Child-Adolescent Suicidal Potential Index (CASPI): a screen for risk for early onset suicidal behavior

This study's purpose was to develop a reliable and valid self-report questionnaire, the Child-Adolescent Suicidal Potential Index (CASPI), to screen for risk for suicidal behavior in children and adolescents. Four hundred twenty-five child and adolescent psychiatric patients and nonpatients completed the CASPI and other research instruments to rate suicidal and assaultive behavior and symptoms of depression, anxiety, and hopelessness. The 30-item CASPI involves 3 factors (anxious-impulsive depression, suicidal ideation or acts, family distress) that contributed to a unidimensional 2nd-order factor accounting for 59% of the total variance. Internal consistency (alpha) for the total score was .90, and test-retest reliability (ICC) for the total score was .76. Total score distinguished between children and adolescents with different severity of psychopathology and different levels of suicidal and assaultive behavior. Each of the 3 factors had different contributions to discriminating between levels of suicidal status. CASPI total score of 11 distinguished suicidal ideation or acts from nonsuicidal behavior, with sensitivity 70% and specificity 65%. CASPI total score positively correlated with symptom severity of depression, anxiety, and hopelessness.     

Anxiety and Depression Symptoms in Children with Asperger Syndrome Compared with Attention-Deficit/Hyperactivity Disorder and Depressive Disorder

The objective of this study was to examine (a) anxiety and depression symptoms in children with Asperger syndrome (AS) compared to children with attention-deficit/hyperactivity disorder (ADHD) and children with depressive disorder; (b) parental anxiety and depressive symptoms in the three groups; and (c) the association between the anxiety and depression symptoms of children and their parents. The emotional and behavioral problems of 56 children with AS (48 boys, 8 girls, mean age, 9.39 ± 2.01 years) were compared with 56 ADHD children and 56 depressive disorder children, matched for age and sex. Their parents’ anxiety and depression symptoms were also compared. Trait-anxiety and internalizing problems in AS children were higher than those in ADHD children and as high as those in depressive disorder children (F = 8.83, p < 0.001 and F = 8.21, p < 0.001). Parents’ anxiety and depression symptoms did not differ among the three groups, but correlations between maternal anxiety and depression and children’s emotional and behavioral problems were most prominent in the AS group. We suggest that the assessment and treatment of children with AS should involve detailed assessment, possible concomitant treatment for comorbid anxiety and depression, and parental education about the effect of parental emotional states on children.     

Working Memory Mediates Increased Negative Affect and Suicidal Ideation in Childhood Attention-Deficit/Hyperactivity Disorder

Children with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for suicidal ideation and suicide attempts compared to those without ADHD. Increased risk is at least partially attributable to a subset of children with ADHD and comorbid depression or disruptive behavior disorders; however, the early predictors and mechanisms driving increased risk are not well understood. Here, we investigate the contributions of two candidate mechanisms for increased suicidal ideation in children with ADHD: executive function and negative affect. 623 clinically well-characterized, community-recruited children classified by research criteria as ADHD (n = 388) or typically-developing controls (n = 253) participated. Parent-report on the Temperament in Middle Childhood Questionnaire provided a measure of negative affectivity. Children completed laboratory tasks to measure response inhibition and working memory. Suicidal ideation was evaluated by parent report during a semi-structured interview and child responses on the Children’s Depression Inventory. Compared to typically developing controls, children with ADHD had higher rates of suicidal ideation, more negative affect, slower stop signal reaction times, and weaker working memory. Statistical path-model analyses confirmed the hypothesis that weaker working memory in ADHD statistically mediated increased negative affect. Weaker working memory also mediated and increased suicidal ideation in these cross sectional data. Findings were not attributable to comorbid disruptive behavioral disorders. Poor response inhibition did not reliably mediate negative affect or suicidal ideation. Impairment in working memory is an important early risk factor for suicidal ideation in children with ADHD, and may help in identifying children for prevention and early intervention efforts.     

Validity of the parenting scale for parents of children with attention-deficit/hyperactivity disorder

The present study examined the validity of the parenting scale for parents of elementary school-aged children with attention-deficit/hyperactivity disorder (ADHD). Parents from 109 families with children who had been diagnosed with ADHD (106 mothers and 93 fathers) and from 70 families with non-problem children (69 mothers and 59 fathers) completed the parenting scale and reported on their children's behavior problems. Factor analyses revealed two interpretable factors for both mothers and fathers, corresponding to the overreactivity and laxness factors identified in previous studies of the parenting scale. Overreactivity and laxness scores were significantly higher for mothers and fathers of ADHD children than of non-ADHD children; this effect appeared to be accounted for by comorbid aggression and conduct problems among ADHD children. Results support the validity of the parenting scale for use with parents of ADHD children.     

Multimethod Assessment of Psychopathology Among DSM-IV Subtypes of Children With Attention-Deficit/Hyperactivity Disorder: Self-, Parent, and Teacher Reports

Using data based on self-, parent, and teacher reports, we assessed various aspects of psychopathology in a large sample of control children and those with ADHD. Confirmatory factor analysis was employed to extract response bias from latent constructs of aggression, anxiety, attention problems, depression, conduct disorder, and hyperactivity. These latent constructs were then entered into logistic regression equations to predict membership in control versus ADHD groups, and to discriminate between ADHD subtypes. Results of the regression equations showed that higher levels of attention problems and aggression were the best predictors of membership in the ADHD group relative to controls. Logistic regression also indicated that a higher degree of aggression was the only significant predictor of membership in the ADHD-Combined group compared to the ADHD-Inattentive group. However, when comorbid diagnoses of Oppositional Defiant Disorder and Conduct Disorder were controlled for in the logistic regression, greater hyperactivity rather than aggression was the sole variable with which to distinguish the ADHD-Combined from the ADHD-Inattentive subtype. Results are discussed in the context of the DSM-IV ADHD nosology and the role of instrument and source bias in the diagnosis of ADHD.     

Children with ADHD and depression: a multisource, multimethod assessment of clinical, social, and academic functioning

Although ADHD and depression are common comorbidities in youth, few studies have examined this particular clinical presentation. To address method bias limitations of previous research, this study uses multiple informants to compare the academic, social, and clinical functioning of children with ADHD, children with ADHD and depression, and children without ADHD, all derived from a large community sample. High levels of comorbid depression are found in children with ADHD. Children withADHDand depression are more depressed and anxious than their non-depressed ADHDcounterparts but do not have more extreme levels of ADHD or aggression. The association between depression and ADHD does not appear to be epiphenomenal, that is, related to a shared association with anxiety or externalizing symptoms. Finally, children with ADHD and depression display more impairment in social and academic functioning compared to controls. Although social impairment is greater in children with ADHD and depression than in children with only ADHD, conduct problems are not.     

Is the Positive Bias an ADHD Phenomenon? Reexamining the Positive Bias and its Correlates in a Heterogeneous Sample of Children

The goals of this study were to (a) evaluate the presence of the positive bias (PB) in elementary-school-aged children with and without ADHD when PB is defined at the individual level through latent profile analysis and (b) examine the extent to which several correlates (i.e., social functioning, aggression, depression, and anxiety) are associated with the PB. Participants were 233 youth (30% female; 8 to 10 years of age), 51% of whom met criteria for ADHD. During an individual evaluation, children and parents completed a battery of questionnaires to assess child competence, depression, anxiety, and aggression. Children also participated in a novel group session with same-sex unfamiliar peers (half of the group was comprised of children with ADHD) to engage in group problem-solving tasks and free play activities. After the group session, peers and staff completed ratings of each child’s behavior (e.g., likeability, rule following). The best fitting LPA model for parent and self-ratings of competence revealed four profiles: High Competence/Self-Aware; Variable Competence/Self-Aware; Low Competence/Self-Aware; and Low Competence/PB, in which the PB was present across domains. Only 10% of youth showed a PB and youth with ADHD were no more likely to display the PB than their non-ADHD peers with similar levels of low competence. Lastly, the Low Competence/Self-Aware profile demonstrated higher levels of anxiety and depression than the Low Competence/PB profile; the profiles did not differ on aggression or peer or staff ratings of social/behavioral functioning. Implications for understanding the PB in children with and without ADHD are discussed.     

Do boys with attention-deficit/hyperactivity disorder have positive illusory self-concepts?

One hundred ninety-five boys with attention-deficit/hyperactivity disorder (ADHD) were compared with 73 comparison boys (M = 9.83 years, SD = 1.30) on self-perceptions relative to a teacher-rated criterion. Emphasis was placed on ADHD subgroup comparisons according to level of aggression, academic achievement, and depression compared with control boys. Consistent with the authors' prediction, ADHD boys overestimated relative to teacher report, more than did controls, in the scholastic competence, social acceptance, and behavioral conduct domains. Examination of discrepancy scores (child rating - teacher rating) by comorbidity subgroups suggested that aggressive and low-achieving ADHD boys tended to overestimate their competence the most in the domains in which they were the most impaired. Results are discussed in terms of prior literature on "positive illusions" in ADHD children.     

Severity of Emotional and Behavioral Problems Among Poor and Typical Readers

The purpose of this study was to examine the severity of behavioral and emotional problems among adolescents with poor and typical single word reading ability (N = 188) recruited from public schools and followed for a median of 2.4 years. Youth and parents were repeatedly assessed to obtain information regarding the severity and course of symptoms (depression, anxiety, somatic complaints, aggression, delinquent behaviors, inattention), controlling for demographic variables and diagnosis of ADHD. After adjustment for demographic variables and ADHD, poor readers reported higher levels of depression, trait anxiety, and somatic complaints than typical readers, but there were no differences in reported self-reported delinquent or aggressive behaviors. Parent reports indicated no differences in depression, anxiety or aggression between the two groups but indicated more inattention, somatic complaints, and delinquent behaviors for the poor readers. School and health professionals should carefully assess youth with poor reading for behavioral and emotional symptoms and provide services when indicated.     

Indications of depression and distress in divorce and nondivorce children reflected by the Rorschach test

The appearance of depressive features, as reflected by responses to the Rorschach test, were explored in two groups of children from divorced and nondivorced families (referred to here as divorce and nondivorce children). The relationships between the depression scores and the children's hostility, aggression, and anxiety levels were also studied. The Rorschach Inkblot Test was individually administered to a nonclinical sample of 108 Swedish school children between 10 and 12 years old. The subjects constituted two groups, a divorce group (27 girls, 27 boys) and a nondivorce group (27 girls, 27 boys). Divorce children scored significantly higher on Exner's (1986) Depression Index than their nondivorce peers. Furthermore, divorce children with depressive features in their Rorschach responses were found to have a high level of hostility and aggression (as manifested in their Rorschach protocols), whereas no such associations were found among nondivorce children.     

The Moderating Role of Verbal Aggression on the Relationship Between Parental Feedback and Peer Status Among Children with ADHD

We examined associations between children's sociometric status and (a) observed parental feedback as well as (b) child aggression. Participants were 94 children ages 6-10 (64 male; 44 with ADHD) and their parents. Children's peer status, parental feedback to their children, and child aggression were all assessed during lab-based playgroups of four children and their parents. Parent criticism in front of the child's peers was associated with the child receiving more negative ("disliked") and fewer positive ("liked") nominations, but only for children who displayed aggression; this interaction applied almost exclusively to children with ADHD. Parent praise in front of peers was associated with fewer negative nominations when children displayed low levels of aggression, but more at higher levels. Additional analyses revealed that relationships did not exist in the full sample between privately-given parental feedback and children's peer status. Processes by which peers use overheard adult feedback to inform their assessments of children are discussed.     

Learning, attention, writing, and processing speed in typical children and children with ADHD, autism, anxiety, depression, and oppositional-defiant disorder.

Learning, attention, graphomotor, and processing speed scores were analyzed in 149 typical control children and 886 clinical children with normal intelligence. Nonsignificant differences were found between control children and children with anxiety, depression, and oppositional-defiant disorder. Control children performed better than children with ADHD and autism in all areas. Children with ADHD and autism did not differ, except that children with ADHD had greater learning problems. Attention, graphomotor, and speed weaknesses were likely to coexist, the majority of children with autism and ADHD had weaknesses in all three areas, and these scores contributed significantly to the prediction of academic achievement.     

Learning,Attention, Writing,and Processing Speed in Typical Children and Children with ADHD,Autism, Anxiety,Depression, and Oppositional-Defiant Disorder

Learning, attention, graphomotor, and processing speed scores were analyzed in 149 typical control children and 886 clinical children with normal intelligence. Nonsignificant differences were found between control children and children with anxiety, depression, and oppositional-defiant disorder. Control children performed better than children with ADHD and autism in all areas. Children with ADHD and autism did not differ, except that children with ADHD had greater learning problems. Attention, graphomotor, and speed weaknesses were likely to coexist, the majority of children with autism and ADHD had weaknesses in all three areas, and these scores contributed significantly to the prediction of academic achievement.     

Aggression and the Risk for Suicidal Behaviors among Children

Two subtypes of aggression—reactive and proactive—were examined to see how they relate to suicidal behaviors among young children admitted for acute psychiatric inpatient care. The children and their parents completed self‐report questionnaires/interviews. Regression analyses revealed that depressed girls who scored higher on reactive aggression reported more suicidal behaviors; whereas proactive aggression did not relate to suicidal behaviors for either boys or girls.     

Aggression Among Children with ADHD,Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

Competing hypotheses for explaining the role of anxiety in the relation between attention-deficit/hyperactivity disorder (ADHD) symptoms and childhood aggression were evaluated. Two studies tested whether anxiety exacerbated, attenuated, or had no effect on the relation between ADHD and aggression subtypes among psychiatrically hospitalized children. In Study 1 (N = 99), children who scored above clinical cut-off levels for anxiety only, ADHD only, and co-occurring ADHD and anxiety were compared on aggression subtypes (i.e., reactive, proactive, overt, and relational aggression). In Study 2, the moderating role of anxiety on the relation between ADHD and aggression subtypes was examined with a larger sample (N = 265) and with continuous variables. No support was found for either the attenuation or exacerbation hypothesis, and results remained consistent when separately examining hyperactivity/impulsivity and inattention symptoms of ADHD. Although ADHD symptoms were significantly associated with all aggression subtypes, this association did not remain when including symptoms of oppositional defiant disorder.     

Comorbidity of Attention Deficit Hyperactive Disorder (ADHD) and major depression in primary school children

The study investigated comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and depression in a sample of rural primary school children in Limpopo Province, South Africa. A total of 320 learners participated in this study of whom 160 learners had teacher and parent identified ADHD symptoms (females?=?50%; age range 6–14 years). All the learners took the Beck Depression Youth Inventory, second edition. Data were analysed applying ANOVA to investigate the possible differences between and within age, gender, and ADHD subtype group differences in depression symptomatology. Results indicated no statistically significant differences in the scores on the depression scale between the children with ADHD as identified by parents and teachers and the comparison group peers.     

Depression, suicide ideation, and aggression among high school students whose parents are divorced and use alcohol at home.

106 high school students from a small rural high school completed the Children of Alcoholics Scale, Zaks and Walters' Aggression Scale, Beck Depression Scale, and a modified version of the Beck Scale of Suicide Ideation. Analyses of variance showed boys were not experiencing suicide ideation any more than girls; suicide ideation was similar across the four grades, but on aggression alcohol-dependent boys scored significantly higher than girls, and in Grade 9 boys' scores were significantly higher than those in Grade 10. The sophomores' scores on alcohol dependency were significantly lower than the freshmen's scores. Boys and children from divorced homes had higher scores on aggression than girls and children from nondivorced homes. Children from homes in which alcohol was used had higher depression scores than children from nonalcoholic homes. Freshman girls and sophomore boys had higher depression scores than senior boys and girls. A Pearson r of 0.28 between scores on alcohol dependency and suicide ideation was significant, but research is needed to understand better the associations of thoughts of suicide and drug-alcohol dependency among these high school students so strategies for prevention and intervention can be focused.     

Directory of Members of the Society for Projective Techniques as of March 1, 1964

The appearance of depressive features, as reflected by responses to the Rorschach test, were explored in two groups of children from divorced and nondivorced families (referred to here as divorce and nondivorce children). The relationships between the depression scores and the children's hostility, aggression, and anxiety levels were also studied. The Rorschach Inkblot Test was individually administered to a nonclinical sample of 108 Swedish school children between 10 and 12 years old. The subjects constituted two groups,, a divorce group (27 girls, 27 boys) and a nondivorce group (27 girls, 27 boys). Divorce children scored significantly higher on Exner's (1986) Depression Index than their nondivorce peers. Furthermore, divorce children with depressive features in their Rorschach responses were found to have a high level of hostility and aggression (as manifested in their Rorschach protocols), whereas no such associations were found among nondivorce children.     

Experiences of physical and relational victimization in children with ADHD: The role of social problems and aggression

The social risk factors for physical and relational peer victimization were examined within a mixed‐gender sample of children with and without attention‐deficit/hyperactivity disorder (ADHD). Participants were 124 children (ages 8–12 years; 48% boys), with 47% exhibiting sub‐clinical or clinical elevations in ADHD symptoms. ADHD and oppositional defiant disorder (ODD) symptom counts were assessed based on parent‐ and teacher‐reports; parents rated children's social problems and teachers rated children's use of physical and relational aggression and experiences of physical and relational victimization. A multiple mediator model was used to test whether there were indirect effects of ADHD or ODD symptoms on physical and relational victimization through social problems, physical aggression, or relational aggression. At the bivariate level, ADHD and ODD symptoms were both significantly associated with higher rates of physical and relational victimization. In the mediational model, there were significant indirect effects of ADHD symptoms on relational victimization via social problems, of ODD on relational victimization via relational aggression, and of ODD symptoms on physical victimization via physical aggression. Results suggest that there are distinct risk factors implicated in the physical and relational victimization of youth with ADHD and that the co‐occurrence of ODD symptoms is important to assess. Clinical implications for addressing victimization in children with ADHD are discussed.

     

Attention control in middle childhood: relations to psychopathological symptoms and threat perception distortions

The present study examined the construct of attention control, which is an important aspect of effortful control, in a sample of non-clinical children aged between 9 and 13 years. Results demonstrated that attention control was associated with a broad range of psychopathological complaints, including symptoms of anxiety, aggression, depression, and ADHD. As predicted, lower levels of attention control were accompanied by higher levels of these symptoms. Further, attention control was also negatively related to threat perception distortions, which indicates that children who display low levels of this regulative temperament factor are more prone to such cognitive biases. Third, when controlling for neuroticism, attention control remained significantly (negatively) associated with symptoms of anxiety, depression (child report only), and ADHD. The correlations between attention control and threat perception distortions largely disappeared when the influence of neuroticism was partialled out. Only the link between attention control and anxious interpretations of ambiguous vignettes survived this correction. Finally, no evidence was found for the hypothesised mediating role of cognitive distortions on the relation between temperament factors and psychopathological symptoms.