Naturalistic-observational studies in the framework of ADHD health care.
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Adolescent↗
Biomedical subjects
H C Steinhausen
Publications and source records attributed to H C Steinhausen.
[A global scale for assessment of the family environment].
OBJECTIVES: Reliability of the Global Family Environment Scale (GFES) which has been developed in Australia and translated into German. METHOD: Comparison of ratings and reliability of written case vignettes by international raters and clinicians of the own institution. Assessment of interrater-reliability of clinical cases before and after group trainings with introduction of the manual and discussion of written case vignettes. RESULTS: The ratings of seven training case vignettes were rather similar by clinicians from Zurich and in an international study by the Australian authors. In the same way interrater agreements were similar in the two studies and satisfying. In the present study a single training session in comparison to reading the manual did not result in higher interrater agreement. CONCLUSIONS: The existing psychometric properties and the availability of a translation represent important prerequisites for the applicability of the GFES in the German-speaking countries.
Adolescent↗
Behavioral evaluation of GH treatment in short statured children and adolescents: findings from a pilot study.
A cohort of 93 short-statured children and adolescents undergoing GH treatment were evaluated with respect to behavior, emotions, and attitudes. The sample consisted of patients suffering from either idiopathic GH deficiency or neurosecretory dysfunction (no.=47), Turner syndrome (no.=20), organic GH deficiency due to brain tumors (no.=10), or other etiologies (no.=16). The Child Behavior Checklist (CBCL) together with a brief Evaluation of Treatment Questionnaire (ETQ) were filled out by the patient's parents. These evaluations were performed at onset and after 12 and 24 months of GH treatment, respectively. There was a highly significant but clinically small decline of behavioral abnormalities over time and parents saw major benefits of GH treatment in the total group of patients. The behavioral changes over time were independent of diagnostic category, gender, height velocity, puberty and age.
Adolescent↗
[The hyperactive child: diagnosis and therapy].
After briefly defining the hyperkinetic disorder of childhood the typical process of clinical assessment is described. The latter includes the psychiatric interview with parents, child and teachers, the history of the child, the use of questionnaires and rating scales, neuropsychological testing and the physical examination of the child. Careful consideration of differential diagnoses is mandatory in order to avoid false negative and false positive diagnoses. The etiology is dominated by neurobiological concepts with a special emphasis on genetic causes. Treatment is multimodal giving special weight to pharmacotherapy with stimulants.
Attention Deficit Disorder with Hyperactivity↗
Global measures of impairment in children and adolescents: results from a Swiss community survey.
OBJECTIVE: Based on data from a Swiss epidemiological survey, both the parent and the child versions of two global measures of impairment, the Columbia Impairment Scale (CIS) and the Children's Global Assessment Scale (CGAS) were analysed with regard to validity and the effects of gender. METHOD: Concurrent and discriminant validity were evaluated by examining the associations with other indicators of impairment. Gender effects on impairment were considered in each type of analysis. RESULTS: Based on the total sample and on the girls' data, concurrent validity of the various impairment scores as computed by correlations with other indicators of psychological dysfunction was good. When based on the boys' data it was less convincing. Discriminant validity was estimated by comparing impairment scores between those using and not using services and was proven for all impairment scores. There were significant gender effects for almost all scores, indicating that girls in contrast to boys were more impaired and functioned less well when professional contacts and psychiatric diagnosis were considered. CONCLUSIONS: The two impairment measures are well suited to community studies. Gender and informant differences have to be considered when defining thresholds for caseness. The two scales could also be used clinically, for example for training and evaluation purposes and for the decision whether or not a child or adolescent requires treatment.
Adolescent↗
Attentional and neuromotor deficits in ADHD.
In order to classify attention-deficit-hyperactivity disorder (ADHD) in 11-year-old children, the role of specific attentional and motor deficits was examined. Participants comprised 22 children with ADHD (19 male, 3 female; median age 11 years, range 8.8 to 13.5 years) and 20 control children (17 male, 3 female; median age 10.6 years, range 8.2 to 12.6 years). Neuromotor assessment indicated that while both groups needed more time to complete finger compared to hand movements, this increase was more pronounced in children with ADHD. Reaction-time testing with continuous-force recording identified both motor and attentional deficits in children with ADHD. Longer intervals between force onset and force peak, and higher rate of responses with multiple force peaks (particularly in the bilateral condition) revealed specific deficits in the speed and quality of their motor output. Increase in errors and variability of force onsets indicated attentional deficits. Prediction analysis indicated that force-onset variability contributed significantly to group classification which was 85.7% correct. Neither neuromotor assessment nor specific motor deficits contributed significantly to classification, indicating that pure motor-speed measures play a minor role in characterizing ADHD in this age range.
Adolescent↗
Brain mapping of bilateral visual interactions in children.
Interhemispheric interactions were studied with functional brain mapping of visual processing. Children performed a reaction time task with uni- and bilateral targets and nontargets. The visual evoked potential (VEP) was segmented into P1a, P1b, and N1 microstates using map rather than channel features. Map latencies, amplitudes and sources were tested for bilateral interactions. Bilateral targets yielded shorter VEP map latencies but later response onsets than unilateral ones. Source analyses of the unilateral VEPs indicated a transition from contra- (P1a) to ipsilateral (P1b) visual cortex activation (interhemispheric transfer). Bilateral VEPs were smaller than the summed unilateral VEPs in all microstates. indicating that interhemispheric interactions both precede and follow interhemispheric transfer. Brain mapping of uni- and bilateral VEPs in children thus revealed several distinct forms of interhemispheric interactions in the same, early time range.
Brain Mapping↗
Evaluation of treatment and intermediate and long-term outcome of adolescent eating disorders.
BACKGROUND: A cohort of 60 adolescent eating-disordered patients that was consecutively admitted between 1979 and 1988 to a child and adolescent psychiatric university department in Berlin, Germany was followed up at a mean of 5-0 years and for a second time at a mean of 11.5 years. METHODS: Each patient was personally interviewed and findings dealing with eating disorder symptoms and psychosocial functioning were rated on four-point scales. In addition, the duration of both in-patient and out-patient treatment and the Body Mass Index (BMI) were recorded. RESULTS: Patients were in treatment for a mean of 33 % of the initial 5-year follow-up period, but this has dropped to a mean of 17% of the entire 11-year follow-up period. No predictors of treatment duration were found. The mortality rate was 8.3% at the second follow-up. The distribution of abnormal BMIs ( < 17.5) reflected a trend of improvement with increasing duration of follow-up. In comparison to the 5-year follow-up, fewer patients suffered from symptoms of the full clinical picture of an eating disorder at the 11-year follow-up. Among the surviving patients 80% recovered during the long-term course. There were few specific predictors of three different outcome criteria. CONCLUSION: This outcome study of adolescent eating disorders provides further evidence that the long-term course of the disorders in terms of the eating pathology is better than can be expected after a few years. Very little can be said with regard to individual prognosis.
Adolescent↗
A transcultural outcome study of adolescent eating disorders.
OBJECTIVE: The aim of the study was to assess the treatment and outcome of adolescent eating disorders in an international study including Western and Eastern European clinical and research centres. METHOD: A total of 138 patients with adolescent onset of an eating disorder (primarily anorexia nervosa) were followed-up after a mean interval of 5 years after first admission. RESULTS: On average, the patients had spent 25% of the total follow-up period in either in-patient or out-patient treatment. Half of them required a second hospitalization and a quarter required a third hospitalization for the eating disorder. At follow-up, 68% of the total sample did not have an eating disorder. The prediction of outcome revealed different patterns of risk variables depending on the type of criterion. CONCLUSION: The outcome of adolescent eating disorders is relatively similar across cultures, and better than in patients with later onset of the disorder.
Adolescent↗
The behavior profile of children and adolescents with short stature.
The relation between behavior profiles and short stature was assessed in 311 children and adolescents with various diagnoses. The mean Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) profile of the entire group of children with growth deficiency significantly exceeded population norms on all scales and scores. However, there were no significant differences between five major diagnostic groups across CBCL scales. Neither age, gender, socioeconomic status, nor severity of short stature had any effect on the various CBCL and YSR scores. Correlations between parent (CBCL) and child (YSR) scores were significant, though only at a low to medium level. It was concluded that probably short stature per se, rather than a specific diagnosis, has an impact on behavioral adaptation.
Adolescent↗
[Abbreviated Psychopathological Scale in basic documentation in child and adolescent psychiatry--results of a multicenter study].
The short form of the Clinical Assessment Scale of Child and Adolescent Psychopathology (CASCAP) assesses psychopathological features only on the level of symptom domains and not on the level of single symptoms. The instrument is part of the basic documentation of child and adolescent psychiatry. Based on the multicenter study sample of CASCAP the ratings of the symptom domains in the different centers were analysed. Inpatients receive higher ratings than outpatients on nearly all symptom domains. Only minor differences could be found between the centres. Advantages and disadvantages of this short version are discussed.
Adolescent↗
The continuous performance test revisited with neuroelectric mapping: impaired orienting in children with attention deficits.
A total of 11 children with attention deficit disorder (ADD) and nine control children performed a continuous performance test (CPT) of the A-X type with concurrent neuroelectric brain mapping to assess preparatory processing, purportedly mediated by the frontal lobes. This cued CPT task proved to be a highly specific task. The groups could be clearly differentiated both at the behavioral and electrophysiological level. ADD children detected fewer signals and made more false alarms. There were no major group differences in topographical distribution of the event-related potential microstates, but ADD children displayed reduced global field power (GFP) in an early CNV/P3 microstate to cues. This indicated that impaired orienting to cues, rather than impaired executive target processing, determines the initial processing stages in ADD. In comparison with data from the same task run in Utrecht, the same orienting deficit in clinically diagnosed ADHD children was demonstrated. Low resolution electromagnetic tomography (LORETA) estimated posterior sources underlying these orienting processes and the orienting deficit. This argued against frontal lobe involvement at this stage and suggested involvement of a posterior attention system.
Arousal↗
Neuroelectric mapping reveals precursor of stop failures in children with attention deficits.
Children with attention deficit disorders (ADD) may have specific problems with response inhibition in the STOP task. This task requires that subjects stop responses to a primary task if a second signal follows. However, it is unclear whether these problems reflect an impairment of the stopping process per se, whether they are related to reduced frontal lobe activation and whether they are confined to severe and pervasive forms of ADD. In 11 ADD and nine control children, 32 channel event-related EEG potentials (ERPs) were recorded in a STOP and a delayed GO task. Mapping revealed that both tasks evoked a similar sequence of neuroelectric microstates, i.e. of time segments with stable map topography. Adaptive segmentation identified the transition between these microstates. Reliable group differences were found in several microstates and in both tasks despite matched performance. In the GO task, ADD children had topographically altered P2/N2 microstates and attenuated P300-type microstates. In the STOP task, a topographically altered N1 microstate which coincided with the onset of the stop signal preceded the stop failures of ADD children. The timing of this microstate is too early to reflect deficits in actual stop signal processing and instead suggests altered initial orienting of attention to the primary signal in ADD children. Imaging with low resolution tomography (LORETA) during this microstate to stop failures indicated mainly posterior activation for both groups and increased rather than reduced frontal activation in ADD children. For a later microstate (P550), LORETA indicated strong frontal activation after successful stopping, but no group differences. The results suggest that information processing of ADD children deviates during activation of posterior mechanisms which may be related to the orienting of attention and which precedes and partly determines inhibitory control problems in ADD.
Arousal↗
The Zurich long-term outcome study of child and adolescent psychiatric disorders in males.
BACKGROUND: Within the framework of developmental psychopathology the outcome of male former child and adolescent psychiatric patients at age 36 or 38 was studied in order to add to the limited knowledge in this field. METHODS: A total of 269 former child psychiatric patients of male sex and a control group of more than 2700 men, who were all born in 1952, were compared with regard to mortality, delinquency and adult psychiatric disorders. The study was based on case-file data from assessments conducted with the child and adolescent psychiatric patients and on adults, derived from either federal registers (mortality, delinquency) or army health records and records of the psychiatric facilities of the canton. The study is based on lifetime prevalence rates. RESULTS: The two samples did not differ with regard to mortality rates. Delinquency tended to be more prevalent and psychiatric disorders were significantly more prevalent among the former child psychiatric patients. Close to 10% of the latter group showed major delinquency, one-quarter was psychiatrically disturbed and 30% displayed one of these two indicators or maladjustment at least once during the follow-up period. A correspondence in pattern of varying between child and adult psychiatric spectrum disorders was observed. Whereas the type of child and adolescent psychiatric disorders did not predict adult maladjustment, there was some indication that deprived environments, broken homes and parental psychiatric disorders during childhood increased the likelihood of poor adult outcome. CONCLUSIONS: This study clearly underlines the long-term negative effects of child and adolescent mental abnormalities in males.
Adolescent↗
Long-term outcome of children with fetal alcohol syndrome: psychopathology, behavior, and intelligence.
Within an interdisciplinary research project, the long-term outcome of children with fetal alcohol syndrome was studied. Methods for the assessment of psychopathology, behavior, and intelligence included psychiatric interviews, behavior checklists for parents and teachers, and intelligence tests. The children were assessed during preschool age, early school age (6 to 12 years), and late school age (> or =13 years). An excess of psychopathology, (including hyperkinetic disorders, emotional disorders, sleep disorders, and abnormal habits and stereotypes) with a strong persistence over time was found. Cognitive functioning was marked by a large proportion of mentally retarded children and also did not change considerably over time. This long-term outcome study reflects the handicapping effects of fetal alcohol syndrome.
Adolescent↗
Prevalence of child and adolescent psychiatric disorders: the Zürich Epidemiological Study.
Psychiatric disorders were studied in an epidemiological and representative sample of 1964 pupils attending the first to ninth grade in various types of schools in the Canton of Zürich, Switzerland. Using a two-stage procedure, parents were asked to respond to a standardized behaviour problem checklist in the screening phase. In the second stage, structured interviews were performed with 399 parents representing both screen positive and control children. DSM-III-R diagnoses were derived from the interviews. The total prevalence figure for any disorder amounted to 22.5%. Prevalence rates were influenced by the multi-screen procedure. Among various correlates, sex, nationality, age and residence were to some extent significant. Comorbid disorders were present in 12.5% of the subjects.
Adolescent↗
Frequency and correlates of substance use among preadolescents and adolescents in a Swiss epidemiological study.
Alcohol use and nicotine use were investigated in a representative sample of 1110 study participants aged 10 to 17 years. In addition to questions on substance use, the participants responded to questionnaires covering behavior and emotions, life events, self-related cognitions, coping capacities, perceived parental behavior, perceived school environment, and the social network. The gender gap in substance used tended to close with increasing age. Parental substance use served as a model for substance use in the participants. Substance users had more abnormal scores on almost all variables as compared to abstaining controls. Lack of acceptance and control, pressure to achieve at school, and life events significantly predicted substance use. The latter served as a moderating risk variable for delinquent behavior under stress.
Adolescent↗
[Child and adolescent psychiatric services in the canton of Zurich: a comparison of outpatients, day clinic, and inpatient referral populations].
Findings in intervention research are an important basis for the discussion of issues pertaining to quality control. In Switzerland such findings have been rare. The present study of the entire 1988-1995 referred child and adolescent population of the Child and Adolescent Psychiatric Service of the Canton of Zurich (N = 7538 treated patients) concentrated on the demographic, diagnostic, and therapeutic attributes of the outpatient, day clinic, and inpatient populations that comprised the referred population. Marked differences are found in comparable studies from Germany with regard to patients treated in an inpatient setting. For example, the mean age of the patients in the Zurich sample is lower and patients with conduct disorders are more frequently represented. On the other hand, patients with psychotic illness are missing and, on the average, the duration of treatment is considerably longer. The reasons for these differences are to be found in the various structural attributes of the cantonal services that are provided in Zurich. In the area of inpatient care, where in comparison to outpatient settings and also day care settings patients with severe disorders are treated, there is a lack of places for the short-term care of acutely ill patients--for example, psychotic patients. This is especially true for adolescent patients. The limitations of traditional outpatient settings are frequently marked by unsatisfactory treatment results in outpatients with conduct disorders, developmental disorders, and a high impact of abnormal psychosocial circumstances.
Adolescent↗