Behavior in preschool children with the 22q11.2 deletion syndrome

Children with the 22q11.2 deletion syndrome (22q11DS) are at an increased risk of psychiatric problems from pre‐adolescence; little is known, however, about behavioral problems at a preschool age and the relationship between speech and behavior in this group. Parents of 90 children (aged 1.42–5.99 years) with 22q11DS filled out the Child Behavior Checklist, documenting behaviors including speech problems. Their profiles were compared with those of a comparison group consisting of 33 children with nonsyndromic orofacial clefts without 22q11DS, since both children with 22q11DS and children with clefts are expected to have speech problems. In the 22q11DS group, data on intelligence was acquired by means of formal tests. Parents of children with 22q11DS reported significantly higher mean scores on withdrawn behavior, affective problems and pervasive developmental problems compared to children with nonsyndromic clefts. Approximately 30% of children with 22q11DS had a score above the 97th percentile on at least one of the behavior subscales, indicating psychopathology. In children with 22q11DS, the reported behavioral problems were not associated with speech problems. Behavioral problems were found in 30% of young children with 22q11DS and were unlikely to be caused by speech problems. Within the 22q11DS group, behavioral problems were not related to the degree of cognitive impairment. This shows that many children with 22q11DS, known to be at an increased risk of psychiatric problems from pre‐adolescence, already show behavioral problems before the age of 6 years. © 2012 Wiley Periodicals, Inc.     

Preventing disruptive behavior in elementary schoolchildren: impact of a universal classroom-based intervention

A population-based, randomized universal classroom intervention trial for the prevention of disruptive behavior (i.e., attention-deficit/hyperactivity problems, oppositional defiant problems, and conduct problems) is described. Impact on developmental trajectories in young elementary schoolchildren was studied. Three trajectories were identified in children with high, intermediate, or low levels of problems on all 3 disruptive behaviors at baseline. The intervention had a positive impact on the development of all disruptive behavior problems in children with intermediate levels of these problems at baseline. Effect sizes of mean difference at outcome were medium or small. In children with the highest levels of disruptive behavior at baseline, a positive impact of the intervention was found for conduct problems.     

Honing in on the Social Difficulties Associated With Sluggish Cognitive Tempo in Children: Withdrawal,Peer Ignoring,and Low Engagement

Sluggish cognitive tempo (SCT) symptoms are associated with social difficulties in children, though findings are mixed and many studies have used global measures of social impairment. The present study tested the hypothesis that SCT would be uniquely associated with aspects of social functioning characterized by withdrawal and isolation, whereas attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms would be uniquely associated with aspects of social functioning characterized by inappropriate responding in social situations and active peer exclusion. Participants were 158 children (70% boys) between 7–12 years of age being evaluated for possible ADHD. Both parents and teachers completed measures of SCT, ADHD, ODD, and internalizing (anxiety/depression) symptoms. Parents also completed ratings of social engagement and self-control. Teachers also completed measures assessing asociality and exclusion, as well as peer ignoring and dislike. In regression analyses controlling for demographic characteristics and other psychopathology symptoms, parent-reported SCT symptoms were significantly associated with lower social engagement (e.g., starting conversations, joining activities). Teacher-reported SCT symptoms were significantly associated with greater asociality/withdrawal and ratings of more frequent ignoring by peers, as well as greater exclusion. ODD symptoms and ADHD hyperactive-impulsive symptoms were more consistently associated with other aspects of social behavior, including peer exclusion, being disliked by peers, and poorer self-control during social situations. Findings provide the clearest evidence to date that the social difficulties associated with SCT are primarily due to withdrawal, isolation, and low initiative in social situations. Social skills training interventions may be effective for children displaying elevated SCT symptomatology.     

A Developmental Cascade Model of Behavioral Sleep Problems and Emotional and Attentional Self-Regulation Across Early Childhood

This article documents the longitudinal and reciprocal relations among behavioral sleep problems and emotional and attentional self-regulation in a population sample of 4,109 children participating in Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC)–Infant Cohort. Maternal reports of children’s sleep problems and self-regulation were collected at five time-points from infancy to 8–9 years of age. Longitudinal structural equation modeling supported a developmental cascade model in which sleep problems have a persistent negative effect on emotional regulation, which in turn contributes to ongoing sleep problems and poorer attentional regulation in children over time. Findings suggest that sleep behaviors are a key target for interventions that aim to improve children’s self-regulatory capacities.     

Polygenic inheritance of Tourette syndrome,stuttering, attention deficit hyperactivity,conduct, and oppositional defiant disorder: The additive and subtractive effect of the three dopaminergic genes—DRD2, DβH,and DAT1

Polymorphisms of three different dopaminergic genes, dopamine D₂ receptor (DRD2), dopamine β-hydroxylase (DβH), and dopamine transporter (DAT1), were examined in Tourette syndrome (TS) probands, their relatives, and controls. Each gene individually showed a significant correlation with various behavioral variables in these subjects. The additive and subtractive effects of the three genes were examined by genotyping all three genes in the same set of subjects. For 9 of 20 TS associated comorbid behaviors there was a significant linear association between the degree of loading for markers of three genes and the mean behavior scores. The behavior variables showing the significant associations were, in order, attention deficit hyperactivity disorder (ADHD), stuttering, oppositional defiant, tics, conduct, obsessive-compulsive, mania, alcohol abuse, and general anxiety-behaviors that constitute the most overt clinical aspects of TS. For 16 of the 20 behavior scores there was a linear progressive decrease in the mean score with progressively lesser loading for the three gene markers. These results suggest that TS, ADHD, stuttering, oppositional defiant and conduct disorder, and other behaviors associated with TS, are polygenic, due in part to these three dopaminergic genes, and that the genetics of other polygenic psychiatric disorders may be deciphered using this technique. © 1996 Wiley-Liss, Inc.     

Psychopathology in 7‐year‐old children: Differences in maternal and paternal ratings and the genetic epidemiology

The assessment of children's psychopathology is often based on parental report. Earlier studies have suggested that rater bias can affect the estimates of genetic, shared environmental and unique environmental influences on differences between children. The availability of a large dataset of maternal as well as paternal ratings of psychopathology in 7‐year old children enabled (i) the analysis of informant effects on these assessments, and (ii) to obtain more reliable estimates of the genetic and non‐genetic effects. DSM‐oriented measures of affective, anxiety, somatic, attention‐deficit/hyperactivity, oppositional‐defiant, conduct, and obsessive‐compulsive problems were rated for 12,310 twin pairs from the Netherlands Twin Register by mothers (N = 12,085) and fathers (N = 8,516). The effects of genetic and non‐genetic effects were estimated on the common and rater‐specific variance. For all scales, mean scores on maternal ratings exceeded paternal ratings. Parents largely agreed on the ranking of their child's problems (r 0.60–0.75). The heritability was estimated over 55% for maternal and paternal ratings for all scales, except for conduct problems (44–46%). Unbiased shared environmental influences, i.e., on the common variance, were significant for affective (13%), oppositional (13%), and conduct problems (37%). In clinical settings, different cutoffs for (sub)clinical scores could be applied to paternal and maternal ratings of their child's psychopathology. Only for conduct problems, shared environmental and genetic influences explain an equal amount in differences between children. For the other scales, genetic factors explain the majority of the variance, especially for the common part that is free of rater bias. © 2016 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.     

No objectively measured sleep disturbances in children with attention‐deficit/hyperactivity disorder

The main goal of this study was to gain more insight into sleep disturbances in children with attention‐deficit/hyperactivity disorder, using objective measures of sleep quality and quantity. The evidence for sleep problems in children with attention‐deficit/hyperactivity disorder thus far is inconsistent, which might be explained by confounding influences of comorbid internalizing and externalizing problems and low socio‐economic status. We therefore investigated the mediating and moderating role of these factors in the association between attention‐deficit/hyperactivity disorder and sleep problems. To control for the effects of stimulant medication use, all participants were tested free of medication. Sixty‐three children with attention‐deficit/hyperactivity disorder and 61 typically developing children, aged 6–13 years, participated. Sleep was monitored for one to three school nights using actigraphy. Parent and teacher questionnaires assessed symptoms of attention‐deficit/hyperactivity disorder, internalizing behaviour, oppositional defiant disorder and conduct disorder. Results showed no differences between the attention‐deficit/hyperactivity disorder and typically developing group in any sleep parameter. Within the attention‐deficit/hyperactivity disorder group, severity of attention‐deficit/hyperactivity disorder symptoms was not related to sleep quality or quantity. Moderation analyses in the attention‐deficit/hyperactivity disorder group showed an interaction effect between attention‐deficit/hyperactivity disorder symptoms and internalizing and externalizing behaviour on total sleep time, time in bed and average sleep bout duration. The results of our study suggest that having attention‐deficit/hyperactivity disorder is not a risk factor for sleep problems. Internalizing and externalizing behaviour moderate the association between attention‐deficit/hyperactivity disorder and sleep, indicating a complex interplay between psychiatric symptoms and sleep.     

Preschool children's response to behavioural parent training and parental predictors of outcome in routine clinical care

Objective

To investigate the effectiveness of behavioral parent training (BPT) for preschool children with disruptive behaviours and to explore parental predictors of response.

Methods

Parents of 68 preschool children, aged between 2.7 and 5.9 years, participated in BPT. We evaluated the changes in children's behaviour after BPT with a one group pretest–posttest design, using a waiting period for a double pretest. Outcome was based on parents' reports of the intensity and number of behaviour problems on the Eyberg Child Behavior Inventory. Predictor variables included parents' attention‐deficit/hyperactivity disorder symptoms, antisocial behaviours, and alcohol use, and maternal parenting self‐efficacy and disciplining.

Results

Mother‐reported child behaviour problems did not change in the waiting period but improved significantly after BPT (d = 0.63). High levels of alcohol use by fathers and low levels of maternal ineffective disciplining were each associated with somewhat worse outcome.

Conclusions

BPT under routine care conditions clearly improves disruptive behaviours in preschool children. Mothers who consider themselves as inadequate in disciplining and mothers whose partners do not consume high levels of alcohol report the largest improvements.     

Toward Establishing the Transcultural Validity of Sluggish Cognitive Tempo: Evidence From a Sample of South Korean Children

All sluggish cognitive tempo (SCT) research has been conducted in North America and Western Europe, with the addition of 1 study in Chile. Our objective was to determine the internal and external validity of 9 SCT and 9 Diagnostic and Statistical Manual of Mental Disorders (5th ed.) attention deficit/hyperactivity disorder inattention (ADHD-IN) symptoms in South Korean children. Mothers, fathers, and teachers rated SCT, ADHD-IN, ADHD hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, and social impairment in 1st- to 6th-grade children (6–13 years of age) from South Korea (Sample 1: mothers rated 885 children and fathers rated 646 children; 941 unique children, 54% girls; Sample 2: 99 teachers rated 297 children, 44% girls). The SCT and ADHD-IN symptoms showed convergent validity (substantial loadings on their respective factors) and discriminant validity (loadings near zero on the alternative factor) across all three raters. Although ADHD-IN showed a positive relationship with ADHD-HI and ODD even after controlling for SCT across all three raters, SCT was nonsignificantly (mothers and fathers) or negatively (teachers) related to ADHD-HI and ODD after controlling for ADHD-IN. Higher SCT scores predicted higher anxiety, depression, academic impairment (teachers only), and social impairment (teachers only) even after controlling for ADHD-IN, whereas higher ADHD-IN scores predicted higher anxiety (mothers and fathers only), depression, academic impairment, and social impairment after controlling for SCT. The study provides initial evidence for the internal and external validity of SCT relative to ADHD-IN in South Korean children, thereby providing the first evidence for SCT’s validity in Asian children.     

南宁市4-16岁儿童少年心理卫生问题调查

目的：探讨南宁市4-16岁儿童少年心理卫生问题的发生情况。方法：对南宁市2801名4-16岁儿童应用自制的儿少情况调查表、Conners量表家长问卷和教师评定量表、Piers-Harris儿童自我意识量表、儿少主观生活质量问卷进行调查。结果：检出心理障碍520例(18．6％)，其中多动性行为障碍272例(9．7l％)，品行障碍和对立违抗性障碍78例(2．78％)，情绪障碍125例(4．46％)，其它单项症状324例(11．57％)。壮族检出率19．98％，汉族18．4％，瑶族13．2％，其它少数民族6．2％。男孩检出率23．02％，女孩13．65％。壮族儿少的幸福与满足因子得分略低于其它民族。男孩主观生活质量得分略低于女孩。结论：各民族儿少存在程度不同的心理障碍，开展有效的心理干预不容忽视。     

THE EFFECTS OF HEAD START DURATION ON THE BEHAVIORAL COMPETENCE OF SOCIALLY DISADVANTAGED CHILDREN

This study examined the influence of Head Start duration on teacher‐reported children's approaches to learning, behavioral problems, and cooperative classroom behaviors at the end of kindergarten. Propensity score matching was used to create comparable samples of children who experienced different durations of Head Start. Analysis of the Head Start Family and Child Experiences Survey showed that children who attended 2 years of Head Start showed a higher level of approaches to learning (effect size [ES] = .53), cooperative classroom behaviors (ES = .35), and fewer problematic behaviors (ES = ‐.43) in kindergarten. The effects of 2 years of attendance of Head Start were most prominent for children raised in families with high‐risk factors and for Black children, particularly with improvement in approaches to learning. This finding supports the argument that a longer exposure from an earlier age to a preschool program may contribute to improving school readiness for children from economically disadvantaged families.     

Mental health outcomes of cocaine-exposed children at 6 years of age

OBJECTIVE: To assess 6-year-old cocaine- and noncocaine-exposed children's mental health outcomes controlling for potential confounders. METHODS: The sample consisted of 322 children [169 cocaine exposed (CE) and 153 noncocaine exposed (NCE)] enrolled in a longitudinal study since birth. At age 6, children were assessed for mental health symptoms using the Dominic Interactive (DI), a child self-report measure, and the Child Behavior Checklist (CBCL), a caregiver report of behavioral problems. RESULTS: CE children were more likely to self-report symptoms in the probable clinical range for oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD). In contrast, prenatal cocaine exposure was not related to child behavior based on the CBCL. After control for exposure, CE children in adoptive or foster care were rated as having more problems with aggression, externalizing behaviors, and total behavioral problems than NCE children and CE children in maternal or relative care. Also, CE children in adoptive or foster care self-reported more externalizing symptoms than CE children in maternal or relative care and NCE children. Findings could not be attributed to caregiver intelligence or depressive symptoms, or to the quality of the home environment. CONCLUSIONS: CE children report more symptoms of ODD and ADHD than nonexposed children. Adoptive or foster caregivers rated their CE children as having more behavioral problems than did maternal or relative caregivers of CE children or parents of NCE children. Although further studies are needed to understand the basis for the more negative ratings by adoptive or foster caregivers of their CE children, the self-report of CE children indicates a need for psychological interventions.     

BOOK REVIEW: Becoming attached-unfolding the mystery of the infant-mother bond and its impact on later life

Observed normal preschool children from 2 through 5.9 years of age and their mothers using 2 established measurements of child compliance: the Compliance Test and the Clinic Task Analog. The diagnosis of oppositional defiant disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) currently requires subjective integration of interview, questionnaire, and behavioral data. Knowledge of normal child behavior within a parent-controlled task context is needed. Normal 4 - and 5-year olds were found to be more compliant than were normal 2- and 3-year olds; no sex effects were detected. The Compliance Test yielded stronger age associations, better observer reliability, and more individual differences than the Clinic Task Analog. Clinic Task Analog data masked child compliance, probably as a result of maternal instruction-giving style. The Compliance Test is recommended for diagnostic purposes over the Clinic Task Analog.     

学前教育与乙型肝炎表面抗原阳性儿童心理行为关系的研究

目的探讨学前教育与乙型肝炎表面抗原（HBsAg）阳性儿童心理行为的关系,为制定干预措施提供依据。方法采用中国8~12岁儿童气质量表（Chinese school children temperament scale,CSTS）和Achenbach儿童行为量表（Child BehaviorChecklist,CBCL）以及自制的儿童基本情况调查表,对57例未接受过学前教育和45例接受过学前教育的HBsAg阳性儿童进行测试和比较,并收集患儿的健康状况等信息。结果1未接受过学前教育的HBsAg阳性儿童在节律性、趋避性、心境和持久性等4个气质维度得分明显高于接受过学前教育的HBsAg阳性儿童,差异存在非常显著性或显著性（P〈0.01或P〈0.05）;2在退缩、焦虑/抑郁、注意问题、攻击性行为、内向性行为和行为问题总分等行为因子得分明显高于接受过学前教育的HBsAg阳性儿童,差异存在非常显著性（P〈0.01）。结论未接受过学前教育的HBsAg阳性儿童存在更多的心理行为问题。建议开设幼儿园,专门接受这些HBsAg阳性儿童,促进其身心健康成长。     

Comorbidity of Attention‐Deficit/Hyperactivity Disorder and Early‐Onset Conduct Disorder: Biological,Environmental, and Developmental Mechanisms

[Clin Psychol Sci Prac 17: 327–336, 2010] Among boys, about one‐third who exhibit severe attention‐deficit/hyperactivity disorder (ADHD) in preschool follow a developmental trajectory to early‐onset conduct disorder (CD) in later childhood and adolescence. Moreover, the vast majority of adolescent boys with early‐onset CD also meet criteria for ADHD. Although trait impulsivity, a predisposing vulnerability to both ADHD and CD, is about 80% heritable, environmental risk factors play an important role in how impulsivity is expressed, including whether young children with ADHD eventually develop CD. In this article, we (a) describe how environmental risk potentiates early‐onset conduct problems among trait‐impulsive and therefore vulnerable individuals and (b) outline implications for conceptualizations of externalizing comorbidity. Although other pathways to CD exist, we focus on what is likely to be a common developmental trajectory to this costly psychiatric condition.     

Behavioral phenotype of 49,XXXXY syndrome: Presence of anxiety‐related symptoms and intact social awareness

49,XXXXY is a rare X and Y chromosome variation that occurs in 1:85,000 to 1:100,000 live male births and is notable for variable motor, speech, and behavioral deficits. Case studies have described boys with this disorder as shy, impulsive, and aggressive with low frustration tolerances; however, previous studies have been limited due to cohort size. This study reports on the largest cohort of boys with 49,XXXXY to date with an emphasis on the prevalence of anxiety‐related symptoms and sociability from preschool to adolescence. The Child Behavior Checklist, Behavior Rating Inventory of Executive Function, 2nd edition, and Social Responsiveness Scale, 2nd edition were completed by parents on a cohort of 69. The cohort demonstrated deficits in social cognition and communication beginning in preschool, however, presented with consistent social awareness and motivation for social activities not previously appreciated in this disorder. In addition, signs of anxiety presented during preschool years and increased in severity with age, particularly in internalizing problems. Boys with 49,XXXXY presented with wide behavioral variability across all ages and domains. Further research into the potential influences of culture, birth order, biological treatment, and frequency of services is needed to better define the behavioral phenotype of children with this disorder.     

Attention-deficit/hyperactivity disorder and social dysfunctioning

Attention-deficit/hyperactivity disorder (ADHD) is associated with functional impairments in different areas of daily life. One such area is social functioning. The purpose of this paper is to critically review research on social dysfunctioning in children with ADHD. Children with ADHD often have conflicts with adults and peers, and suffer from unpopularity, rejection by peers, and a lack of friendships, in part as a consequence of their ADHD symptoms. Comorbid oppositional defiant or conduct disorder aggravates these impairments. In some cases the inadequate social behavior of children with ADHD may be phenomenologically and etiologically related to pervasive developmental disorders (PDD). However, the causes and consequences of PDD symptoms in ADHD are understudied. Also, the relative contributions of ADHD, on the one hand, and comorbid disorders, on the other, to the course of social impairments are unknown. Social dysfunctioning in children with ADHD appears to increase their risk of later psychopathology other than ADHD. Thus far effective treatment for social dysfunctioning is lacking. Future research should address the exact nature and long-term consequences of social dysfunctioning in children with ADHD, and focus on development of effective treatment strategies.     

Callous-Unemotional Traits and Executive Functions are Unique Correlates of Disruptive Behavior in Children

ABSTRACT

This study examined the influence of executive functions on the association between callous-unemotional traits and severity and type of childhood disruptive behavior. Eighty one children aged 8–12 years and their parents participated in the study. We assessed children’s callous-unemotional traits, executive functions, and two indices of disruptive behavior. Callous-unemotional traits and parent ratings of executive dysfunction were uniquely correlated with elevated conduct problems and oppositional and defiant behavior. Neither performance-based measures, nor parent ratings of executive function, moderated the association between callous-unemotional traits and disruptive behavior. Study findings suggest that executive functions and callous-unemotional traits may impact children’s behavior independently.     

DADS TUNING IN TO KIDS: PILOTING A NEW PARENTING PROGRAM TARGETING FATHERS’ EMOTION COACHING SKILLS

This pilot study reports the preliminary evaluation of an emotion socialization parenting program for fathers of preschool children. The program, Dads Tuning in to Kids (DadsTIK), is a specifically modified version of a universal evidence‐based prevention program, Tuning in to Kids (Havighurst & Harley, 2007). DadsTIK teaches fathers emotion coaching parenting skills that have previously been linked to children's social‐emotional competence and fewer behavior problems. The 7‐session (14 hours total) group program was delivered to 43 fathers who completed pre‐ and post‐program questionnaires assessing their parenting (emotional style, reactions to children's negative emotions, reactive/angry parenting, and parenting competence) and child outcomes (behavioral functioning). Program retention was excellent; and, post‐program, fathers reported increased emotion coaching, decreased emotion dismissing, decreased angry reactivity and improved parenting efficacy and satisfaction. They also reported reductions in difficult child behaviors. These positive outcomes suggest DadsTIK warrants further investigation.