The neuronal stem cell of the olfactory epithelium

Reviews and evaluates psychosocial treatments for attention deficit hyperactivity disorder (ADHD) in children and adolescents according to Task Force Criteria (Lonigan, Elbert, & Johnson, this issue). It is concluded that behavioral parent training and behavioral interventions in the classroom meet criteria for well-established treatments. Cognitive interventions do not meet criteria for well-established or probably efficacious treatments. Issues regarding the evaluative process are discussed and future directions for psychosocial treatment for ADHD are outlined.     

Childhood mania: insights into diagnostic and treatment issues

Our study's objective was to clarify the nosologic status of children who satisfy diagnostic criteria for bipolar disorder. Using blind raters and structured psychiatric interviews as well as data from other instruments, we undertook studies from various vantage points, examining children with bipolar disorder to confirm the existence of the diagnosis in children and to clarify its clinical course and characteristics. We found that (1) bipolar disorder in children referred to our clinical center is not as rare as previously thought; (2) bipolar disorder in children commonly presents with attention-deficit hyperactivity disorder, which makes diagnosis difficult; and (3) bipolar disorder in children presents with a clinical picture considered atypical by adult standards, with irritability, chronicity, and symptoms of mania mixed with those of depression. Our data suggest that childhood bipolar disorder is more common than previously thought, but it may be difficult to diagnose because of comorbidity with attention-deficit hyperactivity disorder and a developmentally different presentation from adults.     

Attention-deficit hyperactivity disorder and substance abuse: relationships and implications for treatment

Attention-deficit hyperactivity disorder (ADHD) and substance-use disorders are related to each other in a variety of ways. Although within the child-psychiatry literature earlier investigations were inconsistent regarding such a link, recent prospective studies that followed hyperactive children and normal controls into adulthood have found that hyperactive adults with a history of ADHD are more likely than controls to have substance-use disorders. The substance-abuse literature is less consistent regarding the potential association between ADHD and substance abuse. However, recent studies suggest that persons with a substance-use disorder, and particularly those with a cocaine-use disorder, may be more likely than the general population to have a childhood history of ADHD. Some of the inconsistency regarding this association is due to differences in diagnostic criteria, type of assessments used, and reliability of information obtained. Each of the potential relationships that may exist between ADHD and substance abuse has treatment implications for the clinician. Pharmacological as well as nonpharmacological approaches deserve further investigation. Because pharmacotherapy is a central component in the treatment of childhood ADHD, clinicians designing a strategy to treat both a substance-use disorder and ADHD need to consider pharmacological interventions. At present, the literature on pharmacological treatment for childhood ADHD is extensive and that for adult ADHD is growing; information regarding the treatment of cocaine abuse and concomitant ADHD symptoms remains limited.     

The importance of callous–unemotional traits for extending the concept of psychopathy to children.

This study focused on the use of callous–unemotional (CU) traits to identify a subgroup of children with both attention deficit/hyperactivity disorder (ADHD) and a conduct problem diagnosis (oppositional defiant disorder [ODD] or conduct disorder [CD]) who show characteristics similar to adults with psychopathy. In a clinic-referred sample of children aged 6 to 13 years (N?=?154), those with diagnoses of both ADHD and ODD/CD were divided on the basis of teacher ratings of CU traits. Children high on these traits showed features typically associated with psychopathy, such as a lack of fearfulness and a reward-dominant response style. Furthermore, children with CU traits seemed less distressed by their behavior problems. These findings are consistent with research on adults showing that impulsivity and antisocial behavior alone are insufficient to document persons who fit the construct of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention-deficit hyperactivity and conduct disorder: Comorbidity and implications for treatment.

The distinguishing and overlapping features of attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) are discussed. Conclusions regarding comorbidity, treatment efficacy, and long-term outcome can be influenced by several factors, including diagnostic procedures and sample characteristics. The need to distinguish between referred and nonreferred samples is particularly crucial when considering treatment and comorbidity issues. The efficacy of psychosocial and pharmacological treatments in ADHD and CD children is reviewed as are the few studies of psychostimulant medication in comorbid youngsters. Suggestions regarding treatment planning and recommendations for treatment and research are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive factors differentiating attention deficit–hyperactivity disorder with and without a comorbid mood disorder.

Mood disorders and attention deficit–hyperactivity disorder (ADHD) co-occur in 20–30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n?=?14) or ADHD and a comorbid mood disorder (n?=?27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inhibition of cGMP mediated relaxation in small rat coronary arteries by block of CA++ activated K+ channels

Children with sleep disorders are often inattentive or hyperactive, and some carry a diagnosis of attention deficit/hyperactivity disorder (ADHD) until their sleep disorder is detected. However, the potential behavioral impact of undiagnosed sleep disorders is not known. We sought to determine whether children with higher levels of inattention and hyperactivity more frequently have symptoms of sleep-related breathing disorders (SRBDs) or periodic limb movement disorder (PLMD). We surveyed parents of 2-18-year-old patients at a child psychiatry clinic (n = 70) and a general pediatrics clinic (n = 73) to assess the children's behavior, snoring, complaints of restless legs at night, and daytime sleepiness. A validated pediatric sleep questionnaire provided the explanatory variables, and a scale for inattention and hyperactivity, derived from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), provided the dependent variable. Habitual snoring was more frequent (33%) among children who carried a diagnosis of ADHD than among the other children at the psychiatry or general pediatric clinics (11 and 9%, respectively, chi-square test, p = 0.01). Snoring scores, derived from six snoring- and SRBD-related question items, were associated with higher levels of inattention and hyperactivity. The complaint of restless legs and a composite score for daytime sleepiness showed some evidence, though less consistent, of an association with inattention and hyperactivity. The association of snoring with inattention and hyperactivity suggests that SRBDs and perhaps other sleep disorders could be a cause of inattention and hyperactivity in some children. If a causal effect is present, our data suggest that 81% of habitually snoring children who have ADHD--25% of all children with ADHD--could have their ADHD eliminated if their habitual snoring and any associated SRBD were effectively treated.     

Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children

OBJECTIVE: Little is known about the validity of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children. Moreover, the results of the DSM-IV field trials raised concerns that inclusion of the new predominantly hyperactive-impulsive type of ADHD in DSM-IV might increase the likelihood of the diagnosis being given to active but unimpaired preschool and primary school children. METHOD: The validity of DSM-IV criteria for each subtype of ADHD was evaluated in 126 children, aged 4 through 6 years, and 126 matched comparison children. Probands and controls were classified by using structured diagnostic interviews of the parent and a DSM-IV checklist completed by the teacher. RESULTS: Children who met DSM-IV criteria for each subtype of ADHD according to parent and teacher reports differed consistently from controls on a wide range of measures of social and academic impairment, even when other types of psychopathology and other potential confounds were controlled. CONCLUSIONS: When diagnosed by means of a structured diagnostic protocol, all three DSM-IV subtypes of ADHD are valid for 4- through 6-year-old children in the sense of identifying children with lower mean scores on measures of adaptive functioning that are independently associated with ADHD.     

Psychopathology in children and adolescents with developmental disorders

Children and adolescents with developmental disorders suffer from a wide range of psychopathology. However, there are no published studies examining this subject exclusively in this population using recent diagnostic criteria. The primary purpose of this paper is to report on the diagnosis encountered in a clinical setting using DSM-III-R. The medical records of all individuals assessed in a specialized program during a 1-year period were reviewed looking at their demographic features, diagnoses, and target behaviors. Our sample consisted of 233 subjects and contained significantly more boys than girls. The most common psychiatric diagnoses were oppositional defiant disorder and attention deficit hyperactivity disorder. Pica, organic mental disorder NOS, and Autistic Disorder were more often encountered in individuals with low intellectual functioning. Depressive disorders, posttraumatic stress disorder, and developmental speech/language disorders were diagnosed more in high functioning subjects. The most common symptom was impulsivity. This retrospective study highlights the need for more rigorous examination of current diagnostic concepts and criteria in children and adolescents with developmental disorders. Prospective studies should be conducted with standardized instruments in clinics and community samples to provide more information on psychiatric disorders in this population.     

Assessment of attention deficits in children.

Presents a critical analysis of the view that a general attention deficit can be identified and objectively measured in children. Research regarding the specific nature of attentional difficulties in hyperactive children and the measurement of attention and attention deficits is selectively reviewed. School psychologists are cautioned against premature use of the attention deficit disorder label and measurement strategies for the following reasons: (a) The experimental, clinical, and educational literature reviewed indicates that a consensual definition of attention deficit is lacking; (b) research and theory have not yet adequately identified the specific attentional processes in question; and (c) few clearly conceptualized measures of specific attention deficits are yet available that have been adequately normed for use with children for diagnostic and programming purposes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hyperkinetic syndrome (attention deficit-/hyperactivity disorder) in adulthood

The clinical picture of adult hyperkinetic syndrome (HKS) or attention deficit/hyperactivity disorder is nearly unknown in Germany. It can be estimated, that approximately one third of affected children also show symptoms as adults. In the combined type of the syndrome symptoms of inattention as well as of hyperactivity and impulsivity are present, a predominantly inattentive or hyperactive-impulsive type is possible. Retrospective diagnosis of HKS in childhood can be difficult. Disorganization, emotional disturbances and stress intolerance are common in adults with HKS as well as residual symptoms of learning disorders like dyslexia, dyscalculia and dysgraphia. In differential diagnosis especially affective, anxiety and antisocial personality disorders have to be considered, for which on the other side a frequent comorbidity with HKS is known. There is strong evidence for genetic transmission. Neurobiological findings revealed dysregulation of neurotransmitters. For treatment stimulants as pemoline and methamphetamin are effective, in addition tricyclic antidepressants or beta blockers; positive effects are probable for moclobemide, bupropion, fluoxetine and venlafaxine.     

Is attention deficit hyperactivity disorder familial?

Using two sources of data, we review methodologic issues pertinent to family studies of attention deficit hyperactivity disorder to evaluate whether such studies define attention deficit hyperactivity disorder as a familial disorder. We systematically evaluate the relevant literature and provide a detailed overview of the Massachusetts General Hospital family-genetic studies of attention deficit disorder as defined in DSM-III and attention deficit hyperactivity disorder as defined in DSM-III-R. The available literature, and our double-blind, controlled studies indicate that attention deficit disorder and attention deficit hyperactivity disorder are familial. Moreover, the pattern of transmission of comorbid disorders suggests that attention deficit hyperactivity disorder is, from a familial perspective, distinct from anxiety disorders and learning disabilities. In contrast, attention deficit hyperactivity disorder with conduct disorder appears to be a familial subtype, and major depression appears to be a variable expression of the familial predisposition to attention deficit hyperactivity disorder. Although the available literature provides strong evidence for the familial transmission of attention deficit hyperactivity disorder, the mode of transmission requires further clarification. In addition, attention deficit hyperactivity disorder appears to be genetically heterogeneous, indicating that more work is needed to delineate genetically homogeneous subtypes and to describe the range of expression of their underlying genotypes. Family-genetic studies will continue to clarify the etiology and nosology of attention deficit hyperactivity disorder.     

Clinical utility of the Test of Variables of Attention (TOVA) in the diagnosis of attention-deficit/hyperactivity disorder

Ability of the Test of Variables of Attention (TOVA) to distinguish between referred children with attention-deficit/hyperactivity disorder (ADHD) and other (OTHER) clinical diagnoses were studied. The ADHD group differed from the OTHER group on TOVA variables and most measures from the Revised Conners Teacher Rating Scale (RCTRS) and ADD-H Comprehensive Teacher's Rating Scale (ACTeRS). The criteria of any one TOVA variable > 1.5 standard deviations from age and sex adjusted means correctly identified 80% of the sample with attention deficit disorders and 72% of the sample without attention deficit disorder. Cases misclassified by teacher ratings were often correctly classified by the TOVA and conversely. The TOVA makes a unique and important contribution to diagnostic evaluations.     

Neuropsychological test performance and the attention deficit disorders: Clinical utility of the Luria-Nebraska Neuropsychological Battery—Children's Revision.

The Luria-Nebraska Neuropsychological Battery—Children"s Revision (LNNB—CR) was administered to 54 clinic-referred children aged 8–12 years. Children reliably diagnosed as attention deficit disorder with hyperactivity were compared with children diagnosed as attention deficit disorder without hyperactivity and with a clinic control group diagnosed with internalizing disorders. Both attention deficit disorder groups were lower than the control group in verbal and Full Scale IQ scores but did not differ from one another. The groups did not differ significantly on any of the LNNB—CR clinical scales, on the right or left hemisphere scores, or on the pathognomonic score using analyses of variance (ANOVA) or analyses of covariance (ANCOVA) with both Full Scale IQ and age as covariates. These findings failed to support the hypothesis that attention deficit disorder, either with or without hyperactivity, is associated with neuropsychological dysfunction as measured by the LNNB—CR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clonidine therapy for comorbid attention deficit hyperactivity disorder and conduct disorder: preliminary findings in a children's inpatient unit

This retrospective study examined the clinical course of 18 prepubertal boys (aged 6 to 12) who had dual diagnoses of attention deficit hyperactivity disorder and conduct disorder and who received clonidine on an inpatient basis after failed trials of conventional drug therapy, consisting predominantly of psychostimulants. The effects of clonidine were assessed during inpatient treatment and after discharge at intervals of 1 to 2 months. Eleven (61%) of the children had marked improvement as measured by clinical impression. Transient sedation lasting 2 to 3 days occurred after initial administration or dosage increase; otherwise, clonidine was well tolerated. Our findings suggest that clonidine may prove to be an alternative treatment of comorbid attention deficit hyperactivity disorder and conduct disorder.     

Rage attacks in children and adolescents with Tourette''s disorder: a pilot study

BACKGROUND: Sudden, explosive episodes of rage occur in a significant number of clinically referred children with Tourette's disorder and cause considerable psychosocial morbidity. The etiology of these symptoms is unknown. We conducted a pilot study of 12 consecutive children with Tourette's disorder and rage attacks to determine whether comorbidity of Tourette's-associated disorders is related to these symptoms. METHOD: Twelve consecutive children with Tourette's disorder who presented with rage attacks were evaluated, including 2 females and 10 males. Tourette's disorder diagnosis, presence of comorbid disorders, and tic severity were assessed using DSM-IV diagnostic criteria and standardized rating scales. RESULTS: All 12 children met diagnostic criteria for Tourette's disorder, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). Two children were also diagnosed with comorbid oppositional defiant disorder, and 4 children were diagnosed with comorbid conduct disorder. None of the subjects met diagnostic criteria for a mood disorder. All subjects had only mild tic severity. CONCLUSION: The clinical phenomenon of rage attacks in children with Tourette's disorder resembles intermittent explosive disorder and may reflect specific underlying neurologic disturbances. This pilot study suggests that rage attacks in Tourette's disorder may be related to the presence of comorbid disorders.     

Yeast cells expressing differential levels of human or yeast DNA topoisomerase II: a potent tool for identification and characterization of topoisomerase II-targeting antitumour agents

A large school-based sample of children in Grades 1, 2, 3, and 4 were screened for disruptive behavior and subsequently assessed over a 5-year period for DSM-III-R symptoms of attention deficit hyperactivity disorder (ADHD) and other externalizing and internalizing behavior disorders. Parents completed structured diagnostic interviews in Years 1, 4, and 5, and teachers completed Behavioral Assessment for Children-Teacher Rating Scales behavioral ratings annually. For parent-derived diagnostic data, both inattention and hyperactivity/impulsivity symptom groups declined from Year 1 to Year 4, with hyperactivity showing more significant decline. For teacher-rated behavioral dimensions, the Attention Problems scale declined from Year 1 to Year 3 and stabilized thereafter. The Hyperactivity scale showed stability during the first 3 years before declining in Year 4. Of those children diagnosed with ADHD in Year 1, 69% still met criteria for ADHD in either Year 4 or 5. Persisters were more likely to exhibit coexisting conduct disorder in Year 1 and oppositional defiant disorder in Years 1, 4, and 5. Parents of persisters reported more psychosocial adversity on measures of parenting and marital satisfaction.     

A prospective study of hyperactive boys with conduct problems and normal boys: adolescent and adult criminality

OBJECTIVE: To examine the relationship between attention deficit disorder with hyperactivity in childhood and criminality in adolescence and adulthood in 89 hyperactive and 87 normal control subjects. METHOD: In this prospective study, adolescent follow-up intervals ranged from 13 to 21 years and adult follow-up ranged from 18 to 23 years. The official arrest records for all subjects were obtained. RESULTS: Hyperactive subjects had significantly higher juvenile (46% versus 11%) and adult (21% versus 1%) arrest rates. Juvenile and adult incarceration rates were also significantly higher. Childhood conduct problems predicted later criminality, and serious antisocial behavior in adolescence predicted adult criminality. CONCLUSIONS: Hyperactive children are at risk for both juvenile and adult criminality. The risk for becoming an adult offender is associated with conduct problems in childhood and serious antisocial behavior (repeat offending) in adolescence. Hyperactive children who do not have conduct problems are not at increased risk for later criminality.     

High risk for children with DAMP/ADHD to become addicts later in life

The prevalence of attention deficit hyperactivity disorder (ADHD) and of the overlapping condition, deficit in attention, motor control and perception (DAMP), among children of early school age is approximately 5 per cent (1.5% being severe cases). Boys are more commonly affected than girls. The symptoms continue to be disabling at 20 years of age in 50 per cent of cases, and social maladjustment is common. Half of the young boys develop oppositional defiant disorder (ODD), very often progressing to conduct disorder (CD) and antisocial personality disorder (ASPD). Low socio-economic status, parental mental disorder, and persistence of DAMP/ADHD symptoms are all predictors of the development of CD/ASPD. Prospective studies of children with DAMP/ADHD have shown them to be characterised by a high level of alcohol and/or drug abuse comorbidity, particularly the subgroup progressing to CD/ASPD. Conversely, studies of drug abuse and of alcohol abuse series have shown them to be characterised by a high level of DAMP/ADHD comorbidity. Approximately one in five alcoholics has or has had DAMP/ADHD, a comorbidity probably even more pronounced among type II alcoholics. Approximately every third substance-abuser has or has had DAMP/ADHD. The need of more persevering support and treatment efforts for the well-defined category of boys at high risk is emphasised. Better awareness, active diagnosis and treatment of adults with persisting DAMP/ADHD is also warranted.