Psychiatric Symptomatology and Family Functioning in Children and Adolescents with Spina Bifida

The purpose of this study was to (a) examine the occurrence of psychiatric symptomatology in children and adolescents with spina bifida, (b) investigate the relationship between psychiatric features and aspects of disability, and (c) explore the impact of spina bifida and psychiatric status on family functioning. Fifty-four children and adolescents ages 6 to 18 years (M = 12.94, SD = 3.59) were examined. Parents completed the Child Symptom Inventory (CSI) and the Family Assessment Device (FAD). Using the CSI, a psychiatric diagnostic screen, 43% of the sample obtained one, and 13% obtained two or more screening cutoff scores reflective of psychiatric diagnoses. The two most prevalent diagnostic categories were Attention-Deficit/Hyperactivity Disorder (33%) and Oppositional Defiant Disorder (13%). The sample as a whole exhibited elevated levels of clinical symptoms, with internalizing symptoms more prominent than externalizing symptoms. No differences in diagnostic categories or overall symptomatology were found based on age, gender, ambulation status, or lesion level. Overall symptom counts were positively correlated with scales on the FAD reflecting problematic family functioning (.42–.65). Results suggest that psychiatric symptomatology occurs at a high rate in children and youth with spina bifida. Although ADHD was the modal diagnostic category, the sample as a whole exhibited extensive psychiatric symptoms independent of specific diagnostic categories. Psychiatric symptoms were also associated with increased problematic functioning in families.     

Exploring Child and Parent Factors in the Diagnostic Agreement on the Anxiety Disorders Interview Schedule

Worryingly low levels of parent–child agreement on child psychiatric diagnosis are reported. This study examined parent–child agreement on diagnostic categories and severity ratings with the Anxiety Disorders Interview Schedule, Child and Parents versions (ADIS-C/P). Children’s age, gender, motivation and self-concept and parent’s general psychopathology and diagnoses were examined. Participants were 110 children (aged 8–14 years) with a principal specific phobia diagnosis, and their parents. Findings revealed excellent parent–child agreement on principal specific phobia diagnosis (97.3%), and fair levels of concordance on most co-occurring secondary diagnoses. As expected, children with high motivation had generally stronger parent–child agreement on diagnoses and severity ratings (for ADHD p?p?p?相似文献   

Concurrent Validity and Informant Agreement of the ADHD Module of the Anxiety Disorders Interview Schedule for <Emphasis Type="Italic">DSM-IV</Emphasis>

Examined the concurrent validity of the attention-deficit/hyperactivity disorder (ADHD) module of the Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent versions (ADIS-C/P). One hundred eighty-four clinic-referred children were categorized into three ADIS-generated groups: No diagnosis of ADHD (No ADHD; n = 63), parent-only diagnosis of ADHD (Parent Only; n = 81), and parent plus child diagnosis of ADHD (Parent + Child; n = 40). The groups were compared on demographics, comorbid diagnoses, parent and child-report measures, and a computerized test of attention. Results support the concurrent validity of the ADIS ADHD module and highlight the positive relationship between internalizing symptomatology and parent-child agreement on ADHD diagnoses. The clinical implication of this study is that parent-child agreement on ADHD may serve as a marker of internalizing symptomatology. Future research on child self-perceptions is suggested in developing treatments for this internalizing ADHD group.

Association between anxiety and depression in children and adolescents with anxiety disorders

The relationship between anxiety and depression was examined in a sample of 106 children and adolescents referred to an outpatient anxiety disorder clinic for children. Twenty-eight percent of patients with DSM-III diagnoses of anxiety disorders displayed a concurrent major depression. Children with anxiety disorders plus major depression were found (1) to be older, (2) to demonstrate more severe anxiety symptomatology, and (3) to be diagnosed with different rates of certain anxiety-disorder subtypes, when compared to anxious patients without major depression. Nondepressed anxious children and adolescents did not differ from a psychopathological control group in severity of either anxiety or depression symptoms.     

Performance on the Test of Memory Malingering in children with neurological conditions

Despite increasing interest in the use of performance validity tests with youth, relatively little is known about how children and adolescents with neurological diagnoses perform on these measures. The purpose of this study was to examine performance on the Test of Memory Malingering (TOMM) in a general pediatric neurologic sample. Data were obtained from 266 consecutive patients (mean age = 13.0, SD = 3.7, range = 5–18) referred for a neuropsychological assessment in a tertiary care pediatric hospital. As part of a broader neuropsychological battery, patients were administered the TOMM. In this sample, 94% of children passed the TOMM. Pass rate was 87% for 5–7 year-olds but was ≥ 90% for all other ages. Children with a history of stroke had the lowest pass rate (86%), with other diagnostic groups scoring ≥ 90%, including epilepsy, traumatic brain injury, and hydrocephalus. Lower TOMM performance was related to slower processing speed and weaker memory performance. The results support using the TOMM with children and adolescents who have neurological diagnoses. Caution may still be warranted when interpreting scores in those who are younger and/or who have more significant cognitive difficulty.     

Discrepancies among mother,child, and teacher reports: Examining the contributions of maternal depression and anxiety

The relationship between maternal affective symptomatology and discrepancies in maternal reports of child symptoms, relative to teacher and child reports, was evaluated in a community sample of 188 children ages 9–12 years. Mothers, teachers, and children were administered a structured interview about child psychopathology. In general, mothers reported more child behavior problems than children and teachers, regardless of maternal symptomatology. However, maternal affective symptoms were associated with discrepancies between mothers' and daughters' reports and between mothers' and teachers' reports of girls' externalizing symptoms. Furthermore, mothers who reported high levels of both anxiety and depressive symptomatology tended to report a large number of symptoms that were not confirmed by either their daughters or teachers. Findings are discussed as possible evidence of the role of maternal affective symptomatology in both actual increases in child symptomatology and maternal reporting distortions. Although maternal depressive and anxiety symptoms shared variance in reporting discrepancies, only anxiety explained unique variance. Consistent with previous studies, cross-informant agreement was modest to moderate (r= .16 to .50) and all informants reported more behavior problems in boys than in girls. This work was undertaken with the support of National Institute of Mental Health Grants MH43909 and MH46717.     

Test-Retest Reliability of the Spanish Version of the Diagnostic Interview Schedule for Children (DISC-IV)

The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.     

Are the aesthetic preferences towards snake species already formed in pre-school aged children?

This study explores aesthetic preferences towards boa and python species among pre-school children and adults, and compares the ratings between the two groups. A set of snake photographs was presented (56 species) to children and adult respondents. The respondents were asked to select the five most preferred and five least preferred species. The children’s agreement on which species were ‘beautiful’ and which were ‘ugly’ was statistically significant and a positive relationship between the mean ranks provided by children and adults was also found (r = .54, P < .001). Children preferred species with thick necks and inconspicuous heads, usually small species, harmless to children. Large pythons probably posed more danger to children than they did to adults during human evolution in African savannas and therefore we hypothesize that young children’s aesthetic preferences were shaped by natural selection through interactions with dangerous snakes.     

What people believe about memory

Two representative samples of adult Norwegians (n=2000) were asked a set of general and specific questions regarding their beliefs and opinions about human memory. The results indicate that on many questions, such as time of the earliest memories, inhibiting effects of collaboration, and memory for dramatic versus ordinary events, the views of the general public concurred with current research findings, and people in general had realistic views about their own memory performance. On other questions, such as the reliability of olfactory as compared with visual and auditory memory, the memory of small children in comparison with that of adults, the likelihood of repression of adult traumatic memories, and on more general questions such as the possibility of training memory and the capacity limitations of long-term memory, a large proportion of the participants expressed views that are less supported by scientific evidence. Implications of these findings are briefly discussed.     

The Beck Anxiety Inventory: Psychometric Properties with Older Adults

The assessment of anxiety disorders in late life is often hindered by the lack of measures specifically validated with older adults. Because anxiety manifestations may vary across age groups, it is important to design new instruments or validate existing measures with older adults. This study examined the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 281 older adults who were community-dwelling (82.6%) or living in residential care facilities (17.4%). The mean total BAI score was 6.5 (SD = 7.2), indicating minimal anxiety symptomatology in this older sample. There was a trend for older subjects to score higher. Females scored higher than males, and subjects living in a residential facility scored higher than did community dwellers. Item-total correlations were in the moderate range and the internal consistency of the BAI was adequate (alpha = 0.89). A factor analysis yielded a six-factor structure accounting for 64.6% of the variance, with a somatic factor accounting for the largest portion of the variance (32.2%). Because somatic symptoms are more prevalent with aging, such symptoms should not be weighed as heavily in the total BAI score as cognitive or behavioral symptoms. The findings indicate that the BAI is a useful self-report scale for assessing anxiety symptomatology among older adults.     

Relations Among Perceived Control Over Anxiety-Related Events,Worry, and Generalized Anxiety Disorder in a Sample of Adolescents

This study examined the associations among perceived control over anxiety-related events, worry, and both symptoms and diagnoses of generalized anxiety disorder (GAD). The sample was comprised of 140 adolescents (60 girls) between the ages of 10 and 17 years (M _age  = 14.6 years; SD = 2.25) recruited from the general community. Findings were consistent with hypotheses. Self-reported perceived control over anxiety-related events related negatively to worry as well as symptoms and diagnoses of GAD even after accounting for variance associated with age, gender, and negative affectivity. Results are discussed in terms of the theoretical implications that perceived control over anxiety-related events may have for understanding GAD symptomatology among youth.     

Concurrent Validity Studies of the Facial Discrimination Task

We examined the concurrent validity properties of the Facial Discrimination Task (FDT), an instrument for the assessment of facial emotion recognition by comparing it with the widely used Pictures of Facial Affect (PFA). In Study 1, 100 adults with heterogeneous psychiatric diagnoses were administered items of the FDT Emotion Task, the FDT Age Task, and PFA. In Study 2, 25 normally developing preschool children were instructed to label happy, sad, or neutral facial expressions from the FDT and the PFA. Despite methodological differences between the two studies, very similar and high correlations were found between the FDT and the PFA overall correct scores (r = .79 and r = .77, respectively). The data suggest that the FDT and the PFA measure similar competencies in preschoolers and in adults with psychiatric disorders. This finding is important because it establishes the concurrent validity of the FDT in child and adult populations.     

Diagnosis and Treatment of Adults With Attention Deficit Hyperactivity Disorder

It is estimated that between 30% and 50% of children diagnosed with attention deficit hyperactivity disorder (ADHD) will continue to exhibit symptomatology that is disruptive throughout their adult lives. Identification and diagnosis of adult ADHD, as well as primary and secondary characteristics and comorbid disorders, are discussed in this article. Counseling strategies are suggested to help clinicians treat adults with ADHD, such as educating the client about the disorder and providing training in attention management techniques, self-management skills, interpersonal and social skills, stress and time management, anger management, and problem-solving skills. Clinicians are encouraged to prepare themselves for understanding, identifying, diagnosing, and treating the adult population with ADHD.     

Mental Health and Incarcerated Youth. I: Prevalence and Nature of Psychopathology

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the prevalence of psychopathology and level of behavioral symptomatology in incarcerated youth versus youth receiving community mental health services or hospitalization. We randomly recruited youth from middle South Carolina served by a local CMHC (n = 60), youth served by the state adolescent inpatient program (n = 50), and youth in the S.C. Dept. of Juvenile Justice facilities from the same region (n = 75). We used the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and the CBCL and YSR to evaluate behavioral symptomatology. On the DISC, incarcerated youth had significantly higher mean number of diagnoses and symptoms than CMHC youth, but lower numbers than hospitalized youth. Level of caseness (at least one diagnosis) was 86% in hospital youth, 72% in incarcerated youth, and 60% in CMHC youth. The groups differed in CBCL mean total T, internalizing T, and externalizing T scores as well as mean YSR internalizing T scores. Our results indicate the comparability in level of psychopathology in incarcerated and community-treated populations of youth, and the need to develop diversionary programs to prevent the entry of such youth into the juvenile justice system.     

The frequency and significance of additional self-reported psychiatric diagnoses in children with attention deficit disorder

The frequency of additional self-reported diagnoses in a large, heterogeneous sample of attention defiict disorder (ADD) children (N=182)was determined using the Diagnostic Interview for Children and Adolescents (DICA). Over half the children had additional DICA diagnoses, with oppositional disorder and anxiety/mood disorders the most frequent. ADD boys with internalizing-type diagnoses had lower verbal IQs and arithmetic scores and performed more poorly on attention tasks than those without; parents also rated them more adversely. Those with externalizing- type diagnoses were rated as more aggressive by teachers and had sociopathic, thrill- seeking profiles on paper-pencil self-ratings. Over 40% of the children were dyslexic or slow learners but they had no higher rate of DICA diagnoses than those who read adequately.This research was supported by NIMH grant R01-MH39189 and by the Marie Wilson Howells Fund. The authors are grateful to the Chid Study Center staff who assisted in recruiting and evaluating subjects and to the Behavioral Laboratory team members who collected and analyzed the data.     

Who benefits from psychotherapies for adult depression? A meta-analytic update of the evidence

It is not clear whether specific target groups for psychotherapies in adult depression benefit as much from these treatments as other patients. We examined target groups that have been examined in randomized trials, including women, older adults, students, minorities, patients with general medical disorders, and specific types of depression, and we examined where patients were recruited. We conducted subgroup and multivariate metaregression analyses in a sample of 256 trials (with 332 comparisons) comparing psychotherapy with an inactive control condition. Only 22% of the studies had low risk of bias (RoB), heterogeneity was high and there was a considerable risk of publication bias. A meta-regression analysis among low RoB studies showed that effect sizes found for studies among women, older adults, patients with general medical disorders, patients recruited from primary care, and patients scoring above a cut-off on a self-rating depression scale, did not differ significantly from effect sizes from other studies. For other target groups, the number of low RoB studies was too small to draw any conclusion. We found few indications that psychotherapies for adult depression are more or less effective in women, older adults, patients with comorbid general medical disorders, and primary care patients.     

Reliability of diagnosis in older psychiatric patients using the structured clinical interview for DSM-III-R

We conducted one of the few studies that has examined the reliability of the Structured Clinical Interview for DSM-III-R Axis I (SCID-I) with a mixed inpatient and outpatient population of adults 55 years old and over (range, 56–84 years; mean, 67.33 years). All SCID interviews were videotaped or audiotaped and were administered by Master's-level clinicians working toward their doctorate degrees in clinical psychology. Interrater reliability estimates (kappa and percentage agreement) were calculated for current major depressive episode (47% base rate) and the broad diagnostic categories of anxiety disorders (15% base rate) and somatoform disorders (12% base rate). Kappa values were .70, .77, and 1.0. Respective percentage agreement was 85% for major depression, 94% for anxiety disorders, and 100% for somatoform disorders. Overall percentage agreement was 91%. We conclude that the SCID-I can be effectively administered by relatively inexperienced clinicians to diagnose older psychiatric patients reliably. Directions that future research might take are offered.     

Identification of Oppositional Defiant Disorder in Young Adult College Students

Long-considered a disorder restricted to children and adolescents, more research is needed to understand how oppositional defiant disorder (ODD) affects adults. Recent research suggests that symptoms of ODD persist into adulthood and are associated with specific negative functional outcomes. This current study seeks to investigate the prevalence and associated impairments of ODD symptoms in young adults. Two large samples of college students between the ages of 18–24 years old (N =?1792; N =?1497) completed self-report measures of ODD symptoms, ADHD symptoms, psychiatric diagnoses, and functional impairments. Rates and internal consistency of ODD symptoms were calculated, and multiple regression was used to estimate the association between high levels of ODD severity scores and social and authority-related impairments, as well as online antagonistic behavior. In the two samples, the proportion of individuals reporting four or more symptoms of ODD was estimated to be 3.39 and 4.12% respectively, and did not vary significantly by gender. Higher ODD severity was associated with social impairment, online antagonistic behavior, and greater conflict with authority figures, even after controlling for ADHD symptoms and self-reported depression or anxiety diagnoses. ODD symptoms measured in college students demonstrate acceptable reliability and are uniquely associated with specific impairments. The findings from this study support greater consideration of ODD symptoms in adult populations.     

A construction based analysis of child directed speech

The child directed speech of twelve English‐speaking motherswas analyzed in terms of utterance‐level constructions. First, the mothers' utterances were categorized in terms of general constructional categories such as Wh‐questions, copulas and transitives. Second, mothers' utterances within these categories were further specified in terms of the initial words that framed the utterance, item‐based phrases such as Are you …, I'll …, It's …, Let's …, What did … The findings were: (i) overall, only about 15% of all maternal utterances had SVO form (most were questions, imperatives, copulas, and fragments); (ii) 51% of all maternal utterances began with one of 52 item‐based phrases, mostly consisting of two words or morphemes (45% began with one of just 17 words); and (iii) children used many of these same item‐based phrases, in some cases at a rate that correlated highly with their own mother's frequency of use. We suggest that analyses of adult–child linguistic interaction should take into account not just general constructional categories, but also the item‐based constructions that adults and children use and the frequency with which they use them.