On symbiosis and symbiotic relations in the mental hospital.
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Adolescent↗
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Premorbid risk factors for alcohol dependence in antisocial personality disorder.
BACKGROUND: Many, but not all, types of antisocial personality disorders (ASP) are complicated by alcohol dependence. Therefore, some additional risk factors may exist for alcohol dependence co-occurring with ASP. We studied whether severe childhood conduct disorder and a family history of alcohol dependence are possible risk factors for the development of alcohol dependence in ASP. METHODS: The subjects were 81 male Japanese criminals diagnosed with DSM-III-R ASP. Relative risks of alcohol dependence for severe conduct disorder and for a positive family history were estimated by using a multiple logistic model. RESULTS: Forty-three subjects (53.0%) met criteria for DSM-III-R alcohol dependence. The relative risk of alcohol dependence for severe conduct disorder (n = 44), compared with mild conduct disorder, was 4.1; whereas the relative risk for a positive family history (n = 31), relative to a negative family history, was 1.9. Severe childhood conduct disorder was also associated with severe adulthood antisocial behavior and an earlier onset of alcohol dependence. CONCLUSIONS: The results suggest that severe childhood conduct disorder and a positive family history of alcohol dependence are independent premorbid risk factors for developing alcohol dependence among persons with ASP.
Adult↗
Boys with reading disabilities and/or ADHD: distinctions in early childhood.
We examined distinctions in the early childhood characteristics of boys with reading disabilities (RD) and/or attention-deficit/ hyperactivity disorder (ADHD). A four-group mixed design consisting of boys identified at age 11 with reading disabilities only (RD only; n = 46), reading disabilities and ADHD (RD/ADHD; n = 16), ADHD only (n = 20), and a comparison group (n = 281) was utilized. Differences on receptive and expressive language and temperament for ages 3 and 5 were investigated. Analyses indicated that the boys from the RD-only group performed worse on measures of receptive and expressive language. The results also indicated that boys from the RD/ADHD groups consistently performed worse on measures of receptive language and exhibited more behaviors indicative of an undercontrolled temperament. In summary, we suggest that reading disabilities and ADHD represent moderately unique disorders that frequently co-occur and are characterized by distinct developmental pathways.
Attention Deficit Disorder with Hyperactivity↗
Increased behavioral morbidity in school-aged children with sleep-disordered breathing.
OBJECTIVE: To assess whether sleep-disordered breathing (SDB), ranging from primary snoring to obstructive sleep apnea (OSA), is associated with increased behavioral morbidity. METHODS: A cross-sectional study was conducted of school-aged children in an urban, community-based cohort, stratified for term or preterm (<37 weeks' gestation) birth status. A total of 829 children, 8 to 11 years old (50% female, 46% black, 46% former preterm birth) were recruited from a cohort study. All children had unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate for measurement of the apnea hypopnea index (number of obstructive apneas and hypopneas per hour). SDB was defined by either parent-reported habitual snoring or objectively measured OSA. Functional outcomes were assessed with 2 well-validated parent ratings of behavior problems: the Child Behavioral Checklist and the Conners Parent Rating Scale-Revised:Long. RESULTS: Forty (5%) children were classified as having OSA (median apnea hypopnea index: 7.1 per hour; interquartile range: 3.1-10.5), 122 (15%) had primary snoring without OSA, and the remaining 667 (80%) had neither snoring nor OSA. Children with SDB had significantly higher odds of elevated problem scores in the following domains: externalizing, hyperactive, emotional lability, oppositional, aggressive, internalizing, somatic complaints, and social problems. CONCLUSIONS: Children with relatively mild SDB, ranging from primary snoring to OSA, have a higher prevalence of problem behaviors, with the strongest, most consistent associations for externalizing, hyperactive-type behaviors.
Attention Deficit and Disruptive Behavior Disorder↗
Satisfaction of parents with their conduct-disordered and substance-abusing youth.
This study examined parental satisfaction (using the Parent Satisfaction With Youth Scale) in 132 parents of adolescents who were dually diagnosed with conduct disorder/oppositional defiant disorder and drug abuse/dependence. Results indicated parental satisfaction did not vary as a function of age, ethnic minority status, or gender. Parents of younger youth were generally more dissatisfied than parents of older adolescents although younger youth were no more delinquent than older youth. These results suggest that parents of delinquent youth become tolerant of their children's behavior problems with time. As expected, parents were most dissatisfied with their youth's use of drugs, illicit behavior, school performance, and response to discipline. Parents who endorsed lower levels of satisfaction reported their youth engaged in more pronounced levels of problem behavior and more drug use than did parents who were relatively more satisfied with their youth. Study implications and future directions are discussed.
Adolescent↗
Behavioral outcomes among children of alcoholics during the early and middle childhood years: familial subtype variations.
This study examined early behavioral outcomes among young children of alcoholics (COAs) as a function of differences in subtype of paternal alcoholism. Participants were 212 children (106 girls and 106 boys, ages 3 through 8) and both of their biological parents. Families were characterized as antisocial alcoholics, nonantisocial alcoholics, and nonalcoholic controls. There were significant familial subtype group differences on parent report measures of children's total behavior problems, externalizing behavior, and internalizing behavior, and on measures of children's intellectual functioning and academic achievement. In all instances, COAs had poorer functioning than controls. In the behavior problem domain, but not for the domain of intellectual functioning, children from antisocial alcoholic families had greater problems than children from nonantisocial alcoholic families. In addition to the subtype effects, boys had higher levels of behavior problems than girls in all three areas, and older children had more internalizing problems than younger children. Maternal functioning pertaining to lifetime alcohol problem involvement and antisocial behavior also contributed to child subtype differences in internalizing behavior. Results indicate that, even at very early ages, male and female COAs are heterogeneous populations that are distinguishable by way of familial subtype membership, as well as distinguishable from their non-COA peers. Thus, findings underscore the need to consider the heterogeneity of alcoholism when looking at its effects on child development.
Alcoholism↗
Development of a continuum of services for children and adults with autism and other severe behavior disorders.
The development of a 12-step continuum of services for individuals with autism is described. The operation and funding of outreach parent training; homebased early intervention; preschool, vocational, and adult intermediate care; and school consultation programs are outlined. The use and importance of evaluative data on both treatment outcome and staff skills are emphasized.
Activities of Daily Living↗
Behavioral symptoms and psychiatric diagnoses among 162 children in nonalcoholic or alcoholic families.
OBJECTIVE: People with alcoholic relatives have high rates of alcohol abuse and dependence as adults, but their patterns of problems earlier in life are less clear. Many studies have not controlled for parental disorders other than alcoholism or for parents' socioeconomic status and general life functioning. The authors' goal was to conduct a study controlling for such factors. METHOD: Personal structured interviews and a behavioral checklist were administered to the parents of 162 children 7 years old or older whose fathers had participated in the 15-year follow-up of 453 sons of alcoholics with no history of antisocial personality disorder and sons of nonalcoholic comparison subjects originally selected from a university population. RESULTS: There was no significant relationship between a family history of alcoholism and childhood diagnoses of conduct, oppositional, or attention deficit disorders or with behavioral checklist summary scores. However, children with alcoholic relatives apparently have a slightly higher risk for drug abuse or dependence than those without alcoholic relatives. CONCLUSIONS: Once familial antisocial disorders and familial socioeconomic status are controlled for, a family history of alcoholism does not appear to relate to childhood externalizing disorders.
Adolescent↗
Childhood autism. A review of the clinical and experimental literature.
This review of the literature on childhood autism discusses the clinical characteristics, differential diagnosis, prognosis and treatment of the autistic behavioral syndrome from a developmental perspective. It includes a discussion of the influence of prenatal and perinatal antecedents, genetic and socio-familial factors, and epidemiologic considerations. Neurologic, electro-encephalographic and experimental neurophysiologic, metabolic, biochemical and hematologic investigations are reviewed. Special emphasis has been given to the changing clinical manifestations which accompany maturation and to the problems of recognition of childhood autism in the very young child.
Aphasia↗
Children of parents with major affective disorder: a review.
The authors review published studies of the children of parents with major affective disorder and report the rates of diagnosable disorder in the children, their clinical symptoms and other behavioral disturbances, and the differing impact of parental illness at different ages and stages of development. There is significant risk to children in having parents with major affective disorder, and considerable impairment is evident in these children. The authors discuss the methodological issues in the studies and offer suggestions for future investigations.
Adolescent↗
Long-term effects of risperidone in children with autism spectrum disorders: a placebo discontinuation study.
OBJECTIVE: The short-term benefit of risperidone in ameliorating severe disruptive behavior in pediatric patients with autism spectrum disorders is well established; however, only one placebo-controlled, long-term study of efficacy is available. METHOD: Thirty-six children with an autism spectrum disorder (5-17 years old) accompanied by severe tantrums, aggression, or self-injurious behavior, started 8-week open-label treatment with risperidone. Responders (n = 26) continued treatment for another 16 weeks, followed by a double-blind discontinuation (n = 24; two patients discontinued treatment because of weight gain) consisting of either 3 weeks of taper and 5 weeks of placebo only or continuing use of risperidone. Relapse was defined as a significant deterioration of symptoms based on clinical judgment and a parent questionnaire. RESULTS: Risperidone was superior to placebo in preventing relapse: this occurred in 3 of 12 patients continuing on risperidone versus 8 of 12 who switched to placebo (p = .049). Weight gain, increased appetite, anxiety, and fatigue were the most frequently reported side effects. CONCLUSIONS: This study indicates the effectiveness of risperidone during a period of several months, reducing disruptive behavior in about half of the children with autism spectrum disorders. The results provide a rationale for the continuing use of risperidone beyond 6 months, although considerable weight gain can limit the use of this agent.
Adolescent↗
Boyhood behaviour problems as precursors of criminality: a fifteen-year follow-up study.
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Adolescent↗
[Conditions facilitating social behavior disorder in children and adolescents in a clinic referred sample].
The patients referred to our center from 1989 to 6/1994 (n = 1076) were divided into three groups: "conduct disorder" (n = 235), "none psychiatric diagnosis" (n = 324) and "other psychiatric diagnosis" (n = 517). These groups were compared with regard to frequency, age, sex, the frequency of specific developmental disorders, the IQ, and the frequency of abnormal psychosocial circumstances. Additional the religiosity of the families and the televiewing of the children were investigated. Abnormal psychosocial circumstances and enlarged televiewing of the children were significantly associated with conduct disorders.
Adolescent↗
Relationship between specific adverse life events and psychiatric disorders.
This study examines whether certain psychiatric disorders are associated more closely with adverse life events than other disorders are, and whether some adverse life events are associated with a specific group of disorders (e.g., depressive disorders), but not with other disorders (e.g., anxiety disorders). A probability sample of youth aged 9-17 at 4 sites is used (N = 1,285). Univariate and multivariate logistic regressions identify specific relationships between 25 adverse life events and 9 common child and adolescent psychiatric disorders, measured by the Diagnostic Interview Schedule for Children. Conduct Disorder, Oppositional Defiant Disorder, Major Depressive Disorder, and Dysthymia are significantly associated with many of the adverse life events examined, whereas Attention Deficit/Hyperactivity Disorder, Agoraphobia, and Social Phobia are related to very few. This study suggests that certain psychiatric disorders may be more closely associated with adverse life events than other psychiatric disorders are, and that some adverse life events seem to be related to specific types of disorders.
Adolescent↗
Comparison of childhood problem behaviors in boys with subsequent schizophrenic, antisocial, and good adult outcomes.
Childhood problem behaviors for 145 boys seen in child guidance clinics were used to compare four adult outcome groups: antisocial men, schizophrenic subjects with good outcomes, schizophrenic subjects with poor outcomes, and subjects with good outcomes. Delinquent and aggressive factor scale scores distinguished the antisocial outcomes from the other groups. A preschizophrenic factor along with lower IQ separated schizophrenics with poor outcome from the others. Subjects with good outcomes had lower scores on factor scales, higher IQ, and less disturbed families. Schizophrenics with good outcomes were the most difficult to identify correctly.
Adult↗
P3 event-related potential amplitude and the risk for disinhibitory disorders in adolescent boys.
BACKGROUND: The children of parents who abuse alcohol typically show reduced amplitude of the P3 event-related potential wave. We determined if this effect was present in a population-based sample of older adolescent boys, whether it was associated with paternal antisocial personality and drug use, and whether it appeared in youth with childhood externalizing and substance use disorders. METHODS: A statewide sample of 502 male youth, identified from Minnesota birth records as members of twin pairs, had their P3 amplitude measured, using a visual oddball paradigm when they were approximately 17 years old. Structured clinical interviews covering attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, antisocial personality disorder, and substance use disorders were administered in person to the youth and his parents at the time of the P3 assessment and again to the youth 3 years later. RESULTS: Reduced P3 was associated with disorders and paternal risk for disorders, reflecting a behavioral disinhibition spectrum that included attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, antisocial personality disorder, alcoholism, nicotine dependence, and illicit drug abuse and dependence. Reduced P3 at age 17 predicted the development of substance use disorders at age 20. Most effect sizes associated with these group differences exceeded 0.70, indicating medium to moderately large group differences. Maternal alcoholism and substance use during pregnancy were unrelated to P3 amplitude in offspring. CONCLUSION: Small amplitude P3 may indicate genetic risk for a dimension of disinhibiting psychiatric disorders, including childhood externalizing, adult antisocial personality disorder, and substance use disorders.
Adolescent↗
Psychopathy: traditional and clinical antisocial concepts.
Advances in our knowledge about the concept of psychopathy and the repeated occurrence of antisocial behaviors in the face of adversity and punishment have been limited by a complex interplay of conceptual and methodological issues that have not yet been addressed adequately by psychosocial scientists. Foremost among the problems facing clinicians and researchers interested in this topic is the lack of agreement on the meaning and labelling of the construct. Scholars have not reached consensus in describing a category within a diagnostic system that distinguishes a relatively homogeneous group of individuals sharing a set of characteristics, or a class of persons that can be identified reliably from those who exhibit other perhaps closely related behavioral abnormalities and so-called normal individuals. Disagreements about the construct in question have been sufficiently problematic that some researchers and clinicians have decided that the notion of psychopathy or APD, taken to represent a mental disorder, is simply a myth or a judgment label concocted to justify societal management of offensive and repugnant behaviors (cf., Blackburn, 1988; Lewis & Balla, 1975; Pilgrim, 1987). Scholars such as Holmes (1991) and Wulach (1983) have called for elimination of the category as a mental disorder diagnosis, because it offers an opportunity for making value assessments rather than clinically appropriate decisions. Few disorders described in our psychopathology nomenclature are associated with such markedly negative attributions as is psychopathy, whether defined in the American or British traditions. The logical underpinning of much work in the field equates psychopathy or APD with heinous forms of criminality, lifestyle criminality, and special cases of antisocial behavior. In keeping with tendencies for society to conceptualize psychopathy as extreme misbehavior and to decry its consequences is a paper by Wells (1988), which exemplifies the emotion-focused thought and rhetoric that have been mobilized in writings explaining the behaviors that are often subsumed under the psychopathy label. Given that this type of persuasion is more common than might be expected in an empirical literature, it is not surprising that some scholars have concluded that the term psychopathy is really relatively useless. On the other hand, the appeal of the realist approach to disease conceptualization, or the notion that such a disorder exists and therefore must have underlying causes, has defied elimination over the years.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Comparison of psychotic and autistic children using behavioral observation.
The purpose of this study was to assess the relationship between autism and childhood psychosis. Fifteen children with psychotic symptoms were compared to 15 children with autism, using two observational measures, the Ritvo-Freeman Real Life Rating Scale (RLRS) and the Childhood Autism Rating Scale (CARS), which rate subjects on behaviors pathognomic to autism. In comparison to autistic persons, psychotic individuals were judged to have better language and social skills. In addition, autistic persons were also rated as having more difficulty adapting to new situations and appeared more "autistic-like." Overall scores on the CARS and RLRS were significantly different between the two groups, indicating that these two assessment instruments may be useful in differential diagnosis. However, 20% of the psychotic subjects received pervasive developmental disorder diagnoses, indicating that there may be a relationship between those two disorders.
Autistic Disorder↗