Chromosomal abnormalities in a clinic sample of individuals with autistic disorder

We examined data from the largest reported sample of autistic individuals who have been karyotyped with the aim of providing additional information in the search for autism disease genes. Individuals seen in the University of Iowa's Child and Adolescent Psychiatry Clinic since 1980 who had been diagnosed with autism were cross-referenced with the University of Iowa's Cytogenetics Laboratory database. We determined the number of individuals referred for cytogenetic testing and, of these, the number found to have gross cytological abnormalities. Medical records were reviewed for all cases with such abnormalities. Between 1980 and 1998, 898 subjects seen in the clinic were diagnosed with autism. Of these, 278 (30.1%) were referred for cytological studies; 25 (9.0%) of these were found to have chromosomal abnormalities. The most common chromosomal abnormalities were Fragile X, other sex chromosome anomalies, and chromosome 15 abnormalities. These data support the contribution of chromosomal abnormalities to a small but significant number of cases of autism, and highlight the involvement of chromosome 15 and the sex chromosomes.     

Affective disorders, anxiety disorders and psychological distress in non-drinkers

BACKGROUND: Non-drinkers have elevated levels of psychological distress but a recent study reported no elevation in prevalence of diagnosed disorders. We aimed to determine the prevalence of affective and anxiety disorders (from the CIDI-A) in current abstainers and contrast results with findings for psychological distress (K10) in the same sample. METHODS: Cross-sectional, representative household survey of adult Australians. RESULTS: Non-/occasional drinkers had higher levels of psychological distress than light drinkers, and distress in heavy drinkers was even higher. Heavy drinkers also had the highest rates of most disorders. Non-/occasional drinkers showed significantly elevated prevalence only of dysthymia, agoraphobia and posttraumatic stress disorder compared with light drinkers. LIMITATIONS: Statistical power was limited for investigating low prevalence disorders. History of alcohol consumption was not collected. The CIDI-A and K10 have finite validity. CONCLUSIONS: This study confirmed J-shaped relationships between psychological distress and alcohol consumption. Although affective and anxiety disorders also showed non-linear relationships with alcohol consumption, non-/occasional drinkers are not at increased risk for all disorders compared to light drinkers. The pattern of symptomatology in non-/occasional drinkers may be of a different character to that in heavy drinkers, as well as being less severe.     

Characterizing the nature of worry in a sample of perinatal women with generalized anxiety disorder

Prevalence of perinatal anxiety disorders continues to grow, with estimates greater than those of postpartum depression. Generalized anxiety disorder (GAD) is the most commonly reported perinatal anxiety disorder, yet very little is known about the worry content experienced during the perinatal period in those with GAD. This study investigated worry content and frequency in a sample of perinatal women (n = 20) and age‐matched nonperinatal women (n = 20) diagnosed with GAD. Participants completed the Penn State Worry Questionnaire (PSWQ) to assess worry severity, in addition to providing their current top worries. Mean scores on the PSWQ in both samples exceeded a clinical cut‐off score of 65, and thematic analyses revealed that perinatal women experienced significantly greater parental‐themed worries compared with the nonperinatal GAD sample (p < .05). Capturing the unique content of worry for perinatal woman will assist clinicians in identifying treatment targets and may enhance treatment outcome.     

Psychiatric disorder in the children of antisocial parents

BACKGROUND: Although parents with psychiatric disorders are likely to have children with psychiatric problems, the nature of disorder risk to offspring of antisocial parents has received limited attention.METHOD: We examined the prevalence of common externalizing and internalizing disorders in the pre-adolescent and late adolescent offspring of antisocial parents. Lifetime diagnoses for a sample of 11-year-old twins (958 males, 1042 females) and a sample of 17-year-old twins (1332 males, 1434 females), as well as their parents, were obtained through in-person interviews. Odds ratios were calculated for the effect of the parent's diagnosis on the child's diagnosis, controlling for the effect of the co-parent's diagnosis.Results. We found that parental antisociality places the child at increased risk for developing a range of externalizing and internalizing disorders. This increase is evident by pre-adolescence and extends to a wide range of disorders by late adolescence. Each parent has an effect net any effects of the co-parent.CONCLUSIONS: Antisocial parents have children who have an increased likelihood of developing a broad range of psychiatric disorders.     

Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial

The current trial examined the value of modifying empirically validated treatment for childhood anxiety for application via written materials for parents of anxious children. Two hundred sixty-seven clinically anxious children ages 6-12 years and their parents were randomly allocated to standard group treatment, waitlist, or a bibliotherapy version of treatment for childhood anxiety. In general, parent bibliotherapy demonstrated benefit for children relative to waitlist but was not as efficacious as standard group treatment. Relative to waitlist, use of written materials for parents with no therapist contact resulted in around 15% more children being free of an anxiety disorder diagnosis after 12 and 24 weeks. These results have implications for the dissemination and efficient delivery of empirically validated treatment for childhood anxiety.     

Emotion regulation in children with anxiety disorders.

This study examined emotion management skills in addition to the role of emotional intensity and self-efficacy in emotion regulation in 26 children with anxiety disorders (ADs) ages 8 to 12 years and their counterparts without any form of psychopathology. Children completed the Children's Emotion Management Scales (CEMS) and Emotion Regulation Interview (ERI), and mothers reported on their children's emotion regulation using the Emotion Regulation Checklist (ERC). Results indicated that children who met Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for an anxiety disorder had difficulty managing worried, sad, and anger experiences, potentially due to their report of experiencing emotions with high intensity and having little confidence in their ability to regulate this arousal. These findings indicate that emotion regulation needs to be considered centrally in research with anxious populations.     

Sadistic and self-defeating personality disorder criteria in a rural clinic sample.

A sample of 176 outpatients at a mental health clinic in rural southern Georgia were rated for the presence or absence of the DMS-III-R sadistic and self-defeating personality disorder criteria. On the basis of these ratings, 48 patients met the criteria for sadistic (n = 14) and self-defeating (n = 41). Surprisingly, half of the patients who met the sadistic criteria also fulfilled the self-defeating criteria. A factor analysis failed to divide the criteria cleanly into sadistic and self-defeating subsets.     

Effects of parental anxiety disorders in children at high risk for panic disorder: a controlled study

BACKGROUND: To examine the association between anxiety disorders in parents and offspring in a sample of children at risk for panic disorder. We hypothesized that individual anxiety disorders will breed true in offspring. METHODS: Comparisons were made between offspring of parents with PD+MD (N=136), PD (N=27), MD (N=27), and Controls (N=103). All subjects were assessed with structured diagnostic interviews. Individual anxiety disorders in the offspring were used as dependent variables in logistic regression models where parental PD status, parental MD, and the same parental anxiety diagnosis were used as independent binary variables. RESULTS: Social phobia and separation anxiety disorder in the offspring were accounted for by the same disorders in the parent, whereas agoraphobia and OCD in the offspring were accounted for by parental panic disorder. CONCLUSIONS: These findings suggest that differing risk factors underlie the expression of individual anxiety disorders in children at risk for panic disorder.     

Anxiety disorders comorbidity in mood disorder subgroups: data from a mood disorders clinic

BACKGROUND: Previous research has identified a high rate of anxiety disorders comorbidity in patients with a primary mood disorder diagnosis. Discrepancies between studies in the comorbidity prevalence of specific anxiety disorders in mood disorders, and of anxiety disorders comorbidity between unipolar depression and bipolar mood disorder are in part due to differences in sampling and diagnostic assessment methodology. METHOD: The authors reviewed the charts of 138 patients who received the SCID-P for DSM-III on enrollment in a Mood Disorders Clinic during the period 1982 through 1988. The comorbidity of specific DSM-III Anxiety Disorders with specific mood disorders was determined and comparatively examined using non-parametric statistics. RESULTS: There was high overall comorbidity of anxiety disorders that did not differ between bipolar and unipolar subjects. There were no differences in the comorbidity of individual anxiety disorder diagnoses in the unipolar vs. bipolar groups. However, in unipolar patients with, compared to those without an additional diagnosis of dysthymia, there was greater overall anxiety disorders comorbidity, with a particularly high prevalence of generalized anxiety disorder. LIMITATION: The subgroup of patients with bipolar I disorder was relatively small (N=8). CONCLUSION: Mood and anxiety disorders comorbidity is complex and presents a continuing challenge for both clinicians and researchers.     

Reproductive decisions of parents of children with metabolic disorders

The Interaction Model of Client Health Behavior (IMCHB) served as a guide for variable selection and instrument development for telephone interviews with 230 parents of children with metabolic disorders. Sociodemographic, psycho-affective and client-professional interaction variables were examined in relation to three outcomes: (1) receptivity to future prenatal diagnosis (56% were receptive); (2) likelihood of terminating an affected pregnancy (10% would); and (3) whether or not the parent had taken measures to prevent another affected pregnancy (41% had). All three outcomes were significantly correlated with higher scores on the Parent Stress Index, lower scores on the Vineland Adaptive Behavior Scales, fewer persons in the parent's social support network, greater worry about the living child's future and greater perceived difficulty meeting the child's extra care needs. A regression model constructed to explain taking measures to prevent a future affected pregnancy illustrated the usefulness of the IMCHB in research that involves multiple interacting variables on health outcomes. Few of the parents (7.4%) reported an interaction with a genetic counsellor, highlighting the need for practitioners from multiple disciplines to be adequately educated in principles of genetics, especially the psychological and affective aspects of counselling.     

Automaticity in anxiety disorders and major depressive disorder

In this paper we examine the nature of automatic cognitive processing in anxiety disorders and Major Depressive Disorder (MDD). Rather than viewing automaticity as a unitary construct, we follow a social cognition perspective (Bargh, 1994) that argues for four theoretically independent features of automaticity: unconscious (processing of emotional stimuli occurs outside awareness), efficient (processing emotional meaning uses minimal attentional resources), unintentional (no goal is needed to engage in processing emotional meaning), and uncontrollable (limited ability to avoid, alter or terminate processing emotional stimuli). Our review of the literature suggests that most anxiety disorders are characterized by uncontrollable, and likely also unconscious and unintentional, biased processing of threat-relevant information. In contrast, MDD is most clearly typified by uncontrollable, but not unconscious or unintentional, processing of negative information. For the anxiety disorders and for MDD, there is no sufficient evidence to draw firm conclusions about efficiency of processing, though early indications are that neither anxiety disorders nor MDD are characterized by this feature. Clinical and theoretical implications of these findings are discussed and directions for future research are offered. In particular, it is clear that paradigms that more directly delineate the different features of automaticity are required to gain a more comprehensive and systematic understanding of the importance of automatic processing in emotion dysregulation.     

Psychometric properties of the frost multidimensional perfectionism scale in a clinical anxiety disorders sample

The purpose of this study was to examine the factor structure of the Frost Multidimensional Perfectionism Scale (MPS-F; Frost, Marten, Laharte, & Rosenblate, 1990). Although perfectionism is thought to contribute to the development of psychopathology and the MPS-F is gaining popularity for use in assessing perfectionism in clinical samples, to date the factor structure has not been examined in a clinical sample. Three hundred and twenty-two individuals diagnosed with an anxiety disorder using the SCID for DSM-IV and 49 nonclinical controls completed the MPS-F as well as a measure of perfectionism (MPS-H) developed by Hewitt and Flett ( 1991 ). Analyses suggested that the MPS-F has similar psychometric properties in clinical samples to those in nonclinical samples, and factors very similar to those observed by Frost et al. (1990) could be extracted. A 3-factor solution appeared more appropriate for statistical reasons, and the 3 scales based on these factors distinguished among diagnostic groups in a manner similar to scales based on the 6-factor solution in past research. Results were discussed in terms of the potential utility of a 3-factor solution and in terms of the general construct of perfectionism and the distinction between nonpathological high performance standards and neurotic perfectionism.     

Sleep-related problems in children and adolescents with anxiety disorders

This study examined the prevalence and patterns of sleep problems in a sample of children with anxiety disorders. Participants were 175 children, aged 6 to 18 years, with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, social phobia, or obsessive-compulsive disorder, presenting for assessment at an anxiety specialty clinic. Ninety percent of the sample demonstrated at least one sleep-related problem (SRP), and 82% experienced two or more. Frequencies of sleep problems did not differ between males and females or across younger and older children. However, type of sleep problems varied by diagnostic category. Findings also revealed strong associations between SRPs and a range of child anxiety measures, as well as a predictive relationship whereby number of anxiety disorders predicted number of sleep problems. Results highlight the high co-occurrence of sleep and anxiety problems, emphasizing the need for assessment and intervention efforts targeting sleep disturbance in this population.     

Examining the association between pediatric bipolar disorder and anxiety disorders in psychiatrically referred children and adolescents

BACKGROUND: To examine the association between anxiety (ANX) and bipolar disorders (BPD) in a clinically referred pediatric sample. METHODS: Subjects were consecutively referred youth aged <18 years, with a DSM-III-R/DSM-IV diagnosis of BPD (n=297) or a disruptive behavior disorder (DBD) (n=1100) on structured interview. RESULTS: Bipolar disorder in youth was associated with a significantly increased risk for most of the DSM-IV anxiety disorders and was not specifically linked to any one disorder in particular. CONCLUSIONS: Bipolar disorder in youth is a significant risk factor for anxiety comorbidity. Considering the morbidity and dysfunction as well as the differing therapeutic needs associated with bipolar and anxiety symptomatology, appropriate therapeutic approaches will be needed for the management of youth with this comorbidity.     

Missed opportunities: mental disorder in children of parents with depression

Background

Emerging evidence suggests that early intervention and prevention programmes for mental health problems in the offspring of parents with depression are important. Such programmes are difficult to implement if children with psychiatric disorder are not identified and are not accessing services, even if their parents are known to primary care.

Aim

To investigate service use in children of parents who have recurrent depression, and factors that influence such contact.

Design and setting

A total of 333 families were recruited, mainly through primary health care, in which at least one parent had received treatment for recurrent depression and had a child aged 9–17 years.

Method

Psychiatric assessments of parents and children were completed using research diagnostic interviews. The service-use interview recorded current (in the 3 months prior to interview) and lifetime contact with health, educational, and social services due to concerns about the child’s emotions or behaviour.

Results

Only 37% of children who met criteria for psychiatric disorder were in contact with any service at the time of interview. A third, who were suicidal or self-harming and had a psychiatric disorder at that time, were not in contact with any service. Lack of parental worry predicted lower service use, with higher rates in children with comorbidity and suicidality.

Conclusion

Most children with a psychiatric disorder in this high-risk sample were not in contact with services. Improving ease of access to services, increasing parental and professional awareness that mental health problems can cluster in families, and improving links between adult and child services may help early detection and intervention strategies for the offspring of parents with depression.     

Comorbidity of generalized social anxiety disorder and depression in a pediatric primary care sample

Background: Comorbidity between adult social anxiety disorder and major depression is extensive. Considerably less information about this relationship is available among youth. Methods: A randomly selected (from enrollees in a pediatric primary care clinic) sample of 190 families with children between the ages of 8 and 17 responded by mail to questionnaires assessing social anxiety, depression, and social functioning. Parents also completed a semi-structured telephone diagnostic interview about their child. Results: The generalized type of social anxiety disorder was highly comorbid with major depression, generalized anxiety disorder, specific phobias, and ADHD, while little comorbidity was present for the nongeneralized subtype of social anxiety disorder. Logistic regression analyses indicated that generalized social anxiety disorder was the only anxiety disorder associated with an increased likelihood of major depression (OR=5.1). In all cases, social anxiety disorder had a significantly earlier age of onset than major depression. Limitations: This study relies on cross-sectional data and diagnoses are based on parent reporting of child behavior. Conclusions: Generalized social anxiety disorder is strongly associated with depressive illness in youth. Screening and treatment approaches that consider both social anxiety and depressive symptoms are necessary. Early intervention to treat social anxiety disorder may prevent later depressive disorders.     

Childhood attention deficit/hyperactivity disorder in adults with anxiety disorders.

BACKGROUND: Previous research has reported co-morbidity between attention deficit hyperactivity disorder (ADHD) and anxiety disorders. Interpretation of these findings is complicated by symptom overlap in the clinical presentation of the disorders. We estimate the prevalence of ADHD in both the current and childhood histories of adults with anxiety disorders, while taking symptom overlap into account. We also evaluate the utility of the Wender Utah Rating Scale (WURS) for retrospective reporting of ADHD. METHODS: Consecutive admissions (N = 149) to an anxiety disorders clinic were given a diagnostic and psychometric assessment. The WURS was administered to obtain a retrospective diagnosis of childhood ADHD. Twenty-nine of the 35 people surpassing the cut-off score on the WURS were given a structured interview of adult ADHD symptoms. RESULTS: The WURS contains many 'internalizing' items that may inflate retrospective accounts of ADHD. After taking this into account, there is still a significantly higher prevalence of ADHD in the retrospective reports of adults with anxiety disorders (15%) than would be expected by chance (4%). Furthermore, of those who meet retrospective criteria for ADHD, 45% (13 of 29) continue to meet diagnostic criteria for ADHD as adults. CONCLUSIONS: The WURS may require considerable revision for use with clinical populations. In spite of these difficulties with retrospective assessment, available evidence indicates that ADHD is more prevalent in the histories of anxiety disordered patients than would be expected from base rates.     

Educating and counseling of parents of children with attention-deficit hyperactivity disorder

OBJECTIVE: This study surveys the parents' knowledge and attitude about attention-deficit hyperactivity disorder (ADHD), barriers to enrolment for treatment, parents' source of information, reason for delay in treatment, and the first person who suggests the diagnosis of ADHD. METHOD: The subjects of the study were the 119 parents and their children with ADHD. The parents and their children were interviewed and the mothers completed a self-reported questionnaire about ADHD. RESULTS: The knowledge about ADHD was relatively low. Half of them did not agree that ADHD is due to biological and genetic vulnerabilities and causation. Fifty-two percent of all the parents considered ADHD to be the result of parental spoiling. Only 6.2% reported that ADHD relate difficulties would persist for the whole life. About 40% of the respondents considered it as a sign of child independency. The main source of knowledge about ADHD was radio and TV. There were about 1.5 years between the time that the parents were suspected to the ADHD and the time they referred for the first time. The most common reason for the delay was lack of knowledge about where or whom they should refer to. Teachers were the first one who suggested the diagnosis of ADHD in most of the cases. CONCLUSION: Knowledge about ADHD is low and barriers of referral are not usually overcome. PRACTICE IMPLICATIONS: Educating and counseling of the parents should be directed toward emphasizing it as a biological problem, with concerns about its course. Also, targeting of the barriers in delaying the referral is an important issue. Medical personnel, especially GPs should be more informed about ADHD and play more active role in the treatment process.