Pediatrics, 152, 101-105.

Objective: To test the hypothesis that 5,10-methylenetetrahydroreductase (MTHFR) polymorphisms can partially explain the individual variation in developing attention-deficit/hyperactivity disorder (ADHD) after acute lymphoblastic leukemia (ALL) therapy.  Study design: Parents of 48 survivors of childhood ALL completed a clinical diagnostic process to identify subtypes of ADHD. [ADHD was assessed with the Child Symptom Inventory-4.] Genotyping was performed with peripheral blood DNA for MTHFR (C677T and A1298C) polymorphisms. Results: Eleven of the 48 patients (22.9%) had scores consistent with the inattentive symptoms of ADHD. Patients with genotypes related to lower folate levels (11 out of 39; 39.2%) were more likely to have ADHD. The A1298C genotype appeared to be the predominant linkage to the inattentive symptoms, leading to a 7.4-fold increase in diagnosis, compared with a 1.3-fold increase for the C677T genotype. Age at diagnosis and sex were not associated with inattentiveness. Conclusions: Preliminary data imply a strong relationship between MTHFR polymorphisms and the inattentive symptoms of ADHD in survivors of childhood.

08-26. Ladouceur, C.D., Almeida, J.R.C., Birmaher, B., Axelson, D.A., Nau, S., Kalas, C., Monk, K., Kupfer, D.J., & Phillips, M.L. (2008). Subcortical gray matter volume abnormalities in healthy bipolar offspring: Potential neuroanatomical risk marker for bipolar disorder? Journal of the American Academy of Child and Adolescent Psychiatry, 47, 532-539.

Objective: A growing number of structural neuroimaging studies have shown that bipolar disorder (BD) is associated with gray matter (GM) volume abnormalities in brain regions known to support affect regulation. The goal of this study was to examine whole-brain regional GM volume in healthy bipolar offspring (HBO) relative to age-matched controls to identify possible structural abnormalities that may be associated with risk for BD. Method: Participants were 20 youths (8-17 years old) with at least one parent diagnosed with BD, and 22 age-matched healthy individuals. All of them were free of Axis I diagnoses. High-resolution magnetic resonance imaging structural images were acquired using a 3-T Siemens scanner. Voxel-based morphometric analyses were conducted using SPM5. [Child Symptom Inventory-4 was one of several measures used to evaluate psychiatric disorders.]  Results: Relative to controls, HBO had significantly increased GM volume in left parahippocampal/hippocampal gyrus (p < .05 corrected), following whole-brain analyses. This increase was correlated with puberty but not age in HBO. Region-of-interest analyses on the amygdala and orbitomedial prefrontal cortex did not yield any significant group differences after conducting small volume correction. Conclusions: The pattern of increased GM volume in parahippocampal/hippocampal gyrus in HBO suggests a potential marker for risk for BD. It can also be considered as a potential neuroprotective marker for the disorder because HBO were free of current psychopathology. Prospective studies examining the relationship between changes in GM volume in these regions and subsequent development of BD in HBO will allow us to elucidate further the role of this region in either conferring risk for or protecting against the development of BD.

08-27. Lecavalier, L., &  Gadow, K.D. (2008). Pharmacology effects and side effects. In Matson, J.L. (Ed.), Clinical Assessment and Intervention for Autism Spectrum Disorders (pp. 221-263). Elsevier Science.

This book chapter reviews evidence-based assessment instruments for evaluating response to psychotropic medication in individuals with autism spectrum disorder and includes discussion of the Symptom Inventories.

08-28. Loney, B.R., Fowler, S.N., & Joiner, T.E. (2008) Adolescent conduct problems and bulimic tendencies: Study of an emotional distress hypothesis. Journal of Psychopathology and Behavioral Assessment, 30, 298-306.

Prior research has documented an association between adolescent conduct problems and bulimic tendencies. However, there is limited theoretical modeling to explain this association, and prior studies have generally failed to assess for potential mediating variables of impulsivity, anxiety, and depression. The current study assessed these mediating variables in further exploring for unique associations between adolescent conduct problems and bulimic tendencies. A non-referred adolescent sample was assessed for bulimic tendencies, conduct problems, impulsivity, anxiety, and depression using a multi-informant assessment battery including parent, teacher, and self-report measures [including the Adolescent Symptom Inventory-4 oppositional defiant disorder and conduct disorder symptom categories]. There was a significant bivariate association between conduct problems and bulimic tendencies, r=0.29, p < 0.01. However, this association was fully mediated by anxiety and depression symptoms. This suggests that emotional distress could be a primary factor linking adolescent conduct problems and bulimic tendencies. Implications include the potential for more regular screening of youth with conduct problems for associated eating disturbances.

08-29. Moreland, A.D., & Dumas, J.E. (2008) Categorical and dimensional approaches to the measurement of disruptive behavior in the preschool years: A meta-analysis. Clinical Psychology Review, 28, 1059-1070.

Preschool disruptive behavior problems were investigated in a meta-analysis of 26 studies using categorical and/or dimensional approaches to assessment. The review sought to distinguish early disruptiveness from normative preschool conduct by showing that, irrespective of assessment methodology: (a) disruptiveness can be adequately measured in the preschool years; (b) early disruptiveness is stable over time; and (c) disruptive children referred for clinical services in the preschool years can be distinguished from non-referred peers. [Four of the studies used the Early Childhood Inventory-4.] Results indicated that: categorical and dimensional approaches to measurement of early disruptiveness provide comparable data (effect size d = 2.29); both approaches yield comparable estimates of the stability of preschool disruptive behavior over time (categorical approach: d = 1.15; dimensional approach: d = 0.84); and both approaches discriminate between referred and non-referred preschoolers (d = 1.05 and d = .95). Limitations of the existing literature and of this analysis are discussed, as are suggestions for future research.

08-30. Pears, K.C., Kim, H.K., & Fisher, P.A. (2008). Psychosocial and cognitive functioning of children with specific profiles of maltreatment. Child Abuse & Neglect, 32, 958-971.

Objective: Up to 90% of child welfare system cases involve multiple types of maltreatment; however, studies have rarely incorporated multiple dimensions of maltreatment. The present study employed a latent profile analysis to identify naturally occurring subgroups of children who had experienced maltreatment. Methods: Reports of maltreatment incidents for 117 preschool-aged foster children were classified along two dimensions: type (e.g., physical abuse, sexual abuse, physical neglect, supervisory neglect, or emotional maltreatment) and severity within type. Results: The analyses revealed four distinct profiles showing moderate to high levels of maltreatment: (a) supervisory neglect/emotional maltreatment; (b) sexual abuse/emotional maltreatment/neglect (when not otherwise specified neglect refers to both supervisory and physical neglect); (c) physical abuse/emotional maltreatment/neglect; and (d) sexual abuse/physical abuse/emotional maltreatment/neglect. Profile membership was examined with respect to the children's cognitive functioning and externalizing and internalizing problems [assessed in part with the Early Childhood Inventory-4]: lower cognitive functioning was related to profiles with neglect or physical abuse (or both), externalizing was highest in the sexual abuse/physical abuse/emotional maltreatment/neglect profile, and internalizing was highest in the profiles with physical OF sexual abuse (or both).Conclusions: There appear to be distinct profiles of maltreatment among preschoolers that have differential associations to measures of adjustment. Policy and practice implications and future research directions are discussed. Practice implications: Using different profiles Of Maltreatment to understand specific vulnerabilities may guide in tailoring interventions to the needs of maltreated children.

08-31. Poch, F.V., Ballabriga, M.C.J., Sans, J.C., Hidalgo, G.E., Sola, S.B., & Domenech-Llaberia, E. (2008). Assessment of psychopathology in preschool age children through the Early Childhood Inventory-4 (ECI-4): Agreement among parents and teachers. Psicothema, 20, 481-486.

The main purpose of this study is to determine the level of agreement among parents and teachers as informants in each one of the dimensions or diagnostic categories of the Early Childhood Inventory-4 (ECI-4). Moreover, the effect of health problems in parents in the description and appraisal of behaviour of a sample of 204 students of preschool (3-6 years) of various socioeconomic profiles is analyzed. The results indicate that parents tend to value the symptoms with greater severity, and higher agreement was observed when informing about developmental disorders.

08-32. Rapport, M.D., Alderson, R.M., Kofler, M.J., Sarver, D.E., Bolden, J., & Sims, V. (2008). Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): The contribution of central executive and subsystem processes Journal of Abnormal Child Psychology, 36, 825-837.

The current study investigated contradictory findings from recent experimental and meta-analytic studies concerning working memory deficits in ADHD. Working memory refers to the cognitive ability to temporarily store and mentally manipulate limited amounts of information for use in guiding behavior. Phonological (verbal) and visuospatial (nonverbal) working memory were assessed across four memory load conditions in 23 boys (12 ADHD, 11 typically developing) using tasks based on Baddeley's (Working memory, thought, and action, Oxford University Press, New York, 2007) working memory model. [One of several ADHD assessment measures was the Child Symptom Inventory-4.]  The model posits separate phonological and visuospatial storage and rehearsal components that are controlled by a single attentional controller (CE: central executive). A latent variable approach was used to partial task performance related to three variables of interest: phonological buffer/rehearsal loop, visuospatial buffer/rehearsal loop, and the CE attentional controller. ADHD-related working memory deficits were apparent across all three cognitive systems-with the largest magnitude of deficits apparent in the CE-even after controlling for reading speed, nonverbal visual encoding, age, IQ, and SES.

08-33. Reynolds, S., & Lane, S.J. (2008). Diagnostic validity of sensory over-responsivity: A review of the literature and case reports. Journal of Autism and Developmental Disorders, 38, 516-529.  

Atypical responses to sensory stimulation are frequently reported to co-occur with diagnoses such as autism, ADHD, and Fragile-X syndrome. It has also been suggested that children and adults may present with atypical sensory responses while failing to meet the criteria for other medical or psychological diagnoses. This may be particularly true for individuals with over-responsivity to sensation. This article reviews the literature related to sensory over-responsivity and presents three pediatric cases [using the Child Symptom Inventory-4 to screen for co-morbidities] that present a profile of having sensory over-responsivity without a co-occurring diagnosis. Findings from these cases provide very preliminary evidence to support the suggestion that sensory over-responsivity can occur as a sole diagnosis. Within this small group, tactile over-responsivity was the most common and pervasive form of this condition.

08-34. Smith, K.G., & Corkum, P. (2008). Systematic review of measures used to diagnose attention-deficit/hyperactivity disorder in research on preschool children. Topics in Early Childhood Special Education, 27, 164-173.

The diagnosis of attention-deficit/hyper activity disorder (ADHD) in preschool children is challenging because the behavioral manifestations of the disorder are not uncommon for many children this age. Therefore, the assessment of ADHD in preschoolers needs to be multifaceted and requires the use of a variety of assessment measures. A systematic review of the literature from 1985 through to 2005 found 38 relevant articles related to ADHD in preschool children. We extracted the assessment measures used to identify ADHD in preschoolers [which included the Early Childhood Inventory-4] and categorized them into 4 core areas of measurement: standardized rating scales, structured interviews, direct observations of behavior, and direct measures of attention and hyperactivity-impulsivity. We examined quality indicators, such as symptom description, psychometric properties, and logistics, for the most frequent measures in each measurement areas. Our review of the literature highlights the need for more developmentally appropriate measures in 3 of the 4 core areas.

08-35. Sukhodolsky, D.G., Scahill, L., Gadow, K.D., Eugene, A.L., Aman, M.G., McDougle, C.J., McCracken, J.T., Tierney, E., White, S.W., Lecavalier, L., & Vitiello, B. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117-128.

Background: In addition to the core symptoms, children with Pervasive Developmental Disorders (PDD) often exhibit other problem behaviors such as aggression, hyperactivity, and anxiety, which can contribute to overall impairment and, therefore, become the focus of clinical attention. Limited data are available on the prevalence of anxiety in these children. We examined frequency and correlates of parent-rated anxiety symptoms in a large sample of children with PDD. Methods: The goals of this study were to examine the frequency and correlates of parent-rated anxiety symptoms in a sample of 171 medication-free children with PDD who participated in two NIH-funded medication trials. Twenty items of the Child and Adolescent Symptom Inventory-4 (CASI-4)  ADDIN EN.CITE <EndNote><Cite><Author>Gadow</Author><Year>1997</Year><RecNum>1106</RecNum><MDL><REFERENCE_TYPE>1</REFERENCE_TYPE><AUTHORS><AUTHOR>Gadow, K. D.</AUTHOR><AUTHOR>Sprafkin, J.</AUTHOR></AUTHORS><YEAR>1997</YEAR><TITLE>Child Symptom Inventory - 4</TITLE><PLACE_PUBLISHED>Stony Brook, NY</PLACE_PUBLISHED><PUBLISHER>Checkmate Plus</PUBLISHER></MDL></Cite></EndNote>(Gadow & Sprafkin, 1997) were used to measure anxiety. Results: Forty three percent of the total sample met screening cut-off criteria for at least one anxiety disorder. Higher levels of anxiety on the 20-item CASI scale were associated with higher IQ, the presence of functional language use, and with higher levels of stereotyped behaviors. In children with higher IQ, anxiety was also associated with greater impairment in social reciprocity. Conclusion: Anxiety is common in PDD and warrants consideration in clinical evaluation and treatment planning. This study suggests that parent ratings could be a useful source of information about anxiety symptoms in this population. Some anxiety symptoms such as phobic and social anxiety may be closer to core symptoms of PDD. Further efforts to validate tools to ascertain anxiety are needed, as are studies to empirically test approaches to treat anxiety in PDD.

08-36. Tarbell, S., & Li, B.U.K. (2008). Psychiatric symptoms in children and adolescents with cyclic vomiting syndrome and their parents. Headache, 48, 259-266.

Objective: To conduct a pilot study to evaluate the prevalence of psychiatric symptoms in children and adolescents with cyclic vomiting syndrome and to assess-family history of psychiatric disorder. Background: Little is known about psychiatric comorbidity in youth with cyclic vomiting syndrome, a periodic syndrome. Methods: Eighty-five parents, of children aged 3-18 years with cyclic vomiting syndrome confirmed in a multidisciplinary clinic, completed the age-appropriate Child Symptom Inventory-4 (CSI-4), a questionnaire that screens for psychiatric symptoms in pediatric patients. Twenty-one adolescents aged 13-18 years completed the Youth's Inventory-4, a self-report form of this questionnaire. Sixty-two parents completed a family psychiatric history checklist. Results: These children and their parents evidenced a high prevalence of anxiety and mood symptoms compared to norms of the CSI-4 and population norms for internalizing psychiatric disorders. On the age-appropriate CSI-4, 47% of subjects met diagnostic cut-off for an anxiety disorder, and 14% for an affective disorder. Discrepancies were found in parent and adolescent reports for symptoms of panic disorder (chi-square=4.83, df =1, p=.028), posttramnatic stress disorder (chi-square=6.87, df=1, p=.009), and somatization disorder (chi-square=6.41, df=1, p=.01), with parents reporting significantly more symptoms than the adolescents. Internalizing disorders were also prevalent in the parents with 59% endorsing either an anxiety and/or an affective disorder. Mothers reported a significantly higher prevalence of anxiety disorders (35%) than did fathers (13%) (chi-square=8.43, df=1, p<.004).Conclusion: Children and adolescents with cyclic vomiting syndrome appear to be at increased risk for internalizing psychiatric disorders, especially anxiety disorders. Further research using standardized psychiatric interviews and a control group are indicated to further assess psychiatric disorders in children and adolescents with cyclic vomiting syndrome.

08-37. Villalobos, J.A.L. (2008). Freedom from distraction factor in the attention deficit hyperactivity disorder: A short model Psicothema, 20, 718-723.   

Attention deficit hyperactivity disorder (ADHD) usually presents a profile in which the freedom from distraction factor of the WISC-R (FDF) is affected to a greater extent than the verbal comprehension factor (VCF) and the perceptual organization factor (POF). The formulation FDF< (VCF + POF)/2 has good sensitivity for ADHD. The aim of this study was to reduce the number of tests needed for the formulation FDF< (VCF + POF)/2, maintaining the sensitivity for ADHD and concordance with the complete formulation. A clinical sample of 167 children with ADHD is analyzed (6-16 years). The cases of ADHD were defined according to DSM-IV criteria and they were assessed with WISC-R, Child Symptom Inventory-4 and Social and Occupational Activity Assessment Scale. Lineal regression method was used to reduce the number of tests. The results showed that the short formulation reduces the number of tests by half and it has 83% sensitivity for ADHD. This formulation presents a good concordance with the complete version. The FDF is significantly lower than the VCF, POF and intellectual quotient in cases of ADHD. Comorbidity, social or school activity do not have a significant influence on the probability that FDF< (VCF + POF)/2.

08-38. Wakschlag, L.S., Briggs-Gowan, M.J., Hill, C., Danis, B., Leventhal, B.L., Keenan, K., Egger, H.L., Cicchetti, D., & Burns, J., & Carter, A.S. (2008). Observational assessment of preschool disruptive behavior, part II: Validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). Journal of the American Academy of Child and Adolescent Psychiatry, 47, 632-641.

Objective: To examine the validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior. Method: A total of 327 behaviorally heterogeneous preschoolers from low-income environments comprised the validation sample. Parent and teacher reports were used to identify children with clinically significant disruptive behavior. [The teacher version of the Early Childhood Inventory-4 was used to assess ODD and CD symptoms.]  The DB-DOS assessed observed disruptive behavior in two domains, problems in Behavioral Regulation and Anger Modulation, across three interactional contexts: Examiner Engaged, Examiner Busy, and Parent. Convergent and divergent validity of the DB-DOS were tested in relation to parent and teacher reports and independently observed behavior. Clinical validity was tested in terms of criterion and incremental validity of the DB-DOS for discriminating disruptive behavior status and impairment, concurrently and longitudinally. Results: DB-DOS scores were significantly associated with reported and independently observed behavior in a theoretically meaningful fashion. Scores from both DB-DOS domains and each of the three DB-DOS contexts contributed uniquely to discrimination of disruptive behavior status, concurrently and predictively. Observed behavior on the DB-DOS also contributed incrementally to prediction of impairment over time, beyond variance explained by meeting DSM-IV disruptive behavior disorder symptom criteria based on parent/teacher report. Conclusions: The multidomain, multicontext approach of the DB-DOS is a valid method for direct assessment of preschool disruptive behavior. This approach shows promise for enhancing accurate identification of clinically significant disruptive behavior in young children and for characterizing subtypes in a manner that can directly inform etiological and intervention research.

08-39. Wolf, J.M., Tanaka, J.W., Klaiman, C., Cockburn, J., Herlihy, L., Brown, C., South, M., McPartland, J., Kaiser, M.D., Phillips, R., & Schultz, R.T. (2008). Specific impairment of face-processing abilities in children with autism spectrum disorder using the Let's Face It! Skills Battery. Autism Research, 1, 329-340.  

Although it has been well established that individuals with autism exhibit difficulties in their face recognition abilities, it has been debated whether this deficit reflects a category-specific impairment of faces or a general perceptual bias toward the local-level information in a stimulus. In this study, the Let's Face It! Skills Battery [Tanaka & Schultz, 2008] of developmental face- and object-processing measures was administered to a large sample of children diagnosed with autism spectrum disorder (ASD) and typically developing children [screened for psychopathology with the Child Symptom Inventory-4]. The main finding was that when matched for age and IQ individuals with ASD were selectively impaired in their ability to recognize faces across changes in orientation, expression and featural information. In a face discrimination task, ASD participants showed a preserved ability to discriminate featural and configural information in the mouth region of a face, but were compromised in their ability to discriminate featural and configural information in the eyes. On object-processing tasks, ASD participants demonstrated a normal ability to recognize automobiles across changes in orientation and a superior ability to discriminate featural and configural information in houses. These findings indicate that the face-processing deficits in ASD are not due to a local-processing bias, but reflect a category-specific impairment of faces characterized by a failure to form view-invariant face representations and discriminate information in the eye region of the face.

YEAR: 2007

07-1. Beauchaine, T.P., Gatzke-Kopp, L., & Mead, H.K. (2007). Polyvagal theory and developmental psychopathology: Emotion dysregulation and conduct problems from preschool to adolescence. Biological Psychology, 74, 174-184.

Objective: In science, theories lend coherence to vast amounts of descriptive information. However, current diagnostic approaches in psychopathology are primarily atheoretical, emphasizing description over etiological mechanisms. We describe the importance of Polyvagal Theory toward understanding the etiology of emotion dysregulation, a hallmark of psychopathology. When combined with theories of social reinforcement and motivation, Polyvagal Theory specifies etiological mechanisms through which distinct patterns of psychopathology emerge. Method: In this paper, we summarize three studies evaluating autonomic nervous system functioning in children (ages 4-18) with conduct problems [defined in part with Child and Adolescent Symptom Inventories]. Results: At all age ranges, these children exhibit attenuated sympathetic nervous system responses to reward, suggesting deficiencies in approach motivation. By middle school, this reward insensitivity is met with inadequate vagal modulation of cardiac output, suggesting additional deficiencies in emotion regulation. We propose a biosocial developmental model of conduct problems in which inherited impulsivity is amplified through social reinforcement of emotional lability. Implications for early intervention are discussed.

07-2. Chervin, R.D., Weatherly, R.A., Garetz, S.L., Ruzicka, D.L., Giordani, B.J., Hodges, E.K., Dillon, J.E., Guire, K.E. (2007). Pediatric sleep questionnaire: Prediction of sleep apnea and outcomes. Archives of Otolaryngology-Head & Neck Surgery, 133, 216-222.

Objectives: To further validate a questionnaire about symptoms of childhood obstructive sleep apnea (OSA) and to compare the questionnaire with polysomnography in their ability to predict outcomes of adenotonsillectomy. Method: Retrospective analysis of data from a longitudinal study. The Washtenaw County Adenotonsillectomy Cohort, comprising 105 children aged 5.0 to 12.9 years at entry. Parents completed the 22-item Sleep-Related Breathing Disorder (SRBD) scale of the Pediatric Sleep Questionnaire, and children underwent polysomnography before and 1 year after clinically indicated adenotonsillectomy (n = 78, usually for suspected OSA) or unrelated surgical care (n = 27).Measures included commonly used hyperactivity ratings [e.g., Child Symptom Inventory-4], attention tests, and sleepiness tests. Results: At baseline, a high SRBD scale score (1 SD above the mean) predicted an approximately 3-fold increased risk of OSA on polysomnography (odds ratio, 2.80; 95% confidence interval, 1.68-4.68). One year later, OSA and symptoms had largely resolved, but a high SRBD score still predicted an approximately 2-fold increased risk of residual OSA on polysomnography (odds ratio, 1.89; 95% confidence interval, 1.13-3.18). Compared with several standard polysomnographic measures of OSA, the baseline SRBD scale better predicted initial hyperactivity ratings and 1-year improvement, similarly predicted sleepiness and its improvement, and similarly failed to predict attention deficit or its improvement. Conclusions: The SRBD scale predicts polysomnographic results to an extent useful for research but not reliable enough for most individual patients. However, the SRBD scale may predict OSA-related neurobehavioral morbidity and its response to adenotonsillectomy as well or better than does polysomnography.

07-3. 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.

07-4. 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. 22, 161-169

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.

07-5. Edwards, M.C., Gardner, E.S., Chelonis, J.J., Schulz, E.G., Flake, R.A., & Diaz, P.F. (2007). Estimates of the validity and utility of the Conners' continuous performance test in the assessment of inattentive and/or hyperactive-impulsive behaviors in children. Journal of Abnormal Child Psychology, 35, 393-404.

Objective: This study evaluated the validity and classification utility of the Conners' Continuous Performance Test (CCPT) in the assessment of inattentive and hyperactive-impulsive behaviors in children. Significant, positive correlations between the CCPT parameters and behavioral ratings of ADHD behaviors were hypothesized. In addition, it was hypothesized that the CCPT parameters would perform better than a random test (chance) and show fair to moderate utility of classification across the different indices. Method: Participants were 104 children between 6 and 12 years of age who were referred for evaluation of attention problems. [Comorbidities were screened with the Child Symptom Inventory-4.]  Results: The first hypothesis was not supported. There were no significant, positive correlations between the CCPT parameters and parent and teacher ratings of inattentive and hyperactive-impulsive behaviors. The second hypothesis was only partially supported. The CCPT Overall Index and the Omission Errors (84th percentile cutoff) performed better than a random test; however, the utility of the CCPT Overall Index only ranged from poor to slight. Receiver operating characteristic analyses showed the accuracy of the CCPT to be low. The implications and limitations of this study and future research directions are discussed.

07-6. Gadow, K.D., Sprafkin, J., Schneider, J., Nolan, E.E., Schwartz, J., & Weiss, M.D. (2007). ODD, ADHD, versus ODD+ADHD in clinic and community adults. Journal of Attention Disorders, 11, 374-383.

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.

07-7. Gadow, K. D., Sverd, J., Nolan, E.E., Sprafkin, J., & Schneider, J. (2007). Immediate-release methylphenidate for ADHD in children with comorbid chronic multiple tic disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 46, 840-848.

Objective: To examine the safety and efficacy of immediate-release methylphenidate (MRH-IR) for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children with Tourette’s disorder (96%) or chronic motor tic disorder (4%). Method: Two cohorts of pre-pubertal children (N=71) received placebo and three doses of methylphenidate (0.1, 0.3, and 0.5 mg/kg) twice daily for 2 weeks each, under double-blind conditions as part of their involvement in a long-term observation study (1989-2004). [Diagnostic measures included the Child Symptom Inventory-4.] Treatment effects were assessed with an extensive battery of parent-, teacher-, child- and physician-completed rating scales and laboratory tasks. Results: MPH-IR effectively suppressed ADHD, oppositional defiant disorder, and peer aggression behaviors. There was no evidence that MPH-IR altered the overall severity of tic disorder or OCD behaviors. Teacher ratings indicated that MPH-IR therapy decreased tic frequency and severity.  Conclusion:  MPH-IR appears to be a safe and effective short-term treatment for ADHD in the majority of children with chronic tic disorder; nevertheless, the possibility of tic exacerbation in susceptible individuals warrants careful monitoring of all patients.

07-8. Gatzke-Kopp, L.M., &  Beauchaine, T.P. (2007). Direct and passive prenatal nicotine exposure and the development of externalizing psychopathology. Child Psychiatry & Human Development, 38, 255-269.

Objective: The association between maternal smoking during pregnancy and childhood antisocial outcomes has been demonstrated repeatedly across a variety of outcomes. Yet debate continues as to whether this association reflects a direct programming effect of nicotine on fetal brain development, or a phenotypic indicator of heritable liability passed from mother to child. Method: In the current study, we examine relations between maternal smoking and child behavior among 133 women and their 7-15-year-olds, who were recruited for clinical levels of psychopathology. In order to disentangle correlates of maternal smoking, women who smoked during pregnancy were compared with (a) those who did not smoke, and (b) those who did not smoke but experienced significant second-hand exposure. Results: Second-hand exposure was associated with increased externalizing psychopathology in participant mothers' offspring. Moreover, regression analyses indicated that smoke exposure during pregnancy predicted conduct disorder symptoms [assessed with the Child Symptom Inventory-4], over and above the effects of income, parental antisocial tendencies, prematurity, birth weight, and poor parenting practices. This is the first study to extend the findings of externalizing vulnerability to second hand smoke exposure.

07-9. Greve, K.W., Bianchini, K.J., Stickle, T.R., Love, J.M., Doane, B.M., Thompson, M.D. (2007). Effects of a community toxic release on the psychological status of children. Child Psychiatry & Human Development, 37, 307-323.

Objective: This study sought to determine the emotional effects of a major community toxic release on children in the exposed community while controlling for the potential effects of response bias. Controlling for the response bias inherent in litigated contexts is an advance over previous studies of toxic exposure in children. Method: A randomly selected representative sample of Exposed children (n = 31) was compared to a matched Control group (n = 28) from a nearby, unexposed community. Symptoms and complaints were assessed via interview with the children and their guardians, surveys and checklists, and well-established psychological instruments. Results: Even when biased responding was controlled the Exposed children experienced more psychological distress, more physical symptoms, and greater general concern over their physical functioning than the Controls. The Exposed children also reported some concern about their future health and cancer risk but usually only if asked. Limitations and future research directions are discussed.

07-10. Huang-Pollock, C.L., Mikami, A.Y., Pfiffner, L., & McBurnett, K. (2007). ADHD subtype differences in motivational responsivity but not inhibitory control: Evidence from a reward-based variation of the stop signal paradigm. Journal of Clinical Child and Adolescent Psychology, 36, 127-136.

In this study we examined prepotent motor inhibition and responsiveness to reward using a variation of the stop signal reaction time (SSRT) task in clinic and community-recruited children ages 7 to 12 with attention-deficit/hyperactivity disorder-inattentive type (ADHD--I), ADHD-combined type (ADHD-C), and non-ADHD controls. Contrary to theoretical expectations, we found evidence for inhibitory weaknesses in ADHD-I. [The Child Symptom Inventory-4 was used as one of several measures.] We also found evidence that although children with ADHD-I were able to improve their inhibitory control given reward-based motivation, the improvement depended on the order of reward conditions. Results suggest that the 2 primary subtypes of ADHD share similar neuropsychological weaknesses in inhibitory control but that there are subtype differences in response to success and failure that contribute to a child's ultimate level of performance.

07-11. Kollins, S.,  Greenhill, L., Swanson, J., Wigal, S., et al. (2006). Rationale, design, and methods of the preschool ADHD Treatment Study (PATS). Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1275-1283.

Objective: To describe the rationale and design of the Preschool ADHD Treatment Study (PATS). Method: PATS was a National Institutes of Mental Health-funded, multicenter, randomized, efficacy trial designed to evaluate the short-term (5 weeks) efficacy and long-term (40 weeks) safety of methylphenidate (MPH) in preschoolers with attention-deficit/ hyperactivity disorder (ADHD). Three hundred three subjects ages 3 to 5.5 years old who met criteria for a primary DSM-IV diagnosis of ADHD entered the trial. Subjects participated in an 8-phase, 70-week trial that included screening, parent training, baseline, open-label safety lead-in, double-blind crossover titration, double-blind parallel efficacy, open-label maintenance, and double-blind discontinuation. [One of many evaluation instruments was the Early Childhood Inventory-4.] Medication response was assessed during the crossover titration phase using a combination of parent and teacher ratings. Special ethical considerations throughout the trial warranted a number of design changes. Results: This report describes the design of this trial, the rationale for reevaluation and modification of the design, and the methods used to conduct the trial. Conclusions: The PATS adds to a limited literature and improves our understanding of the safety and efficacy of MPH in the treatment of preschoolers with ADHD, but changes in the design and problems in implementation of this study impose some specific limitations that need to be addressed in future studies.

07-12. Kopp, L.M., Beauchaine, T.P. (2007). Patterns of psychopathology in the families of children with conduct problems, depression, and both psychiatric conditions. Journal of Abnormal Child Psychology, 35, 301-312.

Objective: Comorbid conduct problems (CPs) and depression are observed far more often than expected by chance, which is perplexing given minimal symptom overlap. In this study, relations between parental psychopathology and children's diagnostic status were evaluated to test competing theories of comorbidity. Method: Participants included 180 families with an 8-12-year-old child diagnosed with CPs, depression, both conditions, or neither condition. [Child diagnostic classifications were based on the Child Symptom Inventory-4.] Results: Although no single theory of comorbidity was supported fully, evidence suggested that CPs and depression may be inherited separately. Paternal antisocial characteristics and maternal depression provided independent prediction of both child depression and CPs. However, paternal antisocial behavior moderated the effect of maternal depression on CPs. For children with antisocial fathers, CPs were observed regardless of maternal depression levels. In contrast, a strong relation was observed between CPs and maternal depression for children without antisocial fathers.

07-13. Kronenberger, W.G., Giauque, A.L., & Dunn, D.W. (2007). Development and validation of the outburst monitoring scale for children and adolescents Journal Of Child And Adolescent Psychopharmacology, 17, 511-526.

Objective: The aim of this study was to develop a parent-completed questionnaire measure of specific types of aggressive behaviors in children and adolescents. Method: Two studies tested the psychometrics of the Outburst Monitoring Scale (OMS), a questionnaire measure of verbal, property, self, and physical aggression, based in part on the categories of the Overt Aggression Scale. In Study 1, parents of 23 adolescents with a history of aggressive-disruptive behavior and 30 control adolescents completed the OMS and other measures of aggressive-disruptive behavior [including the Adolescent Symptom Inverntory-4]. In Study 2, parents of 9 adolescents with a history of aggressive-disruptive behavior completed the OMS and other measures of aggressive-disruptive behavior during open-label treatment with methylphenidate and quetiapine. Results: Results from both studies demonstrated adequate internal consistency of OMS sub-scale and total scores. OMS scores correlated significantly with measures of conduct disorder and oppositional defiant disorder and differentiated between control and aggressive sub-samples. Changes in OMS scores during treatment correlated with changes in other measures of aggressive and disruptive behavior. Conclusion: The OMS demonstrated good internal consistency, strong correlations with other measures of aggressive/disruptive behavior, good differential validity, and sensitivity to change during a medication trial. The OMS offers a quick, valid, questionnaire-based alternative for measuring frequencies of specific aggressive behaviors in clinical and research settings.

07-14. Lewandowski, A., & Drotar, D. (2007). The relationship between parent-reported social support and adherence to medical treatment in families of adolescents with type 1 diabetes. Journal of Pediatric Psychology, 32, 427-436.

Objective: To investigate the relationships between both mother-reported spousal support and social network support, and mother-adolescent diabetes-related conflict, discrepancies in decision-making autonomy (DDMA), and adolescent adherence to diabetes treatment. Method: Fifty-one mothers of adolescents with IDDM completed self-report measures of social support, diabetes-related conflict, and adolescent autonomy for diabetes care. [Mothers completed the Oppositional Defiant Disorder category of the Adolescent Symptom Inventory-4.] Analyses tested conflict and DDMA as mediators between mother-reported social support and adolescent adherence to treatment. Results: Increased levels of mother-adolescent conflict were associated with poorer treatment adherence and both mother-reported diabetes-related conflict and DDMA predicted adolescents' glycemic control. Higher levels of mother-reported spousal support were associated with less conflict and greater adherence to treatment. Sobel's test indicated a statistical trend for conflict as a mediator between spousal support and adolescent treatment adherence (p <.07). DDMA did not predict mother-adolescent conflict and did not emerge as a mediator between mother-reported social support and adolescent adherence. Conclusions: This study highlights the role of spousal support for mothers of adolescents with IDDM and indicates that the level of spousal support mothers receive may play an important rote in the health care behaviors of their adolescents.

07-15. Lopez-Villalobos, J. A., Serrano-Pintado, I., Delgado Sanchez-Mateos, J., Ruiz-Sanz, F., Sanchez-Azon, M. I., & Sacristan-Martin, A. M. (2007). Attention deficit hyperactivity disorder: Intellectual profile and the freedom from distraction factor. Revista De Neurologia, 44, 589-595.

Objective: Attention deficit hyperactivity, disorder (ADHD) usually presents a neuropsychological profile in which the freedom from distraction factor (FDF) is affected to a greater extent than the verbal comprehension factor (VCF) and the perceptual organisation fiactor (POF). To determine the intellectual profile of clinical cases with ADHD through a specific analysis of the FDF in which we evaluated the differences compared with the VCF and the POF, between types of ADHD and with WISC-R criteria, as well as the variables that affect the probability of FDF < VCF and POE. Method: Our study involved a clinical sample (of 167 cases of ADHD between 6 and 16 years of age. The cases were defined according to DSM-IV criteria and the evaluation was performed using WISC-R, the Child Symptom Inventory-4 and the social and occupational activity assessment scale. Both descriptive and exploratory, statistics were used. Means were compared using ANOVA and/or t tests. Alpha was accepted if it was equal to or below 0.05 and a logistic regression method was used (alpha model parameters below or equal to 0.05). In each factor a 95% confidence interval and odds ratio were determined. Results: The criterion, FDF < VCF and FOP accounted for 71.3% of the cases with ADHD and FDF < (VCF + POF)/2 represented 81.4% (sensitivity: 81.4%). The FDF is significantly lower that? both the mean that corresponds to factorial criteria derived from the WISC-R and the VCF and POF in the cases that were analysed. The mean FDF scores were significantly higher in ADHD-H (a type in which hyperactive-impulsivity predominates) than in ADHD-C (combined type) and ADHD-1 (inattentive type). Comorbidity, social or school activity and intellectual quotient do not have a significant influence on the probability that FDF < VCF and POE. Conclusion: The FDF is a neuropsychologicool dimension that is useful in evaluating ADHD.

07-16. Mikami, A.Y., Huang-Pollock, C.L., Pfiffner, L.J., McBurnett, K., Hangai, D. (2007). Social skills differences among attention-deficit/hyperactivity disorder types in a chat room assessment task. Journal of Abnormal Child Psychology, 35, 509-521.

Objective: This study assessed social skills in 116 children aged 7-12 with ADHD-Combined Type (ADHD-C; n=33), ADHD-Inattentive Type (ADHD-I; n=45), and comparison children (n=38), with consideration of the role sluggish cognitive tempo (SCT) symptoms play in distinguishing profiles. [The Child Symptom Inventory-4 was used as a screening tool for ASHD.] Method: Social skills were assessed using a novel computerized chat room task, in which participants were encouraged to join a conversation and type messages to interact with four computer-simulated peers. Every participant received the identical stimulus from the simulated peers, but was free to respond to it in his or her own unique way. Results: Relative to comparison children, children with ADHD-C made off-topic and hostile responses; children with ADHD-I made off-topic responses, few responses and showed poor memory for the conversation. ADHD subtype differences remained after statistical control of IQ, reading achievement, typing skill, and comorbid disruptive behavior disorders. SCT symptoms, most prevalent among children with ADHD-I, predicted a distinct pattern of social withdrawal and lower hostility. Parent and teacher ratings and in-vivo observations of social skills correlate with this new measure.

07-17. Pfiffner, L.J., Mikami,  A.Y.,  Huang-Pollock, C., Easterlin, B., Zalecki, C., McBurnett, K., (2007). A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1041-1050.

Objective: To evaluate the efficacy of a behavioral psychosocial treatment integrated across home and school (Child Life and Attention Skills Program) with attention-deficit/hyperactivity disorder (ADHD) predominantly inattentive type (ADHD-I). Method: Sixty-nine children ages 7 to 11 years were randomized to the Child Life and Attention Skills Program or a control group who did not receive the intervention. We compared groups posttreatment and at 3- to 5-month follow-up on parent and teacher ratings of inattention sluggish cognitive tempo, and functional impairment. [The Child Symptom Inventory-4 was the primary outcome measure.] Results: Children randomized to the Child Life and Attention Skills Program were reported to have significantly fewer inattention and sluggish cognitive tempo symptoms, and significantly improved social and organizational skills, relative to the control group. Gains were maintained at follow-up. Conclusions: Behavioral psychosocial treatment, when specifically adapted for ADHD-I and coordinated among parents, teachers, and children, appears efficacious in reducing symptoms and impairment associated with ADHD-I.

07-18. Shannon, K.E., Beauchaine, T.P., Brenner, S.L., Neuhaus, E., Gatzke-Kopp, L. (2007). Familial and temperamental predictors of resilience in children at risk for conduct disorder and depression. Development and Psychopathology, 19, 701-727.

Objective: In this study, we evaluated predictors of resilience among 8- to 12-year-old children recruited from primarily low socioeconomic status neighborhoods, 117 of whom suffered from clinical levels of conduct problems and/or depression and 63 of whom suffered from no significant symptoms. [The Child Symptom Inventory-4 was used to evaluate DSM-IV symptoms.] Method: Tests of interactions were conducted between (a) paternal antisocial behavior and maternal depression and (b) several physiological indices of child temperament and emotionality in predicting (c) children's conduct problems and depression. Results: Both internalizing and externalizing outcomes among children were associated specifically with maternal melancholic depression, and not with nonmelancholic depression. In addition, low levels of respiratory sinus arrhythmia (RSA) among children conferred significant risk for depression, regardless of maternal melancholia, whereas high RSA offered partial protection. Furthermore, high levels of maternal melancholia conferred significant risk for child depression, regardless of paternal antisocial behavior, whereas low levels of maternal melancholia offered partial protection. Finally, low levels of electrodermal responding (EDR) conferred significant risk for conduct problems, regardless of paternal antisocial behavior, whereas high EDR offered partial protection. None of the identified protective factors offered complete immunity from psychopathology. Conclusion: These findings underscore the complexity of resilience and resilience-related processes, and suggest several potential avenues for future longitudinal research.

07-19. 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. 17, 75-84.

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.

07-20. 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, 11, 114-124.

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.

07-21. Sullivan K., Hatton, D.D., Hammer, J., Sideris, J., Hooper, S., Ornstein, P.A., & Bailey, D.B. (2007). Sustained attention and response inhibition in boys with fragile X syndrome: Measures of continuous performance. American Journal of Medical Genetics Part B-Neuropsychiatric Genetics, 144:517-532.

Sustained attention and response inhibition were examined in boys with fall mutation fragile X syndrome (FXS) using adapted visual and auditory continuous performance tests (CPTs). Only 61% of 56 boys with visual CPT data and 54% of 52 boys with auditory data were able to demonstrate sufficient understanding to complete the visual and auditory CPTs, respectively. Mental age (MA) predicted whether boys with FXS were able to demonstrate understanding of the CPTs. The performance of boys with FXS who were able to complete the CPTs was compared to a sample of boys without disabilities matched on MA. Boys with FXS demonstrated similar or smaller declines in sustained attention over task time than their MA-matched peers on the visual and auditory CPTs, respectively, but consistently demonstrated greater declines in response inhibition over task time than their MA-matched peers. There were no differences between groups for response time of hits. Higher MAs consistently predicted better sustained attention and response inhibition over task time on the visual and auditory CPTs. Furthermore, boys taking psychotropic medication performed better at the beginning of most tasks, although their performance deteriorated at a faster rate over time, and boys rated as meeting diagnostic criteria for ADHD-hyperactive type [assessed with the Child or Adolescent Symptom Inventory-4] had more difficulty over task time with response inhibition on the auditory CPT. For both boys with FXS and their MA matches, performance was better on the visual CPT than on the auditory CPT though this effect may be attributable to a number of factors other than the modality.

07-22. 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.

07-23. Wade, C.A., Ortiz, C., & Gorman, B.S. (2007).Two-session group parent training for bedtime noncompliance in head start preschoolers. Child & Family Behavior Therapy, 29, 23-55.

Objective: Bedtime struggles are some of the most common childhood behavior problems. These disruptions are associated with children's daytime misbehavior, impaired social functioning, poorer school performance, and even an increased risk of child abuse. These problems also have a number of negative consequences for members of the child's family. Of the evidence-based treatments for bedtime noncompliance in young children, graduated extinction is the most widely used by clinicians. A number of studies have demonstrated its efficacy. The present study is the first to examine the efficacy of graduated extinction with children from ethnic minority or low socioeconomic backgrounds. Additionally, this is one of the first studies to examine the effects of graduated extinction when it is delivered in a group format. Method: In an interrupted time-series design, five parents of children enrolled at a Head Start preschool site participated in one of two groups that received instruction on the use of graduated extinction. [The Early Childhood Inventory-4 was used as a screen for emotional disorders.] Results: According to visual inspection as well as single case and multilevel statistical analyses, parents reported that at posttest their children experienced large reductions in both bedtime and daytime behavior problems. Parents also reported that their own levels of depression and stress declined during this period. At two-month follow-up, gains in the children's bedtime behavior were maintained. Parents also reported high levels of satisfaction with the intervention. Conclusion: These results suggest that graduated extinction for bedtime noncompliance is effective for a wide range of parents and can be successfully administered in a group setting.

07-24. Wightman, A., Schluchter, M., Drotar, D., Andreias, L., Taylor, H.G., Klein, N., Wilson-Costello, D., & Hack, M. (2007). Parental protection of extremely low birth weight children at age 8 years. Journal of Developmental and Behavioral Pediatrics, 28, 317-326.

Objective: To examine parent protection and its correlates among 8-year-old ELBW children compared with normal birth weight (NBW) controls. Methods: The population included 217 eight-year-old ELBW children born 1992-1995 (92% of the surviving birth cohort; mean birth weight, 811 g; mean gestational age, 26.4 weeks) and 176 NBW controls. The primary outcome measure, the Parent Protection Scale (PPS), included a total score and four domains including Supervision, Separation, Dependence, and Control. Multivariate analyses were performed to examine the predictors of parental protection and overprotection. [The Child Symptom Inventory-4 was included in the initial assessment battery.]  Results: After adjusting for socioeconomic status (SES), race, sex, and age of the child, parents of ELBW children reported significantly higher mean total Parent Protection Scale scores (31.1 vs 29.7, p = .03) than parents of NBW children and higher scores on the subscale of Parent Control (8.0 vs 7.5, p = .04). These differences were not significant when the 36 children with neurosensory impairments were excluded. Parents of ELBW children also reported higher rates of overprotection than controls (10% vs 2%, p = .001 ), findings that remained significant even after excluding children with neurosensory impairments (8% vs 2%, p = .011). Multivariate analyses revealed lower SES to be associated with higher total Parent Protection Scale scores in both the ELBW (p < .001) and NBW (p < .05) groups. Additional correlates included neurosensory impairment (p < .05) and functional limitations (p < .001) in the ELBW group and black race (p < .05) and maternal depression (p < .01) in the NBW group. Lower child IQ was significantly associated with higher PPS scores only in the neurosensory impaired subgroup of ELBW children. Conclusions: Longer term follow-up will be necessary to examine the effects of the increased parent protection on the development of autonomy and interpersonal relationships as the children enter adolescence.

 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) (Early Childhood Inventory-4) and 6 to 12- (N=301/191) (Child Symptom Inventory-4) 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 6^th to 10^th-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 teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analysis, treatment planning, and outcome monitoring.

05-16. Pfiffner, L., McBurnett, K., Rathouz, P., & Judice, S. (2005). Family correlates of oppositional and conduct disorders in children with attention deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 33, 551-563.

Objective: Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Method: Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. [Children were initially screened with Child Symptom Inventory-4.]  Parents completed measures of parenting practices. Results: Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. Conclusion: While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.

05-17.  Scahill, L. (2005). Diagnosis and evaluation of pervasive developmental disorders. Journal of Clinical Psychiatry, 66(Suppl. 10), 19-25, 2005.

Accurate diagnosis and appropriate treatment of pervasive developmental disorders (PDDs), including autistic disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified, are necessary to ensure the best possible outcomes for children with these disorders. In the past, it was not uncommon for children with PDDs to wait several years from the time of parental recognition of developmental delay to the determination of the correct diagnosis and initiation of treatment. Increased awareness of PDDs and the availability of better assessment tools have improved the detection of these conditions in children. A wide variety of standardized diagnostic checklists, interviews, and observational measures are available to assist the clinician in making an accurate PDD diagnosis. A comprehensive evaluation also establishes a baseline of adaptive functioning and problematic behavior, which is essential for subsequent assessment of progress. This article discusses the differential diagnosis and evaluation of PDDs, focusing on the various assessment tools. The elements of a contemporary diagnostic evaluation and behavioral assessment are presented. The application of discretionary evaluations for special situations are also introduced. [The authors note that the “advantage of the Child Symptom Inventories over the Autism Behavior Checklist is that they are entirely based on DSM-IV and offer information about other diagnostic categories beyond PDD (p. 21) and ”can assist with the diagnosis of PDD as well as other DSM-IV symptom complexes” (p. 24).]

05-18. Sobin, C., Kiley-Brabeck, K., & Karayiorgou, M. (2005). Lower prepulse inhibition in children with the 22q11 deletion syndrome. American Journal of Psychiatry, 162, 1090-1099.

Objective: The 22q11 deletion syndrome is associated with a range of possible physical anomalies, probable ongoing learning disabilities, and a specific constellation of neuropsychological deficits, including impairments in selective and executive visual attention, working memory, and sensorimotor functioning. It has been estimated that 25% of the children with 22q11 deletion syndrome go on to develop schizophrenia in late adolescence or adulthood. This is of urgent concern. Specification of early brain network vulnerabilities may provide a basis for early intervention while indicating critical links between genes and severe psychiatric illness. Neuropsychological studies of children with 22q11 deletion syndrome have implicated an array of potentially aberrant brain pathways. This study was conducted to determine whether preattentive processing ("sensorimotor gating") deficits are present in this population. Method: The authors administered a test of prepulse inhibition to 25 children with 22q11 deletion syndrome and their 23 sibling comparison subjects, ages 6–13. It was predicted that the children with 22q11 deletion syndrome would have lower prepulse inhibition than the comparison subjects. Results: Prepulse inhibition in the children with 22q11 deletion syndrome (26.06%) was significantly less than that of the sibling comparison subjects (46.41%). Secondary analyses suggested that this decrement did not reflect developmental delay, and lower prepulse inhibition was associated with particular subsyndromal symptoms [as assessed with the Schizophrenia subscale of the Child Symptom Inventory-4] in some children. Conclusion: Sensorimotor gating is lower in children with 22q11 deletion syndrome. These findings may indicate specific brain circuits that are anomalous in 22q11 deletion syndrome.

05-19. Volpe, R.J., DiPerna, J.C., Hintze, J.M., & Shapiro, E.S. (2005). Observing students in classroom settings: A review of seven coding schemes. School Psychology Review, 34, 454-474.

A variety of coding schemes are available for direct observational assessment of student classroom behavior. These instruments have been used for a number of assessment tasks including screening children in need of further evaluation for emotional and behavior problems, diagnostic assessment of emotional and behavior problems, assessment of classroom ecology in the formulation of academic interventions, and monitoring the progress of medical, psychosocial, and academic interventions. Although this method of behavioral assessment has a high degree of face validity, it is essential to consider the psychometric properties of available coding schemes to select the appropriate instrument for a given assessment. This article reviews the structure, content, training requirements, and available psychometric properties of seven available direct observation codes [including the ADHD School Observation Code, ADHD-SOC]. Recommendations for the use of each code and future directions for research in observational assessment are provided. [The authors conclude that “based on the available data, the ADHD-SOC and DOF appear to have the most support for use in the multimethod assessment of externalizing problems” (p. 470).]

05-20. Weisbrot, D.M., Gadow, K.D., DeVincent, C.J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15, 477-496.

Objective: Although DSM-IV diagnostic criteria generally discourage the diagnosis of other Axis I disorders in children with pervasive developmental disorder (PDD), anxiety symptoms are often observed in this clinical population.  Moreover, there are some albeit limited data that suggest an association between anxiety and psychotic symptoms in children. Because co-occurring psychiatric symptoms have important clinical implications, this study examined anxiety and psychotic symptoms in children with and without PDD. Method: Parents and teachers completed the Early Childhood Inventory-4 (ECI-4) or the Child Symptom Inventory-4 (CSI-4) for children evaluated in a developmental disabilities clinic (PDD) or a child psychiatry outpatient clinic (nonPDD). Children were divided into four groups: 3-5 year olds with (n=182) and without (n=135) PDD, and 6-12 year olds with (n=301) and without (n=191) PDD. The 6 to 12 year olds were further divided into high-anxious and low-anxious subgroups based on CSI-4 ratings and compared with regard to severity of psychotic symptoms. Results: Teachers rated preschoolers with PDD as exhibiting more severe anxiety symptoms than the nonPDD group; however, the converse was true for parent ratings. For 6 to 12 year olds, both parents and teachers rated children with PDD as significantly more anxious than nonPDD clinic referrals. In general, these severity of anxiety varied by PDD Subtype (Asperger’s disorder>PDDNOS>Autistic disorder) and IQ (high>low).  Furthermore, highly anxious, 6 to 12 year olds with PDD  received significantly higher parent and teacher ratings of psychotic symptom severity (strange behaviors, hearing voices, illogical thinking, inappropriate affect, and odd thoughts) than our low-anxiety group even when controlling for PDD symptom severity. Moreover, the relation between anxiety level and psychotic symptom severity was similar for both PDD and nonPDD children. Parent and teachers differed in their perceptions of the severity of specific anxiety symptoms. In addition, parent- versus teacher-defined anxiety level groups differed with regard to the differential severity of psychotic symptoms. This supports the continued investigation of source-specific syndromes in children with PDD. Two case vignettes are presented. Conclusion: Anxiety appears to be a clinically important concern in many children with PDD. Similarities in anxiety symptom presentation and their association with psychotic symptoms in both children with and without PDD support the possibility of (a) psychiatric comorbidity in the former, (b) at least some overlap in causal mechanisms for anxiety and psychotic symptoms in both PDD and nonPDD children, and (c) a unique diagnostic entity comprised of PDD, anxiety, and psychotic symptoms. Lastly, clinicians should seriously consider dual diagnoses in children with PDD.

YEAR: 2004

04-1. Aman, M.G., Binder, C., & Turgay, A. (2004). Risperidone effects in the presence/absence of psychostimulant medicine in children with ASDHD, other disruptive behavior disorders, and subaverage IQ. Journal of child and Adolescent Psychopharmacology, 14, 243-254.

The ADHD symptom category of the parent-completed Child Symptom Inventory-4 was used as a screening device for possible inclusion in the study.

04-2. Domenech-Llaberia, E., Jane, C., Canals, J., Ballespi, S., Esparo, G., & Garralda, E. (2004). Parental reports of somatic symptoms in preschool children: Prevalence and associations in a Spanish sample. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 598-604.

Objective: To document prevalence and associations of somatic symptoms in Spanish preschool children. Method: Subjects were 3- to 5-year-olds attending nurseries (8 urban, 30 rural). Parental questionnaires (response rate 77%) were used to inquire about somatic symptoms in the child in the 2 weeks prior to assessment, about preschool absence and pediatric help-seeking, chronic family health problems, and recent stressful life events for the child. Parents completed questionnaires on child psychopathology (Early Childhood Inventory-4) and their own mental health (General Health Questionnaire). Children who were reported as complaining of symptoms frequently (four or more times) were compared to noncomplaining children. Results: parents reported that 452 of the 807 (56%) children complained of somatic symptoms at least once, significantly more so in urban than rural areas. Frequent somatic complaints were reported for 165 of the 807 (20%) (abdominal pains 7.9%, tiredness 5.7%, leg pains 4%, headaches 2%, dizziness 0.4%). There were significant associations of frequent symptom reporting with days off preschool and pediatric clinic attendance, with emotional and behavioral symptoms in children, mental distress in parents, and urban abode. Conclusions: Somatic symptoms are common in preschool children. Results point to family influences.

04-3.  Drabick, D.A.G., Gadow, K.G., Carlson, G.A., & Bromet, E.J. (2004). ODD and ADHD symptoms in Ukrainian children: External validators and comorbidity. Journal of the American Academy of Child and Adolescent Psychiatry. 43, 735-743.

Objective: Examined potential external validators for ODD symptoms and ADHD symptoms in a Ukrainian community-based sample of 600, 10- to 12-year-old children and evaluated the nature of co-occurring ODD and ADHD symptoms using mother- and teacher-defined groups. Method: In 1997, parents, children, and teachers participated in extensive clinical assessments using standard Western measures, including the Child Symptom Inventory-4. Four areas of functioning were assessed: child mental health, parent-child interactions, parental well-being, and school/cognitive performance. Results: Mother-defined ODD versus ADHD symptom groups were differentiated by history of overactivity and tantrums, behavior in school, and maternal anxiety and hostility. Teacher-defined groups were differentiated by conduct problems, internalizing symptoms, mother-child interactions, and paternal alcohol use. The effects of co-occurring ODD and ADHD symptoms were greater than would be expected based on their separate effects for conduct problems, internalizing symptoms, social problems, academic performance, parent-child relations, and marital discord. Conclusion: Children with ODD versus ADHD symptoms were not significantly different from each other for the majority of variables examined, and group differences were dependent on the rater used to define symptom groups.

04-4. Ellis, B.H., Fisher, P.A., & Zaharie, S. (2004). Predictors of disruptive behavior, developmental delays, anxiety, and affective symptomatology among institutionally reared Romanian children. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1283-1292.

Objective: To examine the associations between duration of institutionalization, age at abandonment, and mental and physical health outcomes of young institutionalized children in Romania and to examine patterns of associations between placement history, physical growth variables, and psychiatric symptoms. Method: Institutionalized children (ages 2 to 6 years) in a Romanian orphanage were studies through caregiver reports. Orphanage staff completed the Early Childhood Inventory-4 (ECI-4) on the children’s psychiatric symptoms and physical growth measurements and placement histories on the children. ECI-4 variables included Screening Cutoff, Symptom Severity, Total Severity, and Developmental Deficits Index scores as well as three theoretically-related aggregated symptom scales: disruptive behavior, anxiety/affective symptomatology, and disorders of development. Results: Children showed high rates of developmental delays, anxiety/affective symptoms, and physical growth delays. Patterns of associations between history and growth variables and ECI-4 scores were examined using three sequential multiple regressions. Longer duration of institutionalization and shorter physical stature were significantly associated with anxiety/affective symptoms. Physical stature was significantly associated with developmental delays and disruptive behaviors, with smaller stature being associated with greater developmental delays and fewer disruptive behavior problems. Conclusions: Institutionalized children demonstrate high rates of psychiatric symptoms. Duration of institutionalization, physical stature, and age at abandonment differentially relate to psychiatric symptoms. Findings are interpreted in light of implications for intervention and social policy.

04-5. Esparo, G., Canals, J., Jane, C., Ballespi, S., Vinas, F., & Domenech, E. (2004). Feeding problems in nursery children: Prevalence and psychosocial factors. Acta Paediatrica, 93, 663-668.

Objective: In this study we analyze the prevalence of feeding problems in a sample of nursery children and examine the environmental and psychopathological factors related to such problems. Method: The parent version of the Early Childhood Invcentory-4 was used to assess 851 Spanish children (ages 3 to 6 years) in both urban and rural settings. We collected sociodemographic data and information about life events and the psychopathology of the children’s parents (General Health Questionnaire). Results: Results showed that the prevalence of feeding problems was 4.8% and that there were no differences in gender. Sample subtype, SES, and family characteristics were not linked to feeding problems. Children with feeding problems had significantly more symptoms of psychiatric symptoms and somatic complaints and experienced more life events in the previous 12 months. The psychopathology of the mother, especially in terms of anxiety problems, increased the risk of feeding problems in children. Conclusion: When there are no complaints of feeding problems in preschoolers, the psychological problems of children and their mothers should be taken into consideration during pediatric consultation, irrespective of gender or SES.

04-6. Gadow, K.D., Drabick, D.A.G., Loney, J., Sprafkin, J., Salisbury, H.,  Azizian, A., & Schwartz, J. (2004). Comparison of ADHD symptom subtypes as source-specific syndromes. Journal of Child Psychology and Psychiatry, 45, 1135-1149.

Objective: This study examines differences between the three subtypes of attention-deficit/hyperactivity disorder (ADHD), inattentive (I), hyperactive-impulsive (H), and combined (C), in a heterogeneous sample of 248 boys (ages 6 to 10 years) with emotional and behavioral problems who were recruited for participation in a diagnostic study. Method: The boys and their mothers participated in an extensive evaluation that involved multiple assessments of cognitive, behavioral, academic, and family functioning. ADHD subtypes were defined on the basis of teacher alone, mother alone, and mother/teacher ratings of DSM-IV symptoms using the Child Symptom Inventory-4. Results: ADHD symptom groups showed a differential pattern of impairment socially (H,C>I) and cognitively (I,C>H). The C and H groups were the most and least impaired overall, respectively, and all subtypes were differentiated from the nonADHD clinical control or NONE (N) group in a manner consistent with the primary findings. External validation of group differences was limited, and there were marked inconsistencies in the pattern of findings depending on how groups were defined. For the most part, although the mother/teacher grouping strategy (compared with either alone) captured a greater diversity of differences between subtypes, it also obscured some. Conclusion: Observed findings are consistent with the notion that mothers and teachers interpret symptom statements in terms of behaviors that are most relevant for their daily concerns.

04-7. Gadow, K.D., DeVincent, C.J., Pomeroy, J. & Azizian, A.(2004). Psychiatric symptoms in preschool children with PDD and clinic and comparison samples.Journal of Autism and Developmental Disorders, 34, 379-393.

Objective: This study describes and compares the severity of DSM-IV symptoms in preschool children with diagnosed pervasive developmental disorder (PDD), clinic controls, and two community-based samples. Method: Parents (/and teachers) completed the Early Childhood Inventory-4 (ECI-4), a DSM-IV-referenced rating scale for four samples: PDD (N=172/160) and nonPDD psychiatric clinic referrals (N=135/101) and youngsters in regular (N=507/407) and special (N=64/140) early childhood programs. Children ranged in age from 3 to 5 years old. Results: With the exception of conduct problems, the PDD group generally received higher symptom severity ratings than the regular early childhood group, but the pattern of differences compared with the other two groups often varied by type of symptom and informant. Teachers rated the PDD and nonPDD clinic groups as having equally severe ADHD and oppositional defiant disorder symptoms. Teachers rated the PDD group as having more severe anxiety and depression symptoms than parents. The Asperger group was rated by both informants as more oppositional than the autism and PDDNOS subgroups. Teachers rated males in the regular early childhood sample as having more severe ADHD and aggressive symptoms than females, but this was not the case for the PDD sample. Conclusion: Preschoolers with PDD exhibit more severe DSM-IV psychiatric symptoms than children in regular and special early childhood programs, and to some extent nonPDD psychiatric referrals. The concept of comorbidity warrants further exploration, as does informant-specific syndromes as validators of diagnostic constructs.

04-8. Gadow, K.D., Sprafkin, J., & Weiss, M.D. (2004). Adult Self-Report Inventory-4 Manual. Stony Brook, NY:       Checkmate Plus.

This 165-page Manual is divided into seven chapters: Introduction (Ch. 1), Diagnostic Criteria for Disorders (Ch. 2), Reliability and Validity of Self Report Checklist (Ch. 3), Symptom Prevalence Rates and Norms (Ch. 4), Adult Inventory-4 (Ch. 5), and Clinical Applications (Ch. 6).  Chapter 1 presents a brief overview of the rationale for the Adult Self-Report Inventory-4 and the Adult Inventory-4, history of the SYMPTOM INVENTORIES, and scoring procedures.  Chapter 2 provides a brief description of each disorder included in the ASRI-4/AI-4, DSM-IV diagnostic criteria and symptoms, and ASRI-4 items.  Chapter 3 describes (a) the findings from 6 studies of internal consistency reliabilities (Cronbach's alpha),  (b) test-retest reliability (N=291), (c) correlation with age, education, IQ, and SES, (d) intercorrelations among categorical scores in normative (N=900) and outpatient clinic (N=487) samples, (e) agreement between ASRI-4 and AI-4 scores in a sample (N=75) of adults with ADHD, (f) convergent and discriminant validity with Symptom Checklist-90-R, Brief Symptom Inventory, Conners’ Adult Self Rating Scales, Wender Utah Rating Scale, ADHD Behavior Checklist for Adults, Hamilton Scale for Anxiety, PTSD Checklist, Social Phobia Inventory, Eating Attitudes Test, Beck Depression Inventory, Hamilton Scale for Depression, Mood Disorder Questionnaire, and Seven Symptom Screening Test for Somatization Disorder, and (g) comparison of Symptom Severity T scores with clinician diagnoses. Chapter 6 present the findings of studies of (a) symptom prevalence rates in normative and outpatient clinic samples, gender differences, comparisons with epidemiological studies, and comparisons of normative and clinic samples and (b) symptom severity scores in normative and outpatient clinic samples, gender differences, and comparisons of normative and clinic samples. Chapter 5 describes initial findings for the internal consistency and convergent and discriminant validity of the Adult Inventory-4 completed by a significant other. The last chapter reviews all the material in the Manual and provides guidelines for clinical applications of the ASRI-4/AI-4.  Appendices list frequency of occurrence rates for each item in the ASRI-4 for males and females (separately) for normative and clinic samples (separately); and T scores and percentiles for males and females (separately) in normative sample. Subject Index included.

04-9. Gadow, K.D., Sprafkin, J., Salisbury, H., Schneider, J., & Loney, J. (2004). Further Validity Evidence for the Teacher Version of the Child Symptom Inventory-4. School Psychology Quarterly, 19, 50-71.

Objective: Examined the reliability and validity of the teacher version of the Child Symptom Inventory-4 (CSI-4). Method: Teachers rated 248 boys referred for evaluation of behavioral and emotional problems using the CSI-4, a behavior rating scale whose items correspond to the symptoms of DSM-IV-defined disorders. Results: Findings indicated satisfactory internal consistency reliabilities for most symptom categories: ADHD:I (.93), ADHD:HI (.93), ADHD:C (.93), ODD (.92), Conduct Disorder (.78), Generalized Anxiety Disorder (.76), Social Phobia (.72), Major Depressive Disorder (.73), Dysthymic Disorder (.74), Schizophrenia (.58), Autistic Disorder (.85), and Asperger's Disorder (.82). CSI-4 scores converged and diverged in a theoretically consistent manner with respective scales of the Teacher's Report Form (Achenbach, 1991), the IOWA Conners Teacher's Rating Scale (Loney & Milich, 1982), and the Diagnostic Interview for Children and Adolescents-Revised-Parent Version (DICA-P; Reich, Shayka, & Taibleson, 1991). Age was minimally correlated (r<.16) with CSI-4 symptom severity ratings. Similarly, neither WISC-III Verbal, Performance, or Full Scale IQ (r<.17); WRAT-R Reading, Spelling, or Arithmetic (r<.20); IQ/achievement discrepancy (r<.13); nor SES (r< .28) were associated with any CSI-4 scores. Correlations between teacher and parent CSI-4 ratings were low to moderate, whereas all correlations between teacher ratings and child self report were very low (rs<.16). Children who met DICA-P diagnostic criteria for attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder received significantly higher corresponding CSI-4 teacher symptom ratings than children not so diagnosed. Comparisons of boys with and without IOWA research diagnoses indicated that children with ADHD or ODD received significantly higher scores for corresponding CSI-4 symptom scores than children not so diagnosed. Conclusion: Collectively, findings support the clinical utility of the CSI-4 in clinically-referred boys.

 04-10. Keenan, K., Hipwell, A., Duax, J., Stouthamer-Loeber, M., & Loeber, R. (2004). Phenomenology of depression          in young girls. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1098-1106.

Objective: To examine the prevalence of depressive symptoms, the overlap between caregiver and child report, the association between depression and anxiety, and the relationship between symptoms of depression and impairment in young girls. Method: Participants in the Pittsburgh Girls Study, a community sample of 2,451 girls aged 5-8 years old and their primary caregivers were interviewed in 2000-2001 using the Child Symptom Inventory-4 and the Short Moods and Feelings Questionnaire to measure depression, the Screen for Child Anxiety and Related Emotional Disorders to measure anxiety, and the Children’s Global Assessment Scale to measure impairment. Results: Less than 1% of 5-to-year-old girls had five or more symptoms of major depression according to caregiver report. Individual differences in symptom counts and depression scores by caregiver and child report were observed. Agreement between caregivers and girls on depression symptoms was low, with only 2% of the variance in caregiver-reported depression on the Child Symptom Inventory-4 being accounted for by child report on the Short Moods and Feelings Questionnaire. The level of association between depression and anxiety scores suggested that these constructs are associated but relatively independent in young girls. Both caregiver report and child report of depressive symptoms were uniquely associated with impairment ratings. Conclusions: Although major depression appears to be rare among 5- to-8-year girls, continuous measures of depressive symptoms yield significant individual differences that are associated with impairment. Thus, preliminary evidence suggests that depressive symptoms can be validly measured in 5- to-8-year-old girls.

04-11. Kimonis, E.R., Frick, P.J., & Barry, C.T. (2004). Callous-unemotional traits and delinquent peer affiliation.       Journal of Consulting and Clinical Psychology, 72, 956-966.

Objective: Association with a deviant peer group is a robust correlate of juvenile social behavior. The current study focused on whether this association differed for antisocial youth with and without callous-unemotional (CU) traits and whether potential mediators of this association differed for the 2 groups. Method: Deviant peer group association was examined in a community sample (N=98) of high risk youth. The sample was assessed at 4 yearly intervals. Results: Across all assessment points, children with conduct problems [determined on the basis of parent and teacher ratings of ODD and CD symptoms from the Child Symptom Inventory-4] and CU traits [determined on the basis of parent and teacher ratings of the CU subscale of the Antisocial Process Screening Device] showed the highest level of affiliation with deviant peers. [Parent and teacher ratings were combined using the “or” rule.] At the first 2 assessment points, this effect was largely mediated by dysfunctional parenting and problems in the child’s social relationships. In contrast, the mediational role of these variables was much weaker at the last 2 assessment points.

04-12. Klassen, A.F., Miller, A., & Fine, S. (2004). Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics, 114, 541-547.

Objective: The aim of our study was to measure health-related quality-of-life (HRQL) in a clinic-based sample of children who has a diagnosis of ADHD and consider the impact of 2 clinical factors, symptom severity and comorbidity, on HRQL. Method: The sample included 165 respondents of 259 eligible children, of whom 131 were diagnosed ADHD (of these, 69% had comorbid psychiatric disorder). Measures were the parent version of the Child Health Questionnaire and the parent and teacher versions of the Child and Adolescent Symptom Inventory-4 (CASI-4) Results: Compared with normative samples, the ADHD group had similar physical health, but had clinically important deficits in all HRQL psychosocial domains. In most cases, Children with ≥2 comorbid disorders differed significantly from children with no comorbidity. Interclass correlation coefficients computed for parent- and teacher-reported CASI-4 scores were moderate to low for ADHD Inattentive (.34), ADHD Hyperactive-Impulsive (.39), and ADHD Combined (.30). Parents rated ADHD symptoms significantly higher than teachers for ADHD Inattentive and ADHD Combined symptoms. Conclusion: Our study shows that ADHD has a significant impact on multiple domains of HRQL in children and adolescents. Compared with normative data, children with ADHD had more parent-reported problems in terms of emotional-behavioral role function, behavior, mental health, and self-esteem. In addition, the problems of children with ADHD has a significant impact on the parents’ emotional health and parents’ time to meet their own needs, and they interfered with family activities and family cohesion.

04-13. Lopez-Villalobos, J.A., Pintado, I.S., & Sanchez-Mateos, J.D. (2004). Attention-deficit hyperactivity disorder: Comorbidity with depressive and anxiety disorders. Psicothema, 16, 402-407.

The study analyzes the profile of comorbidity of attention-deficit/hyperactivity disorder (ADHD) and depressive/anxiety disorders (ID), exploring the pattern that could predict this psychopathological association. A sample of 90 cases of ADHD was analyzed (6-16 years). ADHD was defined according to DSM-IV criteria, whereas comorbidity was defined by the Spanish translation of the Child Symptom Inventory-4. The following variables were considered: IQ, academic performance, relational dimension, and previous psychiatric history. There were no significant between group differences.

04-15. Mattison, R.E. (2004). Universal measures of school functioning in middle school special education students. Behavioral Disorders, 29, 359-371.

Universal measures of school functioning/impairment (i.e., grade point average, subject failures, absenteeism, disciplinary referrals/suspensions) were examined over the course of 1 school year for a cohort of 89 special education students classified as having emotional disturbance (ED) who were taught in a unique public school program. On average during the year the students achieved at a high "C" level, failed major subjects infrequently, missed 11 days of school, and rarely were tardy. They averaged one disciplinary referral per marking period, but the majority were never suspended out of school. The measures generally were consistent across marking periods, independent of each other, and significantly correlated to DSM-IV psychiatric disorders as rated by their teachers using the Child Symptom Inventory-4 (CSI-4). [CSI-4 scores were minimally correlated with IQ, gender, SES, or achievement ratios. However, GPA was moderately correlated (r=-.46) with ADHD:I but not ADHD:HI, ODD (r=-.50), MDD (r=-.41) and Dysthymia (r=-.43). School absences were most highly correlated with anxiety and depression symptoms, and disciplinary referrals and suspensions were most highly correlated with ODD and CD symptom severity.] Teachers contributed little variance to the measures. The findings support the increased use of these universal indicators of school function in students with ED as a research tool and a meaningful way of communication with educators about such students.

04-16. Weiss, M.D., & Weiss, J.R. (2004). A guide to the treatment of adults with ADHD. Journal of Clinical Psychiatry,        65 (Suppl. 3), 27-37.

While child and adolescent physicians are familiar with the treatment of attention-deficit/hyperactivity disorder (ADHD), many adult physicians have had little experience with the disorder. It is difficult to develop clinical skills in the management of residual adult manifestations of developmental disorders without clinical experience with their presentation in childhood. Adult patients are increasingly seeking treatment for the symptoms of ADHD, and physicians need practice guidelines. Adult ADHD often presents differentially from childhood ADHD. Because adult ADHD can be comorbid with other disorders and has symptoms similar to those of other disorders, it is important to understand differential diagnosis. “The Adult Self Report-4 (ASRI-4) provides a screening checklist for DSM-IV symptoms of developmental disorders and personality disorder, as well as the major disorders of adulthood. This inventory can be easily reviewed by the clinician, and even without formal scoring can clue clinicians into groupings of symptoms that signify patterns of comorbidity that might otherwise be missed” (p. 29). Physicians should work with patients to provide feedback about their symptoms, to educate them about ADHD, and to set treatment goals. Treatment for ADHD in adults should include a medication trial, restructuring of the patient’s environment to make it more compatible with the symptoms of ADHD, and ongoing supportive management to address any residual impairment and to facilitate functional and developmental improvements.

YEAR: 2003

03-1. Angello, L.M., Volpe, R.J., DiPerna, J.C., Gureasko-Moore, S.P., Gureasko-Moore, D.P., Nebrig, M.R., & Ota, K. (2003). Assessment of attention-deficit/hyperactivity disorder: An evaluation of six published rating scales. School Psychology Review, 32, 241-262.

The current article reports a critical analysis of six published behavior rating scales commonly utilized in a best practices approach to a school-based comprehensive assessment of ADHD (DuPaul & Stoner, 1994). These scales are the ADHD Rating Scale-IV (DuPaul et al., 1998), BASC Monitor (Kamphaus & Reynolds, 1998), Conners's Rating Scales Revised (Conners, 1997), ADHD Symptom Checklist -4 (ADHD-SC4; Gadow & Sprafkin, 1997), ADDES-2nd edition (McCarney, 1995), and ACTeRS (Ullmann et al., 1997). Each of the rating scales was evaluated for strengths and limitations with regard to purpose, content, standardization, and psychometric properties. Recommendations are delineated regarding the use of each rating scale with specific target populations (i.e., culturally diverse students) as well as specific stages of assessment within a problem-solving process. With regard to the ADHD-SC4, the authors state that "there is strong evidence to support the use of the ADHD-SC4 in the screening process" (p. 258), and "with the exception of the ADHD-SC4, all of the rating scales in this review had limited evidence regarding sensitivity to changes in behavior (e.g., resulting from treatment). In addition to providing such evidence, the ADHD-SC4 includes a side effects scale that makes it the best choice for monitoring the impact of pharmacological interventions" (p. 258).

03-2. Baldwin, R.L., Chelonis, J.J., Flake, R.A., Edwards, M.C., Field, C.R., Meaux, J.B., & Paule, M.G. (2004). Effect         of methylphenidate on time perception in children with attention-deficit/hyperactivity disorder. Experimental and             Clinical Psychopharmacology, 12, 57-64.

Objective: The effects of methylphenidate (MPH) on performance of a time-production task were studied in 17 children with attention-deficit/hyperactivity disorder who participated in 1 test session on and off MPH. Method: Screening Cutoff scores on the Child Symptom Inventory-4 were an exclusion criterion for schizophrenia, major depressive disorder, and pervasive developmental disorder. Participants held a response lever down for at least 10 but no longer than 14 seconds. Results: Administration of MPH had no effect on the number of responses or the mean duration of lever holds. MPH administration significantly decreased timing response variability, increased holds of 10- to 11-seconds duration, and decreased lever holds of extremely short durations. Conclusion: These results indicate that administration of MPH resulted in more precise timing performance without changing the means duration of lever holds, suggesting an enhancement in working memory.

03-3. Barry, C.T., Frick, P.J., & Killian, A.L. (2003). The relation of narcissism and self-esteem to conduct problems in children: A preliminary investigation. Journal of Clinical Child and Adolescent Psychology, 32, 139-152.

Objective: Investigated several possible models to explain the seemingly discrepant relations between self-esteem and conduct problems, as both low self-esteem and exaggerated levels of self-esteem, thought to be captured by narcissism, have been associated with aggressive and antisocial behavior. Method: Sample consisted of 98 nonreferred children recruited from public schools who initially scored above the third quartile for the Oppositional Defiant Disorder or Conduct Disorder categories of the parent and teacher Child Symptom Inventory-4. Results: Certain aspects of narcissism were particularly predictive of maladaptive characteristics and outcomes. In addition, the relation between narcissism and conduct problems was moderated by level of self-esteem, such that children with relatively high levels of narcissism and low self-esteem showed the highest rates of conduct-problem symptoms.

03-4. Carlson, G.A., & Mick, E. (2003). Drug-induced disinhibition in psychiatrically hospitalized children. Journal of Child and Adolescent Psychopharmacology, 13, 2003.

Objective: To examine rates and predictors of drug-induced behavioral disinhibition (DIBD) in psychiatrically hospitalized children. Methods: DIBD was examined in 267 children psychiatrically hospitalized for at least 4 weeks. Age, gender, diagnosis, and medication were covariates. DIBD was defined as dramatic increase in aggression identified by increased time outs while on medication. Results: Twenty (7.5%) children met our criteria. The DIBD group was twice as likely to exhibit selected bipolar symptom as rated with the Child Symptom Inventory than the control group. Attention deficit hyperactivity disorder, pervasive developmental disorder, and selective serotonin reuptake inhibitor use appeared to increase the risk, and older age and stimulant use decreased the risk of DIBD. However, it was often difficult to distinguish true DIBD from the behavioral fluctuations of these disturbed children. Fifteen percent of children subsequently improved on the same regimen, 40% improved when the offending drug was stopped and another treatment was started, and the remainder had adverse response to many medications.

03-5. Carlson, G.A., & Youngstrom, E.A. (2003). Clinical implications of pervasive manic symptoms in children. Biological Psychiatry, 53, 1015-1058.

Objective: Examined cross-informant agreement among parents, teachers, and clinicians for manic symptoms. Method: We identified three groups from a large cohort of youths, aged 8-12 years, treated on an inpatient unit. All 108 participants met criteria for an externalizing disorder, based on a semi-structured diagnostic interview. Of these, 49 did not have manic symptoms endorsed by either the parent or teacher based on a modified version of the Child Symptom Inventory-4; 34 has manic symptoms reported by the parent only, and 25 had pervasive manic symptoms (i.e., corroborated by both sources). Results: The "corroborated mania" group consistently showed the most disruptive behavior on the inpatient unit, the worst behavior problems on multiple scales, and the longest admission durations. The "parent-only" group scored in the midrange on all of these measures, with group differences typically representing small to medium effect sizes. The "externalizing only" group consistently scored the lowest on all dependent measures, with the differences representing large to extremely large effects when compared with the corroborated mania group and medium effects compared with the parent-only group. Conclusions: Youths for whom multiple informants report manic symptoms appear likely to have more severe symptom presentation and more complicated, refractory courses than do youths without manic symptoms.

03-6. Colvin, A.N., Yeates, K.O., Enrile, B.G., & Coury, D. (2003). Motor adaptation in children with myelomeningocele: Comparison to children with ADHD and Healthy siblings. Journal of the International Neurological Society, 9, 642-652.

Children in the ADHD group were required to have Screening Cutoff scores for the ADHD symptom category of the parent-completed Child Symptom Inventory-4 for inclusion in the study.

03-7. Dunn, D.W. (2003). Neuropsychiatric aspects of epilepsy in children. Epilepsy & Behavior, 4, 101-106.

Children with epilepsy are at increased risk of behavioral and emotional problems compared with both children from the general population and children with other chronic illnesses not involving the central nervous system. The Child Behavior Checklist and the Child and Adolescent Symptom Inventories are general behavioral screening questionnaires that have been used to assess children with chronic health problems. Risk factors are multiple and include additional neurological impairment, intractable seizures, and family dysfunction. The case of Peter is used to illustrate the neuropsychiatric aspects of epilepsy and to discuss possible interventions for the child with epilepsy and psychiatric problems.

03-8. Dunn, D.W., Austin, J.K., Harezlak, J., & Ambrosius, W.T. (2003). ADHD and epilepsy in childhood. Developmental Medicine and Child Neurology, 45, 50-54.

Objective: Attention-deficit/hyperactivity disorder (ADHD) has been associated with childhood epilepsy; prevalence figures have ranged from 8 to 77%, depending on the sample studied and the criteria used for diagnosis. In the general population the prevalence of ADHD is approximately 5%, with the majority of affected children having ADHD combined type. Method: As part of a larger study of behavioral problems in children with epilepsy, we assessed 175 children (90 males, 85 females; age range 9 to 14 years, mean age was 11 years 10 months, SD 1 year 8 months) for evidence of ADHD. The children had at least a 6-month history of epilepsy. The primary caregiver completed both the Child Behavior Checklist (CBCL) and the Child Symptom Inventory-4 (CSI-4) or Adolescent Symptom Inventory-4 (ASI-4). Results: On the CBCL, the mean Attention Problem T score was 64.6 (SD 10.5) for adolescents and 67.9 (SD 11.6) for children. On the CSI-4 or ASI-4, 11.4% met DSM-IV criteria for ADHD combined type; 24% had ADHD predominantly inattentive type; and 2.3% met criteria for ADHD predominantly hyperactive-impulsive type. There were significant correlations between CBCL Attention Problems scores and CSI-4/ASI-4 ADHD Inattention scores (r=0.68) and CSI-4/ASI-4 ADHD Hyperactive-Impulsive scores (r=0.59). Sex, seizure type, and focus of seizure discharge were not predictors of symptoms of ADHD. Conclusion: Children with epilepsy are at risk for symptoms of ADHD. They differ from other samples of children with ADHD by the higher proportion of children with ADHD predominantly inattentive type and by an equal male:female ratio.

03-9. Frick, P.J., Cornell, A.H., Barry, C.T., Bodin, S.D., & Dane, H.E. (2003). Callous-unemotional traits and conduct problems in the prediction of conduct problem severity, aggression, and self-report of delinquency. Journal of Abnormal Child Psychology, 31, 457-470.

The role of callous-unemotional (CU) traits and conduct problems in predicting conduct problem severity, severity and type of aggression, and self-reported delinquency at a 1-year follow-up was investigated in a sample of 98 children (mean age 12.43; SD=1.72) recruited from a community-wide screening. The Oppositional Defiant Disorder and Conduct Disorder categories of the Child Symptom Inventory-4 were used to form groups. Children with both CU traits and conduct problems had a greater number and variety of conduct problems at follow-up than children who at the screening had high levels of conduct problems alone. However, this poorer outcome for children with CU traits could largely be accounted for by differences in initial level of conduct problem severity. Children with CU traits and conduct problems were also at risk for showing higher levels of aggression, especially proactive aggression, and self-reported delinquency. Importantly, these outcomes could not be solely explained by initial level of conduct problem severity. Finally, CU traits predicted self-reported delinquency in some children who did not initially show high levels of conduct problems and this predictive relationship seemed to be strongest for girls in the sample who were high on CU traits but who did not show significant conduct problems.

03-10. Hill, D.E., Yeo, R.A., Campbell, R.A., Hart, B., Vigil, J., & Brooks, W. (2003). Magnetic resonance imaging correlates of attention-deficit/hyperactivity disorder in children. Neuropsychology, 17, 496-506.

Objective: This study compared magnetic resonance imaging size differences in several brain regions and neurocognitive function in a group of male and female children with attention-deficit/hyperactivity disorder (ADHD) with no comorbid learning disorders with a normal control group of children. The Child Symptom Inventory -4 was one of several measures used to verify the presence of ADHD symptoms in the experimental group as well as to screen for comorbid psychiatric disorders and rule out the presence of significant behavioral symptoms in the control group. Results: The ADHD group demonstrated smaller total brain, superior prefrontal, and right superior prefrontal volumes, as well as significantly smaller areas for cerebellar lobules I-V and VIII-X, total corpus callosum area, and splenium. No group differences were observed for the inferior prefrontal, caudate, or cerebellar volumes, or for the area of cerebellar lobules VI-VII. In the ADHD group but not in the control group, greater right superior prefrontal volume predicted poorer performance on a test of sustained attention. Patterns of brain abnormality did not differ in male and female children with ADHD.

03-11. Loney, B.R., Frick, P.J., Clements, C.B., Ellis, M.L., & Kerlin, K. (2003). Callous-unemotional traits, impulsivity, and emotional processing in adolescents with antisocial behavior problems. Journal of Clinical Child and Adolescent Psychology, 32, 66-80.

Objective: Examined the emotional reactivity of adolescents with antisocial behavior problems using a lexical decision paradigm. Evidence from adult forensic samples indicates that psychopathic traits are associated with abnormalities in the processing of emotional stimuli. Method: In an attempt to extend these findings earlier in development, this association was tested in a sample of adolescents referred to a diversion program for delinquent behavior. Measures included the Antisocial Process Screening Device (ASPD) and the ADHD hyperactivity-impulsivity (HI) category of the Youth's Inventory-4 (YI-4; alpha=.72 in present study). Results: Emotional processing was assessed by comparing recognition time for emotional words, both positive an negative, to recognition time for nonemotional words. Consistent with adult findings, the callous-unemotional (CU) dimension of psychopathy was associated with slower reaction times to negative words. In contrast, problems of impulse control were associated faster recognition times for negative emotional words. YI-4 ADHD:HI scores were moderately correlated with the RCMAS (r=.55) and several APSD scores, including Impulsivity-Conduct Problems scale (r=.48).

03-12. Mattison, R.E., Gadow, K.D., Sprafkin, J., Nolan, E.E., & Schneider, J. (2003). A DSM-IV-referenced teacher rating scale for use in clinical management. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 442-449.

Objective: Two studies were conducted to examine the psychometric properties of a DSM-IV-referenced teacher-completed rating scale in children receiving special education. Method: To assess reliability, teachers rated 74 students on two separate accessions (test-retest) using the teacher version of the Child Symptom Inventory-4 (CSI-4T), and teacher aides also rated the children in the first occasion (interrater). In a second study, teacher CSI-4T and Teacher's Report Form (TRF) ratings and consultant diagnoses were obtained for 101 students. Results: Perhaps the most compelling finding of this study is the similarity of the results for the psychometric properties of the CSI-4T symptom categories with scales derived through multivariate statistical procedures. Internal consistency reliabilities (0.72-0.94), 2-week test-retest reliabilities (r=0.61-0.88), and interrater agreement (r=0.19-0.56) for the CSI-4T major symptom categories were comparable with dimensional rating scales. CSI-4T ratings showed a consistent pattern of convergent and divergent validity with TRF scores and with consultant diagnoses. It is noteworthy the presence-absence of consultant diagnoses of ADHD, oppositional defiant disorder, conduct disorder, and depressive disorders were distinguished significantly only by the same-named CSI-4T symptom categories. Conclusion: Findings provide preliminary support for the reliability and validity of the CSI-4T as a measure of DSM-IV symptoms in children receiving special education.

03-13. Miller, V.A., & Drotar, D. (2003). Discrepancies between mother and adolescent perceptions of diabetes-related decision-making autonomy and their relationship to diabetes-related conflict and adherence to treatment. Journal of Pediatric Psychology, 28, 265-274.

Objective: To document the relationship between discrepancies in mother and adolescent perceptions of diabetes-related decision-making autonomy, diabetes-related conflict, and regimen adherence. Methods: The sample was composed of 82 mother–adolescent dyads. Measures included adolescent and mother reports of diabetes-related decision-making autonomy, diabetes-related conflict, and regimen adherence. Nurses’ reports of adherence and number of glucose tests performed each day were also obtained. Results: The Oppositional Defiant Disorder symptom category of the Adolescent Symptom Inventory-4 was used to control for oppositional symptoms in the analysis of the relationships between discrepancies in perceptions of decision-making autonomy, diabetes-related conflict, and adherence to treatment. Discrepancies between, mother and adolescent perceptions of decision-making autonomy were related to greater maternal report of diabetes-related conflict. In particular, when adolescents reported that they were more in charge of decisions than reported by their mothers, mothers reported more conflict. Discrepancies between mother and adolescent perceptions of decision-making autonomy were not related to regimen adherence. Conclusions: The findings suggest that discrepancies between mother and adolescent perceptions of diabetes-related decision-making autonomy may be a potentially important area for intervention.

03-14. Shytle, R.D., Silver, A.A., Sheehan, K.H., Wilkinson, B.J., Newman, M., Sanberg, P.R., & Sheehan, D.         (2003). The Tourette’s Disorder Scale (TODS): Development, reliability, and validity. Assessment, 10, 273-287.

Authors use the Child Symptom Inventory-4 and the Adolescent Symptom Inventory-4 to examine the convergent and discriminant validity of the TODS.

03-15. Snarr, J.D., Strassberg, Z., & Slep, A.M.S. (2003). Making faces: Testing the relation between child behavior problems and mothers' interpretations of child emotion expressions. Journal of Abnormal Child Psychology, 31, 371-380.

Objective: We examined the relations between preschool boys' behavior problems and mothers' interpretations of children's emotion expressions. Method: A sample of 31 mothers of oppositional boys and 28 control mothers responded to standard stimuli depicting child emotional relations to maternal control attempts; mothers were instructed to think of the stimuli as either (a) their own child or (b) an unfamiliar child. Screening Cutoff scores for the ODD category of the Early Childhood Inventory-4 were used classify children as oppositional. Results: Mothers of oppositional boys were more likely to generate negative interpretations than were control mothers when thinking of their own children; however, this difference did not generalize to the explicitly unfamiliar child condition. Mothers of oppositional boys demonstrated negative and comparison mothers demonstrated positive interpretive tendencies toward their own children. Conclusion: Findings suggest that child emotion cues may trigger biased maternal cognitions even in the absence of the child misbehavior.

03-16. Weiss, M., & Murray, C. (2003). Assessment and management of attention-deficit hyperactivity disorder in adults. Canadian Medical Association Journal, 168, 715-722.

Attention-deficit hyperactivity disorder (ADHD) is estimated to affect 2%-6% of adults. The symptoms in adults with ADHD mirror those in children with the disorder and are associated with significant educational, occupational and interpersonal difficulties. Double-blind, placebo-controlled trials have established that adult ADHD is responsive to stimulant medication treatment. New medications and psychotherapeutic approaches are being developed in an effort to achieve optimal treatment effects in this population. We review the available literature and provide an approach to the assessment and management of ADHD in adults. [The authors' note that the Adult Self Report Inventory-4 (patient) and Adult Inventory-4 (collateral informant) are useful patient evaluation tools because they not only assess ADHD symptoms but also the symptoms of commonly co-occurring disorders.]

03-17. Yeo, R.A., Hill, D.E., Campbell, R.A., Vigil, J., Petropoulos, H., Hart, B., Zamora, L., & Brooks, W.M. (2003). Proton magnetic resonance spectroscopy investigation of the right frontal lobe in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 303-310.

The authors use the Child Symptom Inventory-4 to exclude children who had Screening Cutoff scores for nonADHD diagnoses other than oppositional defiant disorder from the ADHD group and excluded children with elevated scores on all symptom categories from the control group.

YEAR: 2002

02-1. Aman, M.G., Armstrong, S., Buican, B., & Sillick, T. (2002). Four-year follow-up of children with low intelligence and ADHD: A replication. Research in Developmental Disabilities, 23, 119-134.

Objective: Twenty children with attention-deficit/hyperactivity disorder (ADHD) and low IQs, who participated in a drug study, were followed-up 4.5 years later, when their ages averaged 12.4 years (range: 8-20 years; SD=2.78). Method: Participants were assessed by their parents and teachers on the Aberrant Behavior Checklist-Community (ABC; Aman & Singh, 1994), on the Child Symptom Inventory-4 (CSI-4; Gadow & Sprafkin, 1994), and on a structured interview. Outcome variables included summed weighted scores for the combined CSI-4 ODD and CD categories and for all CSI-4 categories related to anxiety. Results: Based on CSI-4 findings, a majority of children continued to screen positive for ADHD at follow-up, as well as display high rates of comorbid anxiety disorders, tics, and elimination disorders. Educational placement became slightly more restrictive over the follow-up interval. Multiple medication trials (30 in all, among 14 participants) were attempted between initial contact and follow-up. Ratings on the ABC by parents and teachers showed significantly lower scores at follow-up on the ABC Hyperactivity subscale. Relatively few associations were found between initial ratings and follow-wp ratings on standardized scales. In general, teacher ABC ratings were more predictive of CSI-4 outcome variables than parent ABC ratings. Most teacher-completed ABC factor scores at intake were at least moderately (r>.40) associated with CSI-4 ODD/CD scores at followup.

02-2. Aman, M.G., Smedt, G.D., Derivan, A., Lyons, B., Findling, R.L., & Risperidone Disruptive B