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PubMed1990

Plasma dexamethasone levels in children given the dexamethasone suppression test.

To determine whether children who demonstrate dexamethasone suppression test (DST) nonsuppression have lower plasma dexamethasone levels than DST suppressors, we administered the DST to 73 patients ranging in age from 5-14 years. Plasma dexamethasone levels and postdexamethasone cortisol levels were measured at 4:00 PM on day 2. We found: (1) DST nonsuppressors had significantly lower plasma dexamethasone levels (p less than 0.03) than suppressors; similar trends were observed when the population was divided into depressed and nondepressed patients; (2) mg/m2 dose of dexamethasone was directly correlated with plasma dexamethasone (p less than 0.003) and inversely correlated with postdexamethasone plasma cortisol levels (p less than 0.04); and (3) a statistically significant inverse correlation between plasma dexamethasone levels and postdexamethasone cortisol levels (p less than 0.04). Our findings show that plasma dexamethasone levels are important in evaluating DST results in psychiatrically disturbed children and suggest that dexamethasone dosage for use in the DST in children might be better calculated in terms of body surface area.

Adolescent↗
PubMed1986

Evidence of lack of abuse or dependence following pemoline treatment: results of a retrospective survey.

Pemoline is recognized as an efficacious and safe therapeutic agent for children suffering from Attention Deficit Disorder (ADD). A review of adverse experience reports submitted to the manufacturer suggests that Cylert (brand of pemoline) has a limited potential for abuse or dependence. Drug dependence studies in animals have demonstrated that pemoline is not self-administered in naive nor cocaine-dependent animals. Human experience indicates that, despite the fact that the drug has been available in the U.S. since 1975, use is limited and is increasing slowly. A review of the literature revealed no published case reports of euphoria, abuse, dependence or withdrawal. While there have been a few reports of tolerance, it is possible that these were a reflection of inadequate dosing rather than actual tolerance to the drug's therapeutic effects. During the 10 years that Cylert has been available in the United States, there have been only four reports of withdrawal reactions and no reported cases of dependence. Reports of intentional overdose of Cylert are minimal, with no reports involving abuse via the intravenous route.

Adolescent↗
PubMed1992

Using guided compliance versus time out to promote child compliance: a preliminary comparative analysis in an analogue context.

Children referred to child management clinics frequently exhibit noncompliance with adult requests. Using a counterbalanced ABAC design, the authors examined the relative efficacy of guided compliance versus time out as a method of promoting child adherence to adult requests. Time out effected larger increases in percentage compliance among four of five participating children.

Attention↗
PubMedDate not supplied

Empirically derived consequences: a data-based method for prescribing treatments for destructive behavior.

Behavioral treatments are often prescribed on the basis of a functional assessment. However, in a significant number of cases, functional assessment results are equivocal or suggest that internal stimuli are maintaining the behavior. In this investigation, we evaluated an alternative data-based assessment that may be useful in such cases. This assessment was used to identify reinforcers and punishers based on the reinforcement assessment procedure described by Pace, Ivancic, Edwards, Iwata, and Page (1985). We then assessed whether empirically derived reinforcers and punishers could be combined to treat the destructive behaviors of two clients. For both clients, the rates of destructive behavior decreased markedly. The results suggest that empirically derived consequences may be useful in decreasing destructive behavior when a functional assessment is inconclusive or is consistent with the hypothesis that the behavior is stereo-typic and maintained by internal stimuli.

Aggression↗
PubMed2004

The interface between publicly funded and industry-funded research in pediatric psychopharmacology: opportunities for integration and collaboration.

Pediatric psychopharmacology research is undergoing a major expansion consequent to increasing use of psychotropic medications in children and recent legislative incentives to industry. In this rapidly changing context, the interface between publicly and privately funded research needs to be reconsidered to integrate activities and avoid unnecessary duplication of efforts. Once, by default, the almost exclusive domain of public research, child research is now increasingly funded by industry. There are, however, important issues unlikely to be addressed through private funding for which public support is needed, such as direct comparisons between active medications, between pharmacological and psychosocial interventions, or between combined and single treatment modalities; development of effective treatment strategies for patients unresponsive to first-line treatments; development of better research methods to assess efficacy and safety; identification of moderators and mechanisms of treatment response; and impact of treatment on illness course and prognosis. Industry-sponsored research is limited by the restricted access to proprietary databases, which impedes independent analyses and meta-analyses. Translation of basic neuroscience discoveries into treatment applications for children with mental illness is a critical area of inquiry that can benefit from integration of efforts and collaborations among academia, government, and industry.

Adolescent↗
PubMed2006

Is ADHD a valid disorder in children with intellectual delays?

To assess the validity of ADHD in children with mental retardation, we applied Robins and Guze's [Robins, E., and Guze, S.B. (1970). Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. American Journal of Psychiatry, 126, 983-987.] criteria for determining the validity of a psychiatric disorder. We review the literature describing clinical correlates, family history, treatment response, laboratory studies, course, and outcome of children with ADHD and mental retardation. Although clearly an area in need of further research, there is preliminary evidence to suggest that ADHD is a valid psychiatric condition in children with mental retardation. Nevertheless, without knowing the base rates of ADHD symptoms in the mental retardation population, the positive predictive power and negative predictive power of ADHD symptoms in this population remain an open question. In addition to assessment of base rate symptoms, future research should consider what diagnostic algorithm may best be applied to the diagnosis of ADHD in mental retardation.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in childhood: prospective evidence from a Dutch birth cohort.

AIM: To examine effects of maternal smoking during pregnancy on academic achievement and emotional and behavioural problems during childhood. METHODS: Least squares regression was used to examine associations between maternal smoking prior to delivery and subsequent academic performance and behaviour of 1186 children aged 5.5-11 years. Crude associations were adjusted for risk factors that were significantly related to the respective outcomes. MAIN OUTCOME MEASURES: Parents and teachers were asked to indicate, on a 10-item questionnaire, whether they regarded the child as more, the same, or less shy/withdrawn (internalising), troublesome (externalising), and attention deficient than the average child. Reading, spelling, and arithmetic performance levels were assessed with short standardised Dutch tests. RESULTS: After adjustment for confounders like socio-economic status and pre- and perinatal complications, children of mothers who smoked during pregnancy showed more signs of attention deficit and displayed higher levels of troublesome (externalising) behaviour than non-cigarette-exposed children. Also, children of smoking mothers performed worse on arithmetic and spelling tasks. Spelling problems were more pronounced when the mother continued to smoke after the child's birth. Excessively withdrawn (internalising) behaviour was not related to maternal smoking but to factors like the mother's use of psychotropic drugs and bottle-instead of breastfeeding. CONCLUSION: Perinatal antecedents of internalising behaviour on the one hand and externalising behaviour, attention deficit, and learning problems on the other seem to be distinct. Only the latter are independently associated with maternal smoking during pregnancy and thus potentially amenable to early preventive effort, for instance, through continued health education emphasising the health hazards of nicotine use by pregnant women.

Adult↗
PubMed2006

Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities.

This study evaluated two variants of a behavioral parent training program known as Stepping Stones Triple P (SSTP) using 74 preschool-aged children with developmental disabilities. Families were randomly allocated to an enhanced parent training intervention that combined parenting skills and care-giving coping skills (SSTP-E), standard parent training intervention alone (SSTP-S) or waitlist control (WL) condition. At post-intervention, both programs were associated with lower levels of observed negative child behavior, reductions in the number of care-giving settings where children displayed problem behavior, and improved parental competence and satisfaction in the parenting role as compared with the waitlist condition. Gains attained at post-intervention were maintained at 1-year follow-up. Both interventions produced significant reductions in child problem behavior, with 67% of children in the SSTP-E and 77% of children in the SSTP-S showing clinically reliable change from pre-intervention to follow-up. Parents reported a high level of satisfaction with both interventions.

Adaptation, Psychological↗
PubMed1999

Risk for later school problems in preterm children who do not cooperate for preschool developmental testing.

OBJECTIVE: To determine whether preterm children born at </=32 weeks' gestation who did not cooperate for developmental testing at 3(1/2) to 4(1/2) years old were more likely to have school problems at 7 to 10 years old than preterm children who completed developmental testing. STUDY DESIGN: The McCarthy Scales of Children's Abilities were administered to a cohort of 118 preterm children at 3(1/2) to 4(1/2) years old when they were seen in the neonatal follow-up clinic. When these children were 7 to 10 years old, their parents completed the Child Behavior Checklist, and the child's teacher completed the Teacher's Report Form. RESULTS: Parents returned questionnaires on 105 (89%) children. On the Teacher's Report Form, children who were untestable had more somatic complications and more attention problems and scored higher on the Total Problems Scale and the Internalizing Scale than children who had completed testing. Children who were untestable were twice as likely to receive help in school than were children who completed developmental testing. CONCLUSIONS: Preterm children born at </=32 weeks' gestation who do not cooperate for developmental testing at 3(1/2) to 4(1/2) years old should be examined at school age for evidence of school and behavior problems.

Child Behavior Disorders↗
PubMed1998

Diagnoses commonly missed in childhood. Long-term outcome and implications for treatment.

Psychiatric and developmental disorders with onset in early childhood are often missed and commonly overlooked by adult psychiatrists. These disorders have important continuities into adulthood and are powerful predictors of chronicity, comorbidity, and severity. It is essential that they are recognized and taken into account in the assessment and treatment of the adult patient.

Adolescent↗
PubMed1996

The impact of inadequate sleep on children's daytime cognitive function.

This report describes the relationship between sleep and cognitive function in children. As reviewed, the empiric data to directly address the effects of sleep loss or disruption on children's cognitive function are quite sparse. However, a wide range of clinical and observational data support a general picture that inadequate sleep results in tiredness, difficulties with focussed attention, low threshold to express negative affect (irritability and easy frustration), and difficulty modulating impulses and emotions. In some cases these symptoms may resemble attention deficit hyperactivity disorder. These findings are discussed in relation to a model of sleep loss influencing prefrontal cortex including executive functions involved in the control of attention and emotions.

Adolescent↗
PubMed1991

Separation of DSM-III attention deficit disorder and conduct disorder: evidence from a family-genetic study of American child psychiatric patients.

Using family study methodology and assessments by blind raters, this study tested hypotheses about patterns of familial association between DSM-III attention deficit disorder (ADD) and antisocial disorders (childhood conduct (CD) and oppositional disorder (OPD) and adult antisocial personality disorder) among 457 first-degree relatives of clinically referred children and adolescents with ADD (73 probands, 264 relatives), psychiatric (26 probands, 101 relatives) and normal controls (26 probands, 92 relatives). Among the 73 ADD probands, 33 (45%) met criteria for OPD, 24 (33%) met criteria for CD, and 16 (22%) had no antisocial diagnosis. After stratifying the ADD sample into those with CD (ADD + CD), those with OPD (ADD + OPD) and those with neither (ADD) familial risk analysis revealed the following: (1) relatives of each ADD proband subgroup were at significantly greater risk for ADD than relatives of both psychiatric and normal controls: (2) the morbidity risk for ADD was highest among relatives of ADD + CD probands (38%), moderate among relatives of ADD + OPD (17%) and ADD probands (24%) and lowest among relatives of psychiatric and normal controls (5% for both); (3) the risk for any antisocial disorder was highest among relatives of ADD + CD (34%) and ADD + OPD (24%) which were significantly greater than the risk to relatives of ADD probands (11%), psychiatric (7%) and normal controls (4%); and (4) both ADD and antisocial disorders occurred in the same relatives more often than expected by chance alone. Although these findings suggest that ADD with and without antisocial disorders may be aetiologically distinct disorders, they are also consistent with a multifactorial hypothesis in which ADD, ADD + OPD and ADD + CD fall along a continuum of increasing levels of familial aetiological factors and, correspondingly, severity of illness.

Adolescent↗