Youth meeting symptom and impairment criteria for mania-like episodes lasting less than four days: an epidemiological enquiry

Background: Little is known about short‐duration episodes of mania‐like symptoms in youth. Here we determine the prevalence, morbid associations, and contribution to social impairment of a phenotype characterised by episodes during which symptom and impairment criteria for mania are met, but DSM‐IV duration criteria are not (bipolar not otherwise specified; BP‐NOS). Methods: A cross‐sectional national survey of a sample (N = 5,326) of 8–19‐year‐olds from the general population using information from parents and youth. Outcome measures were prevalence rates and morbid associations assessed by the Developmental and Well‐Being Assessment, and social impairment assessed by the impact scale of the Strengths and Difficulties Questionnaire. Results: While only seven individuals (.1%) met definite or probable DSM‐IV criteria for BPI or BPII, the prevalence of BP‐NOS was 10‐fold higher, 1.1% by parent report and 1.5% by youth report. Parent–youth agreement was very low: κ = .02, p > .05 for BP‐NOS. Prevalence and episode duration for BP‐NOS did not vary by age. BP‐NOS showed strong associations with externalising disorders. After adjusting for a dimensional measure of general psychopathology, self‐reported (but not parent‐reported) BP‐NOS remained associated with overall social impairment. Conclusions: BP meeting full DSM‐IV criteria is rare in youth. BP‐NOS, defined by episodes shorter than those required by DSM‐IV, but during which DSM‐IV symptom and impairment criteria are met, is commoner and may be associated with social impairment that is beyond what can be accounted for by other psychopathology. These findings support the importance of research into these short episodes during which manic symptoms are met in youth but they also call into question the extent to which BP‐NOS in youth is a variant of DSM‐IV BP – superficially similar symptoms may not necessarily imply deeper similarities in aetiology or treatment response.     

Discrepancies between Mothers' and Fathers' Perceptions of Sons' and Daughters' Problem Behaviour: A Longitudinal Analysis of Parent-Adolescent Agreement on Internalising and Externalising Problem Behaviour

One hundred and ninety-eight adolescents and their mothers ( N = 189) and fathers ( N = 136) participated in a 4-year longitudinal study. Adolescent problem behaviour was assessed by the Youth Self-Report (YSR) and the Child Behavior Checklist (CBCL). In addition, parental stress and marital adjustment were determined.
Results showed that mothers and fathers showed high agreement, especially about their daughters, whereas parents and adolescents showed little agreement. Agreement was higher for internalising than for externalising behaviours. In general, adolescents reported more symptomatology than their parents did. However, mothers' ratings of their children's behaviours were significantly correlated with adolescents' self-ratings, but fathers' ratings were not. Statistical tests of correlations showed that mothers experiencing stress caused by marital problems perceived more problem behaviours in their children. Fathers' perceptions were relatively unaffected by personal adjustment. However, poor marital adjustment perceived by both parents showed a significant negative relation to adolescent externalising problem behaviour.     

孤独症谱系障碍儿童语言和社交沟通障碍相关问题

社交沟通障碍及语言障碍是孤独症谱系障碍（ASD）儿童与其他儿童在互动上常见的障碍表现,而语言障碍常常也是评判ASD儿童严重程度的评判指标之一。该文从沟通障碍角度去分析、诠释ASD儿童在语言障碍及社交沟通障碍的相关表现,并介绍儿童综合行为疗法、关键反应治疗、自然情境教学法、语言表达训练、脚本法、以故事为基础的干预、社交技能训练在内的7种具有临床循证实践的语言干预方法,同时提供美国言语语言听力学会建议的干预方式。ASD儿童的语言早期干预具有重要意义,应推广以社区为基地、家庭积极参与的干预模式,积极开展家长培训,使ASD儿童能在语言关键期获得语言康复。     

Oppositional Disorder in Children: A Validation Study Comparing Conduct Disorder, Oppositional Disorder and Normal Control Children

Subjects with oppositional disorder (OD, N = 21) and conduct disorder (CD, N = 22) were compared with normal controls (NC, N = 20) to determine whether OD is a distinct disorder. OD subjects exhibited high rates of associated attention deficit, emotional and learning disorders. Compared with NC, OD subjects had high rates of problems in social relationships and came from families characterized by marital fights, dysfunction, and paternal psychopathology. Compared with CD, OD was less often characterized by undersocialization and separations from fathers and more often characterized by dissatisfaction in the marital relationship. These results suggest that OD is a variant of CD rather than of normality.     

Language, Achievement, and Cognitive Processing in Psychiatrically Disturbed Children with Previously Identified and Unsuspected Language Impairments

This study examined the language, achievement, and cognitive characteristics of 380 children, aged 7 to 14 years, consecutively referred to child psychiatric services. Among those children referred solely for psychiatric problems, 40% had a language impairment that had never been suspected. Children with previously identified and unsuspected language impairments were similar with respect to receptive and expressive language and on measures of cognitive processing. Although both groups of children with language impairments exhibited poorer academic achievement than children with normal language, children with previously identified language impairments had the lowest achievement. The milder achievement problems of children with unsuspected language impairment may explain why their problems had not been suspected. Both the clinical and theoretical implications of the findings are discussed. Heightened awareness concerning the high frequency of language impairment and other cognitive processing problems in children referred for psychiatric assessment and treatment should lead to more systematic examination of language functioning and evaluation of the impact of language and communication functioning on therapeutic outcomes.     

Extreme/‘pathological’ demand avoidance: an overview

Pathological demand avoidance (PDA) was coined in the 1980s to describe children on the spectrum of pervasive developmental disorders who show an obsessive resistance to everyday demands, an extreme need for control, and an apparently poor sense of social identity, pride, or shame. The term PDA has since attracted considerable interest and controversy. Here, we provide an overview of PDA, discuss the clinical presentation of individuals with a PDA profile, and differences compared to children with documented attachment difficulties. We then discuss empirical work describing how anxiety-driven avoidance of routine demands can emerge in children with ASD. We provide recommendations for strategies that aim to avoid strengthening habitual avoidance behaviours, and instead, allow new mutually rewarding routines to develop, which may provide opportunities to gradually increase the child's tolerance of demands. We argue that using the PDA profile, or describing relevant behaviours, as part of a clinical formulation can be helpful in alerting caregivers and educational professionals to particular challenges surrounding compliance with everyday requests in some children with ASD.     

Executive functioning in high-functioning children with autism

Executive functioning was investigated in 34 children (24 boys and 10 girls) with developmental language disorder (DLD) and 21 children (18 boys and 3 girls) with high-functioning autistic disorder (HAD) matched on Full Scale IQ, Nonverbal IQ, age (mean age 9 year, 1 month), and SES. The DLD group had a Verbal IQ that was 10 points higher than the HAD group. These children were given the Wisconsin Card Sorting Test (WCST), the Mazes subtest from the WISC-R, the Underlining test, and the Rapid Automatized Naming test. In addition, these children were given the Vineland Scales of Adaptive Functioning and the Wing Diagnostic Symptom Checklist in order to assess severity of autistic symptomatology. Results indicated that the only significant difference between the two groups on the cognitive tasks was perseverative errors on the WCST; there was no significant difference on total number of categories achieved or total number of errors on the WCST or on the other executive function measures. There was also significant overlap in the scores between the two groups and the difference in perseverative errors was no longer significant when Verbal IQ was partialled out. Executive functioning was strongly related to all IQ variables in the DLD group and particularly related to Verbal IQ in the HAD group. Although there was a relationship in the HAD group between executive functioning and adaptive functioning, as well as between executive functioning and autistic symptomatology, these relationships were generally no longer significant in the HAD group after the variance due to Verbal IQ was accounted for. The results are interpreted to indicate that although impaired executive functioning is a commonly associated feature of autism, it is not universal in autism and is unlikely to cause autistic behaviors or deficits in adaptive function.     

脑性瘫痪合并视听觉障碍的临床康复研究进展

脑性瘫痪是一组以运动障碍和姿势异常为核心表现的发育障碍综合征,可伴有言语障碍、智力障碍、视听觉障碍和行为障碍等.因其高发病率与致残率,脑性瘫痪现已成为全世界需共同攻克的难题.目前国内的研究主要是针对运动障碍、言语障碍和智力障碍,而对感知觉障碍缺乏足够的重视.感知觉障碍中发病率最高的是视听觉障碍,且后者对儿童运动、认知、语言、交流、心理等方面发育均存在影响.该文重点综述脑性瘫痪合并视听觉障碍的发病率、表现形式、对脑性瘫痪儿童发育的影响以及康复治疗进展,以提高视听觉障碍的重视度,并为促进该类儿童的全面康复奠定基础.     

Language, Social Cognitive Processing, and Behavioral Characteristics of Psychiatrically Disturbed Children with Previously Identified and Unsuspected Language Impairments

This study examined characteristics of social cognitive processing, psychiatric disorder, and behavioral ratings of 380 children aged 7 to 14 years who had been referred consecutively for child psychiatric services with identified and unsuspected language impairments and with normally developing language. The results indicated that children with language impairments generally exhibited greater deficits in social cognitive processing, and particularly emotion decoding and social problem solving, than children who have language that is developing normally. Differences in psychiatric diagnosis and behavior problems were observed only between children with previously identified language impairments and children with normally developing language; children with previously identified language impairments were more likely to be diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) and to be rated by both parents and teachers as having more severe attentional problems. In addition, teachers rated them as more socially withdrawn. The results suggest that it is important to incorporate measures of both social cognition and language functioning routinely into clinical assessment, something that currently is rarely done.     

Psychosocial adversities underestimated in hyperkinetic children

Abnormal psychosocial factors, assessed both clinically and by raters blind to clinical presentation, were examined in 21 hyperkinetic and 26 conduct disordered children. Blind raters found the frequency of psychosocial adversities to be similar in the two disorders. By contrast the clinical rater, who did know the diagnosis of patients, rated adverse psychosocial situations as much lower in hyperkinetic children than in children with conduct disorder. Logistic regression showed, particularly in the category of abnormal intrafamilial relationships (Lack of warmth in parent child relationship, Hostility or scapegoating of the child, Intrafamilial discord among adults), effects of the interaction between rater and knowledge of diagnosis. Clinical raters should be aware of abnormal psychosocial situations in hyperkinetic children and assess possible adverse effects on parents and children. Researchers should be aware of a possible bias in research interviews.     

Attention deficit hyperactivity disorder,tic disorder,and allergy: is there a link? A nationwide population‐based study

Background: Attention deficit hyperactivity disorder (ADHD) and tic disorder usually co‐occur in the same individuals, but the underlying mechanisms remain unclear. Previous evidence has shown that a frequent coexistence of allergic diseases was noted in patients with ADHD or tic disorder. We attempted to investigate the possible link among ADHD, tic disorder, and various allergic diseases. Methods: Utilizing the Taiwan National Health Insurance Research Database from 1996 to 2010, 5,811 patients with ADHD alone, 1,816 patients with tic disorder alone, and 349 patients with dual diagnoses of ADHD and tic disorder were identified and compared with age‐/gender‐matched controls (1:4) in an investigation of the association among ADHD, tic disorder, and allergic diseases. Results: Patients with dual diagnoses of ADHD and tic disorder had a significantly higher prevalence of allergic diseases and psychiatric comorbidities, including allergic rhinitis (43% vs. 28.4% vs. 33.6% vs. 19.7%, p < 0.001), asthma (27.5% vs. 17.2% vs. 18.2% vs. 11.9%, p < 0.001), atopic dermatitis (10.6% vs. 8.4% vs. 7.0 vs. 5.9%, p < 0.001), allergic conjunctivitis (55.6% vs. 34.7% vs. 43.5% vs. 26.3%, p < 0.001), obsessive compulsive disorder (4.0% vs. 1.3% vs. 2.0% vs. 0.1%, p < 0.001), and anxiety disorder (22.1% vs. 18.0% vs. 6.0% vs. 0.5%, p < 0.001) than the ADHD alone group, the tic alone group, and the control group. Furthermore, ADHD patients with more allergic diseases (≥3 comorbidities: OR: 3.73, 95% CI: 2.65～5.25; 2 comorbidities: OR: 2.52, 95% CI: 1.82～3.47; 1 comorbidity: OR: 1.87, 95% CI: 1.41～2.49) exhibited an increased risk of tic disorder compared with ADHD patients without allergic disease. Conclusion: A significant association among ADHD, tic disorder, and allergic diseases was noted in our study. The results may inspire further studies to clarify the underlying mechanisms and help us understand more about the complex etiology of ADHD, tic disorder, and their co‐occurrence.     

Results of the Sensory Profile in Children with Suspected Childhood Apraxia of Speech

Speech-sound disorders are common in preschool-age children, and are characterized by difficulty in the planning and production of speech sounds and their combination into words and sentences. The objective of this study was to review and compare the results of the Sensory Profile () in children with a specific type of speech-sound disorder, childhood apraxia of speech (CAS), and to explore the relationship between sensory processing and sound-production deficits. Participants were identified prospectively through an interdisciplinary apraxia clinic at a tertiary care pediatric hospital, and results of the Sensory Profile were compiled and reviewed. Thirty-eight children aged 3 to 10 years with suspected CAS were evaluated from July 2003 to July 2005. The results of the Sensory Profile indicated a difference for these children in several factor clusters when compared to typical peers from the normative population of the Sensory Profile. These findings imply that children with suspected CAS may present with differences in sensory processing in addition to speech impairment. When present, these differences in sensory processing could be addressed with specific therapeutic approaches through occupational therapy or consultation with an occupational therapist.     

Auditory processing in children with dyslexia

BACKGROUND: It has been claimed that children with dyslexia show a general impairment in the processing of rapid auditory stimuli. However, most previous studies in this field have focused on children with language impairment or children who do not meet accepted criteria for dyslexia. METHODS: In the present study, the processing of rapid non-verbal auditory stimuli (complex tones) was examined in a population-based sample of 24 children with dyslexia, 10 to 12 years of age, and a matched control group. RESULTS: The dyslexia group showed reduced tone processing relative to the control group, with significant main effects of tone duration, inter-stimulus interval and task complexity. The deficit was not specific for temporal order errors, and could not be explained by differences in short-term memory or verbal IQ. However, correlations between tone processing and reading ability were generally low or absent. CONCLUSION: Although a general processing deficit for rapid auditory stimuli in dyslexia was confirmed, its relevance for reading problems and hence for treatment programmes for dyslexia is questioned.