Harmonized Phenotypes for Anxiety,Depression, and Attention-Deficit Hyperactivity Disorder (ADHD)

In multi-cohort consortia, the problem often arises that a phenotype is measured using different questionnaires. This study aimed to harmonize scores based on the Child Behaviour Check List (CBCL) and the Strength and Difficulties Questionnaire (SDQ) for anxiety/depression and ADHD. To link the scales, we used parent reports on 1330 children aged 10–11.5 years from the Raine study on both SDQ and CBCL. Harmonization was done based on Item Response Theory. We started from existing CBCL and SDQ scales related to anxiety/depression and ADHD (theoretical approach). Next, we conducted a data-driven approach using factor analysis to validate the theoretical approach. Both approaches yielded similar scales, validating the combination of existing scales. In addition, we studied the impact of harmonized (IRT-based) scores on the statistical power of the results in meta-analytic gene-finding studies. The results showed that the IRT-based harmonized scores increased the statistical power of the results compared to sum scores, even with an equal sample size. These findings can help future researchers to harmonize data from different samples and/or different questionnaires that measure anxiety, depression, and ADHD, in order to obtain the larger sample sizes, to compare research results across subpopulations or to increase generalizability, the validity or statistical power of research results. We recommend using our item parameters to estimate harmonized scores that represent commensurate phenotypes across cohorts, and we explained in detail how other researchers can use our results to harmonize data in their studies.

     

The Relationship Between Child-Reported Positive Affect and Parent-Reported Emotional and Behavioral Problems in ADHD Youth

Although the adaptive role of positive affect (PA) in childhood internalizing disorders is well-established, less is known about PA in children with Attention-Deficit/Hyperactivity Disorder (ADHD). In this cross-sectional study, we examined associations between child-reported PA and parent-reported emotional and behavioral problems in youth with ADHD using multiple hierarchical regression analyses. Participants included 848 ethnically diverse youth (253 youth with ADHD, 595 with other or no diagnoses; age range 6.12–19.65) referred for mental health assessments. Study measures included the Child Behavior Checklist (CBCL) and the Positive and Negative Affect Scale for Children (PANAS-C). Results indicated that higher levels of child-reported PA were associated with greater parental reports of total and internalizing problems among youth with ADHD but not in other clinic-referred youth. Specifically, child self-reports of PA were positively associated with parental reports of anxious/depressed and somatic problems in youth with ADHD. In addition, associations between child-reported PA and parent-reported problems differed by type of ADHD comorbidity. Findings suggest that at higher levels, PA in youth with ADHD might exert a paradoxical effect and be a subtle risk factor for or an indicator of parent-reported internalizing problems among youth with ADHD only and youth with ADHD and a comorbid externalizing disorder but not for youth with ADHD and a comorbid internalizing disorder or youth without ADHD. Discrepancies between child-reported PA and parent-reported problems may influence treatment planning and treatment response. Further clinical and theoretical implications for child therapists and parents are discussed.     

Assessing ADHD and comorbid disorders in children: the Child Behavior Checklist and the Devereux Scales of Mental Disorders

Evaluated discriminant validity and clinical utility of selected subscales of the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) and the Child Behavior Checklist (CBCL; Achenbach, 1991a) in 228 children referred to a clinic for the evaluation and treatment of attention deficit hyperactivity disorder (ADHD). The DSMD is a multiaxial behavior rating scale that measures symptomatology for a broad range of child psychopathology as described in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-R-III] and 4th ed. [DSM-IV]; American Psychiatric Association, 1987, 1994). Discriminant function analyses as well as sensitivity, specificity, and predictive power analyses were computed to evaluate the discriminant validity and clinical utility of selected DSMD and CBCL subscales for assessing ADHD, oppositional defiant disorder (ODD), and anxiety disorders. Results indicated that the DSMD compared very favorably with the CBCL in the ability to discriminate between children with ADHD and those without ADHD and between children with comorbid ODD and anxiety disorders and children who did not meet criteria for these disorders. The DSMD Attention subscale may be somewhat better at ruling in ADHD combined subtype (ADHD-C) and ADHD inattentive subtype (ADHD-I) than the CBCL Attention Problems subscale, but the CBCL Attention Problems subscale may have slightly better utility than the DSMD Attention subscale in ruling out these subtypes. Both the CBCL and DSMD were more useful for ruling out than for ruling in ODD and anxiety disorders.     

Six-year stability of parent-reported problem behavior in an epidemiological sample

An epidemiological sample of 936 Dutch children originally aged 4–11 years was assessed at 2-year intervals over a 6-year period. Parents completed the Child Behavior Checklist (CBCL) on all four occasions. Stability coefficients computed for eight CBCL syndromes, Internalizing and Externalizing dimensions, and total problems revealed considerable long-term stability. There was no significant difference in the 6-year stability of internalizing vs. externalizing scores. This finding was at odds with reports of considerably lower stability of internalizing behavior, and was consistent with findings suggesting that the stability of internalizing problems should not be underestimated. The magnitude and specificity of the long-term stability of internalizing and externalizing scores lends support to the validity of these behavioral dimensions as tapped by the CBCL. No significant sex or age differences in the stability of problem behaviors were found.     

Measurement Equivalence of the Child Behavior Checklist among Parents of African American Adolescents

The Child Behavior Checklist (CBCL/6-18) is a widely used parent-report measure of youth internalizing and externalizing problems. Accumulating evidence, however, suggests that the CBCL may not adequately assess clinical problems in diverse populations. We investigated the measurement equivalence (ME) of the CBCL in an African American adolescent sample (N = 145). Confirmatory factor analysis indicated poor factor model fit; however, modification indices and an alternative two-factor model produced improved fit statistics. Internal consistency coefficients of CBCL scales ranged from α = .65 to .88 and were generally lower than those reported for the normative sample. The CBCL exhibited convergent validity with conceptually similar scales on the Parent Report Scale of the Behavior Assessment System for Children; however, the correlations were weaker than those reported for the normative sample. The CBCL Internalizing composite failed to predict clinician-rated Emotional problems, however, the Externalizing composite predicted clinician-rated behavior problems. In summary, the CBCL did not exhibit unequivocal evidence of ME, as it both possesses and lacks a number of statistical attributes that would demonstrate its equivalence with African Americans. Future empirical and theoretical work is discussed.     

Test-retest reliability of the Mirowsky-Ross 2 x 2 Index of the Sense of Control

This study investigated the short-term stability of the 1991 Mirowsky-Ross 2 x 2 Index of the Sense of Control. From an ongoing longitudinal study, 304 subjects were randomly selected for test-retest interviews occurring 1 to 4 days after their regularly scheduled first follow-up interview. Test-retest reliability was assessed at the item level using percent agreement and weighted kappa. At the scale score level, reliability was assessed with the intraclass correlation coefficient (ICC). ICCs were also calculated within categories of demographic, socioeconomic, psychosocial, and functional status characteristics. There was moderate to substantial item-level agreement (mean weighted kappa = 51; weighted kappa range = .38 to .66). At the scale score level there was substantial agreement (ICC = .71). No appreciable differences in ICC values were found in the demographic, socioeconomic, psychosocial, and functional comparisons of status characteristics. Thus, this sense of control measure has acceptable test-retest reliability and is appropriate for use in longitudinal research.     

Child Behavior Checklist Scores for School-Aged Children with Autism: Preliminary Evidence of Patterns Suggesting the Need for Referral

The Child Behavior Checklist (CBCL) is a widely used questionnaire to assess behavioral and emotional problems. It is often used as a diagnostic screener, but autism spectrum disorders (ASD) are not included in the CBCL for school-aged children. This study investigated patterns of CBCL scores in 108 children with high-functioning ASD from two independent samples, and 67 IQ- and age-matched controls. Scores on the CBCL Thought and Social Problems scales significantly differentiated children with ASD from controls. Both independent ASD samples had the same pattern of elevations, with mean scores over two standard deviations above the mean for Social, Thought, and Attention Problems. The Withdrawn/Depressed scale was elevated to at least the borderline clinical range for half of the ASD sample. This pattern of elevations is consistent with two prior studies of the CBCL with school-aged children with ASD, and therefore may warrant follow-up assessment to rule out an ASD.     

Adolescent psychopathy features: 6-year temporal stability and the prediction of externalizing symptoms during the transition to adulthood

This study investigated the 6-year stability and predictive validity of adolescent psychopathy features during the transition to young adulthood. It represents one of the longest outcome studies of youth psychopathy to date, and therefore addresses a primary criticism of the research area (i.e., lack of demonstrated associations between child and adult psychopathy features). Recruited participants were 475 males enrolled in the Minnesota Twin and Family Study who had completed a research-based measure of psychopathy features consisting of separate emotional detachment (or affective) and antisocial tendencies (or behavioral) subscales. These psychopathy features and various externalizing symptoms (i.e., conduct problems, impulsivity, and substance use disorder) were assessed through rating scales and structured diagnostic interview at an intake assessment (ages 16-18) and 6-year follow-up. Consistent with prediction, adolescent psychopathy features displayed moderate stability across the transition from adolescence to adulthood [intraclass correlation coefficients (ICCs) = 0.40-0.41]. The antisocial tendencies subscale was uniquely related to most externalizing symptoms both in adolescence and in adulthood, whereas the emotional detachment subscale showed appropriate discriminant validity in its lack of association with externalizing symptoms. These findings suggest that psychopathy features are relatively stable from adolescence to adulthood and provide possible insights into the development and maintenance of externalizing difficulties during the adult transition.     

An evaluation of the response modulation hypothesis in relation to attention-deficit/hyperactivity disorder

Several hypotheses related to Newman's (e.g., Patterson & Newman, 1993) response modulation hypothesis were examined among adolescents with attention-deficit/hyperactivity disorder (ADHD; n=18) and normal controls (n=23). Consistent with predictions, youth with ADHD committed more passive avoidance errors (PAEs) than controls during the latter trials of a computerized go/no go task with mixed incentives, and this effect remained significant or marginally significant even after common variance associated with variables that covary with ADHD (i.e., IQ, oppositional-defiant/conduct disorder [ODD/CD] symptoms, anxious/depressed mood) was removed. While a moderate inverse association was observed between PAE frequency and the amount of time spent viewing response feedback following punishment, both categorical (diagnostic) and dimensional analyses of ADHD symptomatology indicated that ADHD and reflection on punishment feedback are uniquely associated with PAE commission. Findings from this study are discussed in relation to models of disinhibition applicable to youth with ADHD.     

Concurrent validity in Taiwan of the Comprehensive Developmental Inventory for Infants and Toddlers who were full-term infants

This study investigated the concurrent validity of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) with the Bayley Scales of Infant Development-II (BSID-II) in full-term infants. 106 full-term infants ages 6 to 18 months (63 boys, 43 girls) were recruited as a convenience sample. One tester administered the CDIIT and BSID-II to all children. The Developmental Ages and Developmental Quotients of the motor and the mental scales from both tests were analyzed with Pearson correlations and quadratic weighted kappa tests. The results showed that correlation coefficients for Developmental Ages between both tests on cognitive and motor subtests were high (r = .91-.95) and for Developmental Quotients were moderate (r = .57-.67). Moderate classification agreement was found in the two scales (quadratic weighted kappa = .50-.53). Developmental Quotients classification for the CDIIT tended to be a little higher than for the BSID-II. It was concluded that although acceptable concurrent validity was found for the Motor and Cognitive subtests of the CDIIT, the tester should be cautious to compare Developmental Quotients obtained from the above two tests in clinical or in research settings.     

The ADP-IV questionnaire: differential validity and concordance with the semi-structured interview

The Assessment of DSM-IV Personality Disorders questionnaire (ADP-IV) is a self-report measure of the DSM-IV Axis II personality disorders (PDs). The ADP-IV assesses for each DSM-IV criterion its typicality as well as the accompanying distress and impairment. This study investigates two important aspects of the construct validity of the ADP-IV: (a) the differential validity (i.e., the ability to differentiate between a sample of the general Flemish population ( n = 659) and a sample of psychiatric inpatients ( n = 487) with a high prevalence of clinical PD diagnoses, and patients with and without a PD in the psychiatric sample; (b) the convergent validity with the SCID-II semi-structured interview in a population of psychiatric inpatients ( n = 59). The results indicate a good differential validity: the dimensional scales and the categorical measures discriminated well between both groups and between patients with and without a PD diagnosis in the psychiatric sample. Concerning the concordance with the SCID-II, a decent level of agreement is exemplified by a correlation of.67 between the dimensional total scores of both instruments and by kappa coefficients for an "any" Axis II diagnosis at the.50 level. In conclusion, the results indicate that the ADP-IV is an efficient method for assessing PD in dimensional and categorical ways.     

Emotion Regulation Mediates the Association Between ADHD and Depressive Symptoms in a Community Sample of Youth

The purpose of this study was to examine the longitudinal relationship between attention-deficit/hyperactivity disorder (ADHD) symptoms, emotion regulation (ER) ability, and depressive symptoms within a diverse community sample of 277 youth, ages 9–12 (56 % male). Participants were drawn from a larger study examining adolescent risk behaviors, and completed annual assessments over 3 years. Youth ADHD symptoms were assessed at Time 1 (T1) using the parent-reported Disruptive Behavior Disorders Rating Scale, ER was assessed with the parent-reported Emotion Regulation Checklist at Time 2 (T2), and youth depressive symptoms were assessed using the self-reported Revised Child Anxiety and Depression Scales at Time 3 (T3). Analyses examined T2 ER as a mediator between T1 ADHD symptoms (including the unique contributions of inattentive [IA] versus hyperactive/impulsive [HI] symptoms) and T3 depressive symptoms. Structural equation modeling (SEM) indicated the path model specified provided an excellent fit to the data. Tests of indirect effects suggested that T2 ER appears to be a significant mechanism that underlies the relationship between T1 ADHD and T3 depression, even when accounting for T1 oppositional defiant and depressive symptoms. Furthermore, while both T1 IA and HI symptoms had significant indirect effects on T3 depression through the mechanism T2 ER, HI proved a more robust predictor of T2 ER than IA. Results of this prospective study support cross-sectional findings pointing to ER as a potential mechanism linking ADHD and depressive symptoms in youth. Clinical implications and future directions are discussed.     

Inter-rater and test-retest reliability of the Revised Diagnostic Interview for Borderlines

The baseline inter-rater reliability, test-retest reliability, follow-up inter-rater reliability, and follow-up longitudinal reliability (interrater reliability between generations of raters) of borderline symptoms and the diagnosis of borderline personality disorder (BPD) were assessed using the Revised Diagnostic Interview for Borderlines (DIB-R). Excellent kappa s (> .75) were found in each of these reliability substudies for the diagnosis of BPD itself. Excellent kappa s were also found in each of the three inter-rater reliability substudies for the vast majority of borderline symptoms assessed by the DIB-R. Test-retest reliability for these symptoms was somewhat lower but still very good. More specifically, one-third of the BPD symptoms assessed had a kappa in the excellent range and the remaining two-thirds had a kappa in the fair-good range (.57-.73). The dimensional reliability of BPD symptom areas was somewhat higher than for categorical measures of the subsyndromal phenomenology of BPD. More specifically, all five dimensional measures of borderline psychopathology had intraclass correlation coefficients in the excellent range for all four reliability substudies. Taken together, the results of this study suggest that both the borderline diagnosis and the symptoms of BPD can be diagnosed reliably when using the DIB-R. They also suggest that excellent reliability, once achieved, can be maintained over time for both the syndromal and subsyndromal phenomenology of BPD.     

Does Long-Term Medication Use Improve the Academic Outcomes of Youth with Attention-Deficit/Hyperactivity Disorder?

Youth with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently experience academic impairment, including lower grades than their peers and elevated risk for grade retention and school dropout. Medication is the most commonly used treatment for youth with ADHD, and it is therefore essential to understand the extent to which medication use improves long-term academic functioning. This paper reviews the literature on the relation between long-term medication use and the academic outcomes of youth with ADHD. A systematic literature search was conducted to identify pertinent studies published since 2000 that followed youth with ADHD for 3 or more years. Academic outcomes of interest included school grades, achievement test scores, and grade retention. Nine studies were identified reporting on eight distinct longitudinal samples (N across studies?=?8,721). These studies demonstrate that long-term medication use is associated with improvements in standardized achievement scores. However, the magnitude of these improvements is small and the clinical or educational significance is questionable. Evidence for long-term improvements in school grades and grade retention is less compelling. This review highlights methodological considerations in providing directions for future research. The importance of using multiple sources to gather information about medication adherence is discussed, including use of methodologies such as electronic monitors, rather than relying solely on parent report or chart review. Future research should also examine a range of medication adherence definitions in order to determine whether age of onset, duration of use, dose, and/or consistency of use moderates the relation between long-term medication use and academic outcomes.     

A Study of the Relationship Between Family Interaction and Individual Symptomology Over Time

The study was designed to answer two questions: (a) Can a relationship over time between family interaction and individual symptomatology be demonstrated? (b) Can it be shown that changes in interaction have more influence on changes in the symptom than vice versa. Five interaction dimensions were taped in weekly, three-quarter hour sessions over 20 weeks in five families, each consisting of a mother-father-child triad who met certain criteria and had an encopretic child. The interaction dimension scores were abstracted weekly from these sessions by content analyses relying on various scales. The derived ratio scores were then related to the number of days the child soiled himself in the week preceding and following the interaction measurement. The relationship was assessed by Pearson correlation coefficients and step-wise multiple regression analyses adjusted to account for the possible inflationary effects of taking measures from the same subjects more than once. The results of the analyses answered both questions posed by the study in the affirmative, thus supporting the rationale underlying family therapy.     

Interrater reliability of teacher rating scales for children with attention-deficit hyperactivity disorder

Interrater reliability of eight teacher rating scales designed to assess characteristics of attention-deficit hyperactivity disorder was investigated. Coteachers of 46 students completed the rating scales. The students, ages 8–17, were designated as having a Serious Emotional Disturbance. The resulting interrater reliability correlation coefficients ranged from .62 to .87. The percentage of variance shared between raters ranged from a low of 38.4% (the ACTeRS Oppositional factor and the CBCL-TRF Attention Problems factor) to 75.7% (ADHD Rating Scale). The percent of shared variance was higher for younger children. Kappa scores evaluating rater agreement were highest at the two standard deviations above the mean cutoff. The reliability coefficients were consistent with those reported in prior research.     

Demographic Influences on Psychiatric Diagnoses Among Youth Served in California Systems of Care

We examined the influences of demographic factors on diagnostic assignment among youth served in California public mental health systems after adjusting for the effects of county characteristics and standardized symptom and functioning indices. The sample consisted of 12,106 youth with severe emotional disturbance being served in integrated and coordinated service systems in 13 counties of California. African Americans were overrepresented in the sample relative to the ethnic characteristics of the counties and Asian Americans were under-represented. Results from logistic regression analyses showed that gender, age, and ethnicity affected the assignment of eight categories of clinical diagnosis at admission. However, standardized measurement of clinical status and functioning had little relationship to clinicians' assignment of diagnosis. Whereas no significant gender and age differences were found on broadband CBCL syndromes, ethnically diverse youth differed on CBCL internalizing and externalizing scores. Youth's role functioning as assessed by the CAFAS also significantly differed by gender, age, and ethnicity.     

The reliability and predictive ability of the Test of Infant Motor Performance (TIMP) in a community-based study in Bhaktapur,Nepal

AimIn a Nepalese setting, to measure the reliability of the Test of Infant Motor Performance (TIMP) and its ability to predict development scores at 6 months.MethodsNepalese infants (n = 705) were assessed by the TIMP when they were 8–12 weeks old and the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 6 months. Inter-rater agreement was expressed by intraclass correlation coefficients (ICCs), the internal consistency by Cronbach’s alphas and Pearson correlation coefficients. Predictive ability was estimated in linear regression models.ResultsInter-rater agreement was excellent (ICCs > 0.93). Alphas for the TIMP total scores were 0.76 for infants born to term and 0.72 in those born preterm. Correlation coefficients between TIMP total and Bayley-III subscale-scores ranged from 0.05 to 0.28 for term infants and from 0.15 to 0.43 for preterm infants. Using American norms, 56.3 % had TIMP scores within average and 43.7 % below average range. Bayley-III subscale scores were lower in children with TIMP scores below the average range, with the strongest estimates for Gross motor and Socio-emotional development.InterpretationThe reliability of the TIMP was acceptable, and the TIMP could be a feasible tool to monitor infant motor development in low-resource settings. Properties of the TIMP differed according to gestational age.     

Mental Health Problems of Displaced War-Affected Adolescents in Northern Uganda: Patterns of Agreement Between Self and Caregiver Assessment

We evaluate caregiver and adolescent concordance on adolescent mental health severity in war-affected Northern Uganda. Data were collected from 628 caregiver-adolescent dyads in two internally displaced persons’ camps. Internalizing and externalizing-type mental health problems were assessed using locally-developed scales. To evaluate concordance, mean caregiver and adolescent scores on each scale were compared using Pearson’s correlation coefficients and within-pair-differences were compared by subtracting caregiver from adolescent responses and using t tests to assess whether these differed from 0. Mental heath problem type and youth/caregiver gender and age were investigated as potential indicators of group differences. Adolescents consistently rated their problems as more severe for internalizing problems and less severe for externalizing problems compared with caregivers. Mothers’ reports exhibited better concordance for internalizing problems while fathers’ and other caregivers’ exhibited better concordance of externalizing problems. Results suggest researchers and program implementers need to be aware of respondent differences when planning studies and services.     

Is the Positive Illusory Bias Illusory? Examining Discrepant Self-Perceptions of Competence in Girls with ADHD

It has been claimed that excessively positive self-perceptions of competence are a key risk factor for concurrent and subsequent impairments in youth with attention-deficit/ hyperactivity disorder (ADHD). We examined whether girls with ADHD demonstrate positive illusory self-perceptions in scholastic competence, social acceptance, and behavioral conduct domains. We then tested, across a five-year longitudinal span, whether (a) such self-perceptions versus (b) the constituent informant ratings or test scores were more strongly predictive of adolescent impairment and positive adjustment. Participants included an ethnically diverse sample of 140 girls with ADHD and 88 comparison girls, aged 6-12 at baseline (M?=?9.0, SD?=?1.7). Girls with ADHD rated themselves as more positive than indicated by external ratings, but these self-reports were still in a negative direction (comparison girls rated themselves as less positive than these indicators). ADHD subtypes were not related to discrepancy scores. Higher rates of depression symptoms were associated with attenuated discrepancy scores. Crucially, measures of actual competence were more strongly associated with adolescent impairment and positive adjustment than were "illusory" self-perceptions for girls with ADHD. Our findings challenge the view that, at least in girls with ADHD, overly positive and "illusory" appraisals of competence are strongly associated with future impairment and adjustment. The key psychometric point is that, in difference or discrepancy scores, the individual components of such scores should be separately examined.