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PubMed2004

Behaviour profiles in a population of infants later diagnosed as having autistic disorder.

In order to complement findings in the field of early autism and in the context of our studies on the quantitative neurobiological evaluation of patients with autism, we studied a large population of infants later diagnosed as having autistic disorder, using multivariate descriptive statistical methods. The population included 74 infants between six and 35 months, evaluated with the Infant Behavioural Summarised Evaluation (IBSE) scale. Thirteen of the 33 items of the IBSE scale were selected according to previous studies on older patients with autistic disorder. Correspondence analysis was applied to these 13 items, followed by a classical cluster analysis. This procedure permitted the identification of four different profiles which were distinguished on the basis of five main behaviours: activity, auditory perception, sensorimotility, eye contact and use of objects. These profiles are similar to those identified in older children with autism. This study provides an objective description of early clinical markers of the heterogeneity in autism and thus contributes to the description of the onset of autistic disorder. It identified more precise clinical subtyping which will be valuable for future bioclinical studies.

Autistic Disorder↗
PubMed2006

Parenting interventions for children with autism spectrum and disruptive behavior disorders: opportunities for cross-fertilization.

Empirical support exists for parent training/education (PT/PE) interventions for children with disruptive behavior disorders (DBD) and autism spectrum disorders (ASD). While the models share common roots, current approaches have largely developed independently and the research findings have been disseminated in two different literature traditions: mental health and developmental disabilities. Given that these populations often have overlapping clinical needs and are likely to receive services in similar settings, efforts to integrate the knowledge gained in the disparate literature may be beneficial. This article provides a systematic overview of the current (1995-2005) empirical research on PT/PE for children with DBD and ASD; attending to factors for cross-fertilization. Twenty-two ASD and 38 DBD studies were coded for review. Literature was compared in three main areas: (1) research methodology, (2) focus of PT/PE intervention, and (3) PT/PE procedures. There was no overlap in publication outlets between the studies for the two populations. Results indicate that there are opportunities for cross-fertilization in the areas of (1) research methodology, (2) intervention targets, and (3) format of parenting interventions. The practical implications of integrating these two highly related areas of research are identified and discussed.

Autistic Disorder↗
PubMed1986

Individual psychotherapy for the sexually abused child.

This paper describes one Center's experience using individual psychotherapy to help the sexually abused child. The approach described rests upon a five-part conceptualization of the traumatic experience: trauma, threat to ontogeny, neglect and emotional unavailability by the caregiver, child's feeling of exploitation, and the child's adaptation. The process of treatment is divided into three phases: starting, middle and closing. Some common issues which occur are guilt, loss and anger, as well as alterations in the child's sexual feelings. The psychotherapeutic approach to these and other issues is coordinated with other therapies. If the child is to appear in court, the experience of testifying provides a reality-based focus for treatment and is not a divisive problem for the therapist. At times, therapists experience feelings of anger, hopelessness and a desire to rescue their patients. The therapists meeting in a supervision group provided a means of understanding and working through the therapists' experiences. Future study of the therapy process with long term follow-up could reveal the issues necessary for an abused child to negotiate in order to achieve full recovery. Further research could establish which treatment modality is primarily suited to a particular type of sexually abused child taking into account differences in age, duration and severity of abuse, family dynamics and psychological impact.

Adaptation, Psychological↗
PubMed2005

Psychopathology in the offspring of parents with bipolar disorder: a controlled study.

BACKGROUND: To examine the risk for psychopathology in offspring at risk for bipolar disorder and the course of psychiatric disorders in these youth. METHODS: Using structured diagnostic interviews (Structured Clinical Interview for DSM-IV [SCID] and Kiddie Schedule for Affective Disorders and Schizophrenia [K-SADS]), psychiatric diagnoses of 117 nonreferred offspring of parents with diagnosed bipolar disorder were compared with those of 171 age- and gender-matched offspring of parents without bipolar disorder or major depression. RESULTS: Compared with offspring of parents without mood disorders, high-risk youth had elevated rates of major depression and bipolar disorder, anxiety, and disruptive behavior disorders. High-risk offspring also had significantly more impaired Global Assessment of Functioning (GAF) scores, higher rates of psychiatric treatment, and higher rates of placement in special education classes. Disruptive behavior disorders, separation anxiety disorder, generalized anxiety disorder (GAD), social phobia, and depression tended to have their onset in early or middle childhood, whereas bipolar disorder, obsessive-compulsive disorder (OCD), panic disorder, and substance use disorder had onset most frequently in adolescence. CONCLUSIONS: These findings support the hypothesis that offspring of parents with bipolar disorder are at significantly increased risk for developing a wide range of severe psychiatric disorders and accompanying dysfunction. Early disruptive behavior and anxiety disorders, as well as early-onset depression, may be useful markers of risk for subsequent bipolar disorder in high-risk samples.

Adolescent↗
PubMedDate not supplied

The effects of fixed-time and contingent schedules of negative reinforcement on compliance and aberrant behavior.

Prior research has suggested that fixed-time (FT) schedules of reinforcement do not necessarily preclude the acquisition of appropriate behavior (e.g., mands) when combined with differential reinforcement (DRA). These studies also note that dense FT schedules are more likely to interfere with DRA packages than lean FT schedules. In the current investigation, we examined whether similar findings would occur with FT schedules of negative reinforcement. Schedule analyses were conducted with two participants following functional analyses that identified escape from task demands as the maintaining variable for problem behavior. Differential negative reinforcement of alternative behavior (DNRA) was implemented first to establish behavioral control (decreased problem behavior and increased compliance). Breaks (negative reinforcement) were then concurrently delivered on a FT basis under either dense (at a greater rate than that obtained during DNRA alone) or lean (at a lower rate than that obtained during DNRA) reinforcement schedules. In general, results showed that FT escape did not preclude compliance when the FT schedule was lean, but treatment gains were significantly disrupted when dense FT schedules were superimposed.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed2003

Clinical implications of pervasive manic symptoms in children.

BACKGROUND: Prior investigations of cross-informant agreement among parents, teachers, and clinicians about externalizing and internalizing problems have not directly addressed agreement about manic symptoms. METHODS: 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 a teacher; 34 had 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 lowest on all dependent measures, with the differences representing large to extremely large effects when compared with the corroborated mania group and medium effects as 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.

Adolescent↗
PubMed1998

Young referred boys with DICA-P manic symptoms vs. two comparison groups.

A total of 23 boys met DICA-P manic symptom and clustering criteria in a diagnostic investigation of 233 outpatient boys between ages 6 and 10. In this manic-symptom group, the most frequently endorsed of an average of five manic symptoms were extreme mood changes, difficulty concentrating, feeling too 'up' to sit still, and racing thoughts. Comparison groups were 23 non-manic boys seen next in the investigation and 23 non-manic boys matched to the manic-symptom boys on symptoms of three comorbid disruptive disorders (ADHD, ODD and CD). Manic-symptom boys differed significantly from next-seen boys, but not from matched comorbid boys, in number of oppositional symptoms and pervasiveness of problems. Manic-symptom boys differed significantly from next-seen boys on six of eight mother-rated RCBCL factors. In contrast, manic-symptom and matched comorbid boys did not differ on any of eight RCBCL factors, which suggests that the RCBCL differences can be attributed to shared ADHD, ODD and/or CD. However, manic-symptom and matched comorbid boys tended to differ on RCBCL Anxiety/Depression. On the teacher-rated TRF, manic-symptom boys were rated higher than next-seen boys on four internalizing factors, and higher than matched comorbid boys on two of those factors, including Anxiety/Depression. Thus, manic symptomatology also predicted substantial emotionality, which was not a controlled comorbidity. The findings of this and other studies suggest that there is a mania dimension or syndrome, which may be an indicator of true bipolar disorder--or simply a marker for disruptive comorbidity, behavioral and emotional multimorbidity, or general severity of psychopathology.

Attention Deficit Disorder with Hyperactivity↗
PubMed2002

Temporal association between childhood psychopathology and substance use disorders: findings from a sample of adults with opioid or alcohol dependency.

Adults with substance use disorders (SUD; alcohol or drug abuse or dependence) were evaluated to determine if childhood-onset psychopathology preceded the onset of SUD. Using structured psychiatric interviews, we assessed 47 clinically referred adults with SUD (27 with opioid dependence and 20 with alcohol dependence), with attention to childhood-onset psychopathology. A sequence of psychopathology and SUD was reconstructed using mean diagnosis onset data. Sixty-two percent of the 47 SUD adults (mean age 39.3+/-6.6 years) had early-onset SUD (defined as < or = 18 years) and 38% had late-onset SUD (> or = 19 years at onset). Psychopathology preceded the onset of SUD in 56% of adults. Attention deficit/hyperactivity disorder, multiple anxiety, and disruptive disorders typically preceded the onset of SUD; in contrast, mood disorders (specifically depressive and bipolar disorders) followed the onset of SUD. The majority of clinically referred adults with SUD had psychopathology that began in childhood, frequently preceding the onset of their SUD. These findings further highlight the importance of targeting antecedent disorders for preventive and early intervention programs aimed at reducing the risk for SUD.

Adult↗
PubMed2001

Judgments of social appropriateness by children and adolescents with autism.

Children and adolescents with autism (autism group, n = 19) and those without autism (Nonautism group, n = 19) of similar age and IQ were asked to make judgments of the social appropriateness of 24 videotaped, staged scenes with adult actors. Each scene depicted an appropriate or an inappropriate interaction. Half contained verbalizations, and half did not. After each scene, the participant was asked: (1) Was that o.k. or was something wrong with it? If the participant judged the scene was wrong, she or he was asked: (2) What was wrong with it?; and (3) Why was that wrong? Both groups correctly identified inappropriate behaviors most of the time, and correct behaviors almost all of the time. However, the Nonautism group detected inappropriate behaviors significantly more often than the Autism group, for verbal but not nonverbal scenes. It was also significantly easier for both groups to identify inappropriate behaviors in the nonverbal than in the verbal scenes. Ratings of the explanations given for Question 3 differed significantly between the groups for verbal but not for nonverbal scenes, with Nonautism participants more likely to give explanations involving social norms and principles, and the Autism group more likely to give explanations that were irrelevant or idiosyncratic.

Adolescent↗
PubMed2002

Problem behavior interventions for young children with autism: a research synthesis.

This paper provides a summary of research on behavioral interventions for children with autism 8 years of age or younger published between 1996 and 2000. The analysis is divided into four sections: (1) emerging themes in the technology of behavior support, (2) a review of existing research syntheses focusing on behavioral interventions, (3) a new literature review of current pertinent research, and (4) an evaluative discussion of the synthesis results and the field's future needs to develop effective behavioral interventions for young children with autism. The authors offer recommendations for strengthening the existing research base and advancing behavioral technology to meet the needs of the defined target population.

Autistic Disorder↗