Mind the gap: assessing impairment among children affected by proposed revisions to the diagnostic criteria for oppositional defiant disorder

The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) workgroup for disruptive behavior disorders is considering adopting a frequency threshold for symptoms of oppositional defiant disorder (ODD). In the present study, the impact of substituting the term "often" with a specific age-based frequency on impairment and prognosis among preschool children was tested in a longitudinal design. Mutually exclusive groups were created to identify children who met criteria for ODD based on a symptom threshold of "often," as in Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-4), and those that met criteria for ODD based on a threshold of "1-2 times per day," which approximated the proposal for DSM-5. Comparisons of these groups to each other and to nondiagnosed peers determined the impact of changing the symptom threshold on impairment and prognosis. Close to one-third of children who met DSM-4 criteria for ODD did not meet criteria under the alternative diagnosis; African American children were overrepresented in this group. Preschoolers who met DSM-4, but not the alternative criteria, had higher rates of ODD, conduct disorder (CD), and were more impaired than their nondiagnosed peers at baseline and follow-up. Preschoolers meeting DSM-4 criteria were less impaired than children meeting the alternative ODD criteria at baseline according to parent, but not according to teacher report. No differences could be detected between those meeting DSM-4 and those meeting the alternative criteria in rate of ODD, CD, or impairment at follow-up. Among clinically referred preschool children, changing the symptom threshold for ODD could result in a sizable group of children who would no longer meet diagnostic criteria, despite demonstrating significant morbidity concurrently and prospectively.     

Remapping the cognitive and neural profiles of children who struggle at school

Our understanding of learning difficulties largely comes from children with specific diagnoses or individuals selected from community/clinical samples according to strict inclusion criteria. Applying strict exclusionary criteria overemphasizes within group homogeneity and between group differences, and fails to capture comorbidity. Here, we identify cognitive profiles in a large heterogeneous sample of struggling learners, using unsupervised machine learning in the form of an artificial neural network. Children were referred to the Centre for Attention Learning and Memory (CALM) by health and education professionals, irrespective of diagnosis or comorbidity, for problems in attention, memory, language, or poor school progress (n = 530). Children completed a battery of cognitive and learning assessments, underwent a structural MRI scan, and their parents completed behavior questionnaires. Within the network we could identify four groups of children: (a) children with broad cognitive difficulties, and severe reading, spelling and maths problems; (b) children with age‐typical cognitive abilities and learning profiles; (c) children with working memory problems; and (d) children with phonological difficulties. Despite their contrasting cognitive profiles, the learning profiles for the latter two groups did not differ: both were around 1 SD below age‐expected levels on all learning measures. Importantly a child's cognitive profile was not predicted by diagnosis or referral reason. We also constructed whole‐brain structural connectomes for children from these four groupings (n = 184), alongside an additional group of typically developing children (n = 36), and identified distinct patterns of brain organization for each group. This study represents a novel move toward identifying data‐driven neurocognitive dimensions underlying learning‐related difficulties in a representative sample of poor learners.     

Transcoding abilities in typical and atypical mathematics achievers: The role of working memory and procedural and lexical competencies

Transcoding between numerical systems is one of the most basic abilities acquired by children during their early school years. One important topic that requires further exploration is how mathematics proficiency can affect number transcoding. The aim of the current study was to investigate transcoding abilities (i.e., reading Arabic numerals and writing dictation) in Brazilian children with and without mathematics difficulties, focusing on different school grades. We observed that children with learning difficulties in mathematics demonstrated lower achievement in number transcoding in both early and middle elementary school. In early elementary school, difficulties were observed in both the basic numerical lexicon and the management of numerical syntax. In middle elementary school, difficulties appeared mainly in the transcoding of more complex numbers. An error analysis revealed that the children with mathematics difficulties struggled mainly with the acquisition of transcoding rules. Although we confirmed the previous evidence on the impact of working memory capacity on number transcoding, we found that it did not fully account for the observed group differences. The results are discussed in the context of a maturational lag in number transcoding ability in children with mathematics difficulties.     

Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents

This study aimed to describe the course of early onset eating disorders in a population-based sample followed from 14 to 20 years; identify variables that could account for the persistence of eating disorders from 14 to 20 years; and describe outcome of early onset eating disorders with reference to general and psychological functioning at age 20. Participants (N?=?1,383; 49 % male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to young adulthood. Eating disorder symptoms were assessed using an adapted version of the Eating Disorder Examination-Questionnaire, at ages 14, 17 and 20. At age 14, 70 participants met DSM-IV criteria for a binge eating or purging eating disorder. Nearly half (44 %) of these adolescents ceased to meet criteria for an eating disorders at ages 17 and 20, whilst one-quarter still met criteria for an eating disorder at age 20 and one-fifth met criteria for an eating disorder at all three time points. Purging at age 17 and externalising behaviour problems at age 14 were the strongest predictors of eating disorder persistence to age 20. Participants who experienced a persistent eating disorder were less likely to complete high school than other participants, and reported pronounced depressive and anxiety symptoms at age 20. This study provides new data the course and outcome of early onset eating disorders at a population level. Behavioural difficulties in early adolescence and purging in middle adolescence may predict persistent eating pathology to young adulthood.     

A population-based 2-year longitudinal study of insomnia disorder in a Chinese population in Hong Kong

There is a paucity of literature examining the longitudinal course of insomnia using standardized diagnostic criteria. This study aims to evaluate the persistence, remission, relapse, and incidence rates of insomnia symptoms and insomnia disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th edition (DSM-IV and DSM-5). A total of 398 community dwellers were interviewed annually over two years using the Brief Insomnia Questionnaire, a validated questionnaire for deriving insomnia diagnoses. Normal sleepers were defined according to the DSM-5 quantitative criteria as having insomnia symptoms at most twice per week. Estimates were weighted against population age and sex distribution. Persistence for two consecutive years was 26.3, 26.4, and 23.0% for insomnia symptoms, DSM-IV, and DSM-5 insomnia disorders; remission rate was 55.8, 22.9, and 26.1%, relapse rate was 21.8, 1.3, and 0%, while incidence rate was 62.4, 19.6, and 4.5%. The common trajectories for DSM-IV insomnia disorder were to remain the same (26.4%), followed by a change to insomnia symptoms at the second year (25.7%), and at the third year (17.3%). For DSM-5 insomnia disorder, a change to insomnia symptoms at the second year was the commonest (28.3%), followed by continuing the same (23.0%), and a change to insomnia symptoms at the third year (14.0%). Over a two-year naturalistic follow-up, persistence of insomnia disorder was roughly 25%. Changes from insomnia disorder to insomnia symptoms were common; however, remission only occurred in about 25%, highlighting the chronic course of insomnia, perhaps due to a lack of treatment, under-treatment, or resistance to treatment. Incidence of insomnia symptoms was 62.4%, suggesting a high risk of developing insomnia in the general population.     

Prevalence and Function of Non-Suicidal Self-Injury (NSSI) in a Community Sample of Adolescents, Using Suggested DSM-5 Criteria for a Potential NSSI Disorder

Previous prevalence rates of non-suicidal self-injury (NSSI) in adolescents have varied considerably. In the present cross-sectional study, prevalence rates, characteristics and functions of NSSI were assessed in a large randomized community sample consisting of 3,060 (50.5 % female) Swedish adolescents aged 15–17 years. The suggested criteria for NSSI disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5) were used to assess prevalence rates with the aim of arriving at a more precise estimate. Out of the whole sample, 1,088 (35.6 %) adolescents (56.2 % female) reported at least one episode of NSSI during the last year, of which 205 (6.7 %) met suggested DSM-5 criteria for a potential NSSI disorder diagnosis. The NSSI disorder diagnosis was significantly more common in girls (11.1 % vs. 2.3 %, χ ² (1, N?=?3046) = 94.08, p?<?0.001, cOR?=?5.43, 95 % CI [3.73, 7.90]). The NSSI disorder group consisted of significantly more smokers and drug users compared to adolescents with NSSI that did not meet DSM-5 criteria for NSSI disorder, and also differed concerning demographic variables. A confirmatory factor analysis (CFA) was conducted on reported functions of NSSI, with the aim of validating Nock and Prinstein’s (Journal of Consulting and Clinical Psychology 72:885–890, 2004, Journal of Abnormal Psychology 114:140–146, 2005) four-factor model on a Swedish community sample, resulting in a close to acceptable fit. A two-factor model (social and automatic reinforcement) resulted in a slightly better fit. The most frequently reported factors were positive and negative automatic reinforcement. A majority of functions were significantly more often reported by girls than boys. The implications of the suggested DSM-5 criteria and reported functions are discussed.     

Educational consequences of developmental speech disorder: Key Stage 1 National Curriculum assessment results in English and mathematics

Background: Children with speech difficulties may have associated educational problems. This paper reports a study examining the educational attainment of children at Key Stage 1 of the National Curriculum who had previously been identified with a speech difficulty. Aims: (1) To examine the educational attainment at Key Stage 1 of children diagnosed with speech difficulties two/three years prior to the present study. (2) To compare the Key Stage 1 assessment results of children whose speech problems had resolved at the time of assessment with those whose problems persisted. Sample(s): Data were available from 39 children who had an earlier diagnosis of speech difficulties at age 4/5 (from an original cohort of 47) at the age of 7. A control group of 35 children identified and matched at preschool on age, nonverbal ability and gender provided comparative data. Methods: Results of Statutory Assessment Tests (SATs) in reading, reading comprehension, spelling, writing and maths, administered to children at the end of Year 2 of school were analysed. Performance across the two groups was compared. Performance was also compared to published statistics on national levels of attainment. Results: Children with a history of speech difficulties performed less well than controls on reading, spelling and maths. However, children whose speech problems had resolved by the time of assessment performed no differently to controls. Children with persisting speech problems performed less well than controls on tests of literacy and maths. Spelling performance was a particular area of difficulty for children with persisting speech problems.     

Symbolic magnitude processing in elementary school children: A group administered paper-and-pencil measure (SYMP Test)

The ability to compare symbolic numerical magnitudes correlates with children’s concurrent and future mathematics achievement. We developed and evaluated a quick timed paper-and-pencil measure that can easily be used, for example in large-scale research, in which children have to cross out the numerically larger of two Arabic one- and two-digit numbers (SYMP Test). We investigated performance on this test in 1,588 primary school children (Grades 1–6) and examined in each grade its associations with mathematics achievement. The SYMP Test had satisfactory test-retest reliability. The SYMP Test showed significant and stable correlations with mathematics achievement for both one-digit and two-digit comparison, across all grades. This replicates the previously observed association between symbolic numerical magnitude processing and mathematics achievement, but extends it by showing that the association is observed in all grades in primary education and occurs for single- as well as multi-digit processing. Children with mathematical learning difficulties performed significantly lower on one-digit comparison and two-digit comparison in all grades. This all suggests satisfactory construct and criterion-related validity of the SYMP Test, which can be used in research, when performing large-scale (intervention) studies, and by practitioners, as screening measure to identify children at risk for mathematical difficulties or dyscalculia.     

干预-应答模式鉴别学习障碍的有效性及其调节因素:20年研究的元分析

本研究采用元分析方法探讨在学习障碍的鉴别中兴起的干预-应答（Response to Intervention,RTI）模式鉴别学习障碍内部亚组的有效性及其调节因素。通过系统检索1996-2015年的文献,获得了34项研究,包括6127名学生的45个样本、261个效应值。元分析结果表明,RTI模式可有效区分学习障碍风险儿童的内部亚组,对干预无应答和有应答的学生在学业成就、认知技能、行为等多方面存在系统、显著和持久的差异,但仍存在个体应答状态的进一步分化。RTI模式对于学习障碍风险儿童内部变异的区分效果受到干预对象、干预层次、干预时间、应答指标选择、测量方法和切分点等因素的影响。本元分析结果不仅为认识RTI模式鉴别学习障碍的有效性提供了进一步证据,更重要的是通过系列调节效应分析,为合理实施RTI模式鉴别学习障碍提供了直接依据。     

Use of operational criteria in an office practice for diagnosis of children referred for evaluation of learning or behavior disorders

100 consecutively referred school-age children were evaluated for learning or behavior disorders. 45 children had one of three classical neurological syndromes of epilepsy, sensorineural deafness, or childhood migraine. The 26 children with epilepsy required medication adjustment to improve behavior or learning. Operational criteria for childhood depression, specific learning disability, developmental hyperactivity, and Gilles de la Tourette syndrome were used to establish the correct diagnosis in 55 children. 32 children had a single diagnosis, while 23 children fulfilled the criteria of two diagnostic categories. The diagnostic categorization permitted specific counseling of the child and family, development of a proper school program, and correct pharmacotherapy (when indicated).     

Developmental dynamics between mathematical performance,task motivation,and teachers' goals during the transition to primary school

Background. It has been suggested that children's learning motivation and interest in a particular subject play an important role in their school performance, particularly in mathematics. However, few cross‐lagged longitudinal studies have been carried out to investigate the prospective relationships between academic achievement and task motivation. Moreover, the role that the classroom context plays in this development is largely unknown. Aims. The aim of the study was to investigate the developmental dynamics of maths‐related motivation and mathematical performance during children's transition to primary school. The role of teachers' pedagogical goals and classroom characteristics on this development was also investigated. Sample. A total of 196 Finnish children were examined four times: (0) in October during their preschool year; (1) in October and (2) April during their first grade of primary school; and (3) in October during their second grade. Method. Children's mathematical performance was tested at each measurement point. Task motivation was examined at measurement points 2, 3, and 4 using the Task‐value scale for children. First‐grade teachers were interviewed in November about their pedagogical goals and classroom characteristics. Results and conclusions. The results showed that children's mathematical performance and related task motivation formed a cumulative developmental cycle: a high level of maths performance at the beginning of the first grade increased subsequent task motivation towards mathematics, which further predicted a high level of maths performance at the beginning of the second grade. The level of maths‐related task motivation increased in those classrooms where the teachers emphasized motivation or self‐concept development as their most important pedagogical goal.     

Eine erfolgreiche Behandlunsgkette bei Zwangsstörung

Obsessive-compulsive disorder (OCD) belongs to a group of disorders with an estimated lifetime prevalence of 2?%, associated with a high socio-economic burden and the risk of chronification. In the latest version of the DSM-5, OCDs were detached from the chapter of anxiety disorders, similar to the ICD-10. Consequently, the fifth revision of the DSM highlights the fact that scientific results so far, like the overactivation of basal-ganglia thalamocortical circuits, basically support a common model for OCDs. Although in the past, OCDs have been ignored as a diagnostic entity, in the DSM-5, the concept of obsessive–compulsive spectrum disorders according to Hollander was partly realized. The present case report outlines an example of a successful therapeutic chain in the treatment of a severe case of OCD with a 90?% reduction of symptoms throughout a calendar-year, emphazising the importance of efficient treatment chains within psychiatric disorders.     

Does DSM-IV Asperger's Disorder Exist?

DSM-IV criteria for autistic and Asperger's disorders were applied to 157 children with clinical diagnoses of autism or Asperger's disorder. All children met the DSM-IV criteria for autistic disorder and none met criteria for Asperger's disorder, including those with normal intelligence and absence of early speech delay. The reason for this was that all children had social impairment and restricted and repetitive behavior and interests (required DSM-IV symptoms for both autistic and Asperger's disorders) and all had a DSM-IV communication impairment (which then qualified them for a diagnosis of autistic disorder and not Asperger's disorder). Communication problems exhibited by all children were impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both), which are DSM-IV criteria for autism. These findings are consistent with those of 5 other studies and indicate that a DSM-IV diagnosis of Asperger's disorder is unlikely or impossible.     

Diagnosis and Treatment of Children and Adolescents With Attention‐Deficit/Hyperactivity Disorder

Attention‐deficit/hyperactive disorder (ADHD) has been estimated to affect between 3% and 5% of school‐age children. The disorder frequently has a profound effect on a child's personal, social and academic development and is a risk factor in the development of other comorbid disorders. Diagnostic criteria and methods for identification of ADHD will be presented. Major intervention strategies appropriate for school and community settings are outlined. Because ADHD is 1 of the most common reasons for referral in both school and community agencies, it is important that clinicians be prepared to provide accurate diagnosis and intervention recommendations.     

Performance Indicators in Math: Implications for Brief Experimental Analysis of Academic Performance

Brief experimental analysis (BEA) can be used to specify intervention characteristics that produce positive learning gains for individual students. A key challenge to the use of BEA for intervention planning is the identification of performance indicators (including topography of the skill, measurement characteristics, and decision criteria) that meaningfully relate to longer term success in the learning environment. This study investigates the utility of various curriculum-based assessment and measurement estimates of mathematics performance for predicting functional outcomes (i.e., retention of learned skills over time and faster learning of related content in the future). All children in grades 2–5 at the participating school participated in protocol-based computational fluency-building intervention 4 days per week for an entire school year. Specific criteria were applied each week to systematically increase intervention difficulty classwide according to a pre-established sequence of computational skill objectives. Three measurements were routinely obtained. Each week children completed a timed probe of the skill for which intervention was currently occurring and a timed probe of previously mastered skills from the sequence of computational skill objectives. Each month, all children completed a timed probe of mathematics skills representing computational skills that students were expected to master by year’s end at each grade level. At all grade levels, learning a skill that appeared early in the hierarchy or sequence of skills related positively to learning of future related and more complex computational skills. Fluency criteria were specified that predicted retention of the skill over several months.     

Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes

The DSM-5 Personality and Personality Disorders Workgroup proposed that five DSM-IV personality disorders be eliminated as formal diagnostic categories (paranoid, schizoid, histrionic, narcissistic, and dependent), because these syndromes purportedly have low clinical utility and minimal evidence for validity. Scrutiny of studies cited in support of this proposal reveals difficulties in three areas: (1) Inadequate information regarding parameters of the literature search; (2) Mixed empirical support for proposed changes; and (3) Selective attention to certain disorders and not others. Review of validity and clinical utility data related to dependent personality disorder indicates that evidence regarding this syndrome does not differ from that of syndromes proposed for retention in DSM-5. Limitations in the research base cited by the workgroup illuminates gaps in the personality disorder literature, and may serve as a starting point for systematic research on personality pathology so that adequate empirical data are available to decide which syndromes to retain, revise, or remove in future versions of the diagnostic manual.     

Assessing the prevalence of mental health disorders and mental health needs among preschool children in care in England

Although school‐aged children living in foster care have been identified as a high‐risk group for mental health and developmental disorders, there is a paucity of data relating to preschool children in care (CIC). This study aimed to identify the prevalence of mental health and developmental disorders along with corresponding need for interventions in preschool CIC. All CIC aged 0 to 5 years in an inner city local authority underwent comprehensive, multifaceted assessments consisting of the Ages and Stages Questionnaire (J. Squires, D. Bricker, & E. Twombly, 2003), interviews with caregivers based on the Preschool Age Psychiatric Assessment (H.L. Egger & A. Angold, 2006), Mullen Scales of Early Learning (E.M. Mullen, 1995 ), and systematic clinical observation. Of 58 eligible preschoolers, 43 completed the assessment. At least one mental health disorder was found in 26 (60.5%) participants, and at least one developmental disorder was found in 11 (25.6%). When mental health and/or developmental disorders were considered together, 30 (69.8%) preschoolers fulfilled criteria for at least one diagnosis, and 18 (41.9%) had two or more comorbid conditions. Whereas 36 (83.7%) of the preschoolers needed an intervention, only 3 of these had received adequate input. In conclusion, preschool CIC constitute a high‐risk group for mental health and developmental disorders. Without age‐appropriate assessments, their needs go undetected, and opportunities for early intervention are being missed.     

The DSM-5 dimensional model of personality disorder: rationale and empirical support

Ideally, a dimensional model of normal and abnormal personality functioning within the forthcoming DSM-5 would represent a common ground among the existing alternative models and would be consistent with the substantial body of empirical research that has accumulated on such models. The DSM-5 Work Group had the opportunity to make an historic step toward the integration of the normal personality traits researched within psychology with the personality disorders of psychiatry. They chose instead to construct a cumbersome six-dimensional model of personality disorder that excludes normal personality traits, is inconsistent with the preponderance of the research, and is distinguished explicitly from the predominant dimensional model of general personality structure.