Resolved: mania is mistaken for ADHD in prepubertal children.
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Attention Deficit Disorder with Hyperactivity↗
Biomedical subjects
R G Klein
Publications and source records attributed to R G Klein.
Adult psychiatric status of hyperactive boys grown up.
OBJECTIVE: Numerous studies have examined the adolescent and young adult fate of children with attention deficit hyperactivity disorder (ADHD). In marked contrast, relatively little is known about the adult outcome of these children. There have been only two controlled, prospective studies of psychiatric status into adulthood. The present study was conducted to gain further understanding of the natural course of this common childhood condition. METHOD: This was a prospective follow-up of clinically diagnosed, white boys of average intelligence who were referred by teachers to a child psychiatric research clinic at an average age of 7.3 years. At a mean age of 24.1 years, 85 probands (82% of the childhood cohort) and 73 comparison subjects (94% of adolescent comparison subjects) were directly interviewed by trained clinicians who were blind to group status. RESULTS: Evaluations of the probands and comparison subjects indicated significantly higher prevalences of antisocial personality disorder (12% versus 3%) and nonalcohol substance abuse (12% versus 4%) in the probands, whereas mood disorders (4% versus 4%) and anxiety disorders (2% versus 7%) were not significantly different. At adult follow-up, ADHD was rare, occurring in only 4% of the probands (no comparison subjects). CONCLUSIONS: The results of the present study are consistent with the authors' previously reported major findings. They strongly suggest that children with ADHD are at significantly higher risk for a specific negative course marked by antisocial and substance-related disorders.
Adolescent↗
Attention deficit and bad behavior.
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Adolescent↗
Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder.
BACKGROUND: Stimulants are not considered appropriate for the treatment of children with conduct disorders (CDs). The postulated differences in stimulant effect between children with attention deficit hyperactivity disorder (ADHD) and CD led to the hypothesis that methylphenidate hydrochloride, which is effective in ADHD, would not significantly improve symptoms of CD. METHODS: We randomly assigned 84 children with CD, between the ages of 6 and 15 years, to receive methylphenidate hydrochloride (up to 60 mg/d) or placebo for 5 weeks. Behavior was evaluated by parent, teacher, and clinician reports and by direct classroom observations. Two thirds of the children also met criteria for ADHD. RESULTS: Contrary to prediction, ratings of antisocial behaviors specific to CD were significantly reduced by methylphenidate treatment. The magnitude of methylphenidate effect indicated meaningful clinical benefit. Partialling out severity of ADHD did not alter the significant superiority of methylphenidate on CD ratings specifically (P < .001). CONCLUSIONS: Methylphenidate has short-term positive effects on children and adolescents with CD. Key aspects of antisocial adjustment appear to be treatment responsive. This effect was independent of severity of the children's initial ADHD symptoms.
Adolescent↗
Teacher ratings of hyperactivity, inattention, and conduct problems in preschoolers.
Age and sex norms of classroom behavior in preschoolers were established on a standard measure, the Revised Conners Teacher Rating Scale, and the utility of this measure for assessing problem behavior in preschoolers was examined. Teachers provided ratings for 455 nonreferred preschoolers. In addition, ratings were obtained for 12 clinically referred preschoolers diagnosed with attention deficit hyperactivity disorder. The Conduct Problems, Inattention, and Hyperactivity subscales, as well as the Hyperactivity Index, were found to have good internal reliability and were related to each other in predictable ways. Normative data are presented by age and sex. Age was inversely related to scores for the Conduct Problems subscale, the Hyperactivity subscale and the Index. Sex was a significant predictor of subscale scores, with boys receiving higher scores than girls. Subscale scores and nearly all item scores were highly significantly different between clinically referred and nonreferred preschoolers. The results provide a standard upon which to evaluate preschool-aged children in clinical and research settings.
Attention Deficit Disorder with Hyperactivity↗
Test-retest reliability of maternal reports of lifetime mental disorders in their children.
This study examined the test-retest reliability of maternal reports of lifetime psychopathology using DSM-III-R criteria in nonreferred offspring. Sixty-three mothers reported on 79 children, ages 6 to 18 years. Retest intervals were between one and 12 months. The results indicated acceptable reliability for all supraordinate categories (any disorder, any anxiety disorder, any disruptive disorder, externalizing disorders, internalizing disorders) as well as for most individual diagnoses (separation anxiety disorder, simple phobias, oppositional defiant disorder, attention deficit disorder with and without hyperactivity, simple phobias, and adjustment disorder). Maternal reports for any diagnosis were significantly better for intervals under 6 months than for longer retest intervals. Reliability of maternal reports was not significantly affected by child's age or gender. This study supports the expectation that a history of psychiatric disturbance in children can be obtained reliably from mothers.
Adolescent↗
Open fluoxetine treatment of mixed anxiety disorders in children and adolescents.
An open-label pilot study examined fluoxetine treatment in 16 outpatients (9-18 years old) with mixed anxiety disorders. Following nonresponse to psychotherapy, fluoxetine monotherapy was started at 5 mg daily and was increased weekly by 5 or 10 mg daily for 6-9 weeks until improvement occurred or to a maximum of 40 mg (children under 12) or 80 mg (adolescents). Among patients on fluoxetine, severity of illness ratings were "much improved" (mean final Clinical Global Impression scale score 2.8 +/- 0.7). Clinical improvement occurred in 10 of 10 patients with current separation anxiety disorder, 8 of 10 with social phobia, 4 of 6 with specific phobia, 3 of 5 with panic disorder, and 1 of 7 with generalized anxiety disorder. Mean time to improvement was 5 weeks. Mean doses were 24 mg (0.7 mg/kg) for children and 40 mg (0.71 mg/kg) for adolescents. Side effects were transient and included drowsiness (31% of patients), sleep problems (19%), decreased appetite (13%), nausea (13%), abdominal pain (13%), and excitement (13%). No patient developed disinhibition, akathisia, or suicidality. These preliminary findings suggest fluoxetine effectiveness in separation anxiety disorder and social phobia. Youths with only one anxiety disorder appeared to respond to lower doses of fluoxetine than patients with multiple anxiety disorders (0.49 +/- 0.14 versus 0.80 +/- 0.28 mg/kg, p < 0.05).
Adolescent↗
Systematic assessment of 50 children with selective mutism.
OBJECTIVE: To clarify the diagnostic significance of selective mutism (elective mutism in DSM-III-R). METHOD: Fifty children with selective mutism were evaluated systematically by means of semistructured clinical interviews and rating scales to obtain detailed diagnostic information. RESULTS: All 50 children met DSM-III-R criteria for social phobia or avoidant disorder and 24 (48%) had additional anxiety disorders. Clinical measures of anxiety and behavioral symptoms supported the presence of anxiety disorders as a characteristic of selectivity mute children. Only one case each of oppositional defiant disorder and attention-deficit hyperactivity disorder was found. CONCLUSIONS: Persistent selective mutism typically presents in the context of anxiety disorders.
Adolescent↗
Educational and occupational outcome of hyperactive boys grown up.
OBJECTIVE: Little is known about the adult outcome of attention-deficit hyperactivity disorder (ADHD), a very prevalent childhood disorder that is known to affect deleteriously academic performance and other areas of child functioning. This study represents a third wave of evaluations that examine the long-term educational achievement and occupational rank of children with ADHD. METHOD: This is a prospective follow-up of white boys of average intelligence whose ADHD was clinically diagnosed according to systematic criteria at an average age of 7 years. Follow-up intervals range from 15 to 21 years (mean, 17 years). At average age 24 years, 85 probands (representing 82% of the childhood cohort) and 73 controls (84%) were directly interviewed by trained clinicians who were blind to group membership. RESULTS: First, probands completed significantly less formal schooling than controls (about 2 years less, on average). Second, probands had lower-ranking occupational positions than controls. Finally, these disadvantages were not accounted for by adult mental status. CONCLUSIONS: The present study suggests that childhood ADHD predisposes to specific disadvantages and continues to affect important functional domains unrelated to current psychiatric diagnosis.
Adult↗
Transport of reactive metabolites of procarcinogens between different liver cell types, as demonstrated by the single cell microgel electrophoresis assay.
Procarcinogens have to be activated by specific cytochromes before showing adverse effects. Freshly isolated hepatocytes (parenchymal liver cells, PC) are characterized by a high content of such xenobiotic enzymes and are widely used to investigate chemically induced DNA damage. But in many cases liver tumors caused by indirect acting carcinogens can also originate from non-parenchymal liver cells (NPC). We used freshly isolated rat PC and NPC to demonstrate that only PC have activation capacity when treated in vitro with different genotoxic procarcinogens (N-nitrosodimethylamine, NDMA; vinyl chloride, VC). The alkaline single cell microgel electrophoresis assay was applied to measure the genotoxic activity of the activated compounds. In order to test the hypothesis that reactive metabolites can be transported from PC to NPC, we performed additional in vivo studies as well as studies in which PC were incubated together with NPC, only separated by a dialysis tube (in vitro coincubation). The results indicate that reactive metabolites of both NDMA and VC are stable enough to be transported intercellularly from PC to NPC.
Administration, Inhalation↗
Comments on expanding the clinical role of psychologists.
The interest by psychologists in prescription privileges is welcome because it is a manifestation of the long overdue acknowledgement of the efficacy of medication for many mental disorders. The lack of national academic standards in psychology, however, poses a problem. Psychologists are certified in title only and are not licensed to perform any procedure, although there have been efforts to standardize the training of psychologists. Currently, states regulate the title, but no national educational standards exists. Therefore, psychologists are not able to claim they are a homogeneous patient care resource.
Curriculum↗
Fluoxetine treatment of children with selective mutism: an open trial.
OBJECTIVE: A pilot study was designed to evaluate the safety and efficacy of fluoxetine treatment for children with selective mutism (elective mutism in DSM-III-R). METHOD: Twenty-one children (mean age 8.2 years, range 5 through 14) participated in a 9-week open trial of fluoxetine in graduated doses (mean end dose 28.1 mg, range 10 to 60 mg) with systematic baseline and outcome evaluations and weekly clinical assessment. RESULTS: All 21 children met DSM-III-R and DSM-IV criteria for anxiety disorders. After fluoxetine treatment, 76% were improved, with diminished anxiety and increased speech in public settings, including school. Improvement at week 9 was inversely correlated with age. CONCLUSIONS: Persistent selective mutism presenting with comorbid anxiety disorders may respond to fluoxetine treatment.
Adolescent↗
Dating and context of three middle stone age sites with bone points in the Upper Semliki Valley, Zaire.
The extent to which the earliest anatomically modern humans in Africa exhibited behavioral and cognitive traits typical of Homo sapiens sapiens is controversial. In eastern Zaire, archaeological sites with bone points have yielded dates older than 89(-15)+22 thousand years ago by several techniques. These include electron spin resonance, thermoluminescence, optically stimulated luminescence, uranium series, and amino acid racemization. Faunal and stratigraphic data are consistent with this age.
Animals↗
Is self-esteem an important outcome in hyperactive children?
Using a prospective design, this study examined (a) whether hyperactive children suffer from low self-esteem as adolescents; (b) whether low self-esteem is associated with poor functioning in adolescence; (c) whether hyperactive children exhibit a positive illusory bias, in which self-esteem is independent of level of functioning; and (d) whether self-esteem in adolescence is associated with poor functioning in adulthood. Subjects were 65 children diagnosed as hyperactive in childhood, and 62 matched controls sampled from a medical clinic. After controlling for current mental disorder, the hyperactive cohort reported lower self-esteem in adolescence, was judged by clinicians to have lower levels of overall adjustment in adolescence, and had lower educational achievement and occupational rank in adulthood, as compared to controls.
Adolescent↗
The New York Teacher Rating Scale for disruptive and antisocial behavior.
OBJECTIVE: A teacher rating scale designed to reflect current diagnostic descriptors of oppositional defiant disorder and conduct disorder was developed and standardized. METHOD: Teacher ratings were obtained for 1,258 1st-through 10th-grade children from two school districts in New York and for 81 clinically referred children with conduct disorder. RESULTS: Three factors relevant to oppositional defiant disorder and conduct disorder were generated: defiance, physical aggression, and delinquent aggression. A fourth factor reflects peer problems. Internal consistency, test-retest reliability, and interrater reliability are documented using a population and a conduct disorder sample. The validity of the factors is supported by the factors' ability to discriminate between children in the general population and those with conduct disorders, by correlations with global impairment items, and by expected sex differences. CONCLUSION: The scale has utility for assessing symptoms of conduct disorder in school settings.
Adolescent↗
The role of methylphenidate in psychiatry.
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Adolescent↗
Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status.
OBJECTIVE: The paucity of data concerning the long-term natural history of attention-deficit hyperactivity disorder (ADHD), a common childhood psychiatric disorder, prompted a longitudinal study to investigate the adult sequelae of the childhood disorder. DESIGN: Prospective study, follow-up intervals ranging from 13 to 19 years (mean, 16 years), with blind systematic clinical assessments. SUBJECTS: Ninety-one white males (mean age, 26 years), representing 88% of a cohort systematically diagnosed as hyperactive in childhood, and 95 (95%) of comparison cases of similar race, gender, age, whose teachers had voiced no complaints about their school behavior in childhood. RESULTS: Probands had significantly higher rates than comparisons of ADHD symptoms (11% vs 1%), antisocial personality disorders (18% vs 2%), and drug abuse disorders (16% vs 4%). Significant comorbidity occurred between antisocial and drug disorders. Educational and occupational achievements were significantly compromised in the probands. These disadvantages were independent of psychiatric status. We did not find increased rates of affective or anxiety disorders in the probands. CONCLUSIONS: Childhood ADHD predicts specific adult psychiatric disorders, namely antisocial and drug abuse disorders. In the adolescent outcome of this cohort, we found that these disturbances were dependent on the continuation of ADHD symptoms. In contrast, in adulthood, antisocial and drug disorders appeared, in part, independent of sustained ADHD. In addition, regardless of psychiatric status, ADHD placed children at relative risk for educational and vocational disadvantage. The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders.
Adolescent↗
Treatment of psychiatric disorders in children and adolescents.
Children's mental disorders are frequent, often chronic, and precursors of adult dysfunction. Most of the 9 million children with mental disorders go untreated. The successful treatment of childhood disorders represents a major public health concern. Although no cure is available for any condition, effective treatments exist. These include psychotherapies, such as behavioral treatment, parental therapy, family therapy, and medications. Mood disorders may respond to psychotherapeutic and pharmacological treatments. Anxiety disorders have been found to respond to medication and psychotherapeutic interventions. Hyperactivity disorders benefit greatly from stimulant medications, as do conduct disorders. Combining medication with behavioral treatment provides optimal efficacy in hyperactive children. Favorable outcomes in conduct disorders are also obtained from psychotherapeutic interventions with parents and children. In autism, the most severely handicapping childhood disorder, treatment can reduce disturbance to a level that enables the child to remain in the home rather than being placed in an institutional setting. The motor and phonic tics of tourette's disorder can be controlled with medication. Symptoms of post-traumatic stress disorder can be improved through psychotherapeutic treatments. There is an array of therapeutic interventions that can bring meaningful relief to children with serious, chronic mental disorders. Their successful application is a wise investment, given the pain, long-term disadvantages, and financial costs associated with untreated childhood behavioral and emotional disorders.
Adolescent↗