Familial clustering of latent class and DSM-IV defined attention-deficit/hyperactivity disorder (ADHD) subtypes

BACKGROUND: Findings from family and twin-based studies of Attention Deficit/Hyperactivity Disorder (ADHD) have indicated that inattentive and combined subtypes cluster together among sibling pairs who both express ADHD symptoms. The current report examines the familial clustering of ADHD subtypes, defined according to latent class and DSM-IV criteria, in a general population sample of 2,848 Australian twins, 1,013 of their non-twin siblings and 4,036 female twins from Missouri, USA. Significant clustering of DSM-IV inattentive and combined subtypes, and significant clustering of the same latent classes among siblings was predicted. METHOD: Logistic regression was used to assess 1) the clustering of same and different subtype combinations among twin and twin-sibling pairs and 2) whether genetic influences contribute significantly to the observed patterns of subtype combinations among siblings. RESULTS: With the exception of the DSM-IV hyperactive-impulsive subtype and the severe hyperactive-impulsive latent class, all other sibling DSM-IV and latent class ADHD subtypes consistently exhibited significant same-subtype clustering with MZ probands, DZ probands and their siblings in both samples. Furthermore, a significant genetic influence contributing to subtype concordance was detected for every DSM-IV subtype excluding hyperactive-impulsive, and for all eight latent classes. While some instances of significant different-subtype clustering among siblings was observed across both classification systems and samples, the particular subtype combinations involved were largely inconsistent across samples and no significant genetic influences contributing towards these discordant subtype combinations were detected. CONCLUSIONS: For both DSM-IV and latent class subtypes, the overall pattern of findings in both samples indicated significant familial clustering of same-subtype combinations and significant genetic influences contributing to these patterns of subtype concordance, despite important sample differences. These findings further extend previous work and are most consistent with the presence of multiple independent forms of ADHD.     

Replication of the latent class structure of Attention-Deficit/Hyperactivity Disorder (ADHD) subtypes in a sample of Australian twins

BACKGROUND: Previous efforts to subtype Attention-Deficit/Hyperactivity Disorder (ADHD) using latent class analysis (LCA) applied to DSM-IV symptom profiles of adolescent female twins from Missouri (USA) have identified distinct classes within the domains of inattention, hyperactivity-impulsivity and combined-type problems. The objective of the current report is to determine if the latent class structure of ADHD subtypes can be replicated in a culturally distinct sample of female and male Australian twins. METHOD: LCA was applied to parent-report DSM-IV ADHD symptom profiles of N=2,848 child and adolescent Australian twins and compared to North American findings. Separate models were fitted for females (N= 1,432) and males (N= 1,416). RESULTS: The most congruent latent ADHD classes across samples included a non-symptomatic class, three mild-moderate and two severe classes. Also present within samples was a rare hyperactive-impulsive class and a unique class, the structure of which was idiosyncratic across samples. Mean symptom endorsement and individual symptom endorsement probabilities for each of the stable classes were similar across samples. Consistent with previous findings, there was substantial overlap between the DSM-IV inattentive and combined subtypes with the severe inattentive and severe combined latent classes. However, DSM-IV inattentive and combined subtypes were distributed over several latent classes in each sample, and a substantial proportion of individuals with no DSM-IV diagnosis were also assigned to these severe classes. CONCLUSIONS: Results from LCA using an Australian twin sample replicate six of the eight latent class subtypes previously reported using Missouri female twins and extend the findings to male twins. LCA and DSM-IV systems of ADHD classification identify different phenotypic groups, and the basis of this disparity merits further investigation.     

Latent Class Analysis of ADHD and Comorbid Symptoms in a Population Sample of Adolescent Female Twins

Attention-deficit/hyperactivity disorder (ADHD) is a phenotypically heterogeneous and highly heritable syndrome. which commonly co-occurs with other psychiatry disorders. To assess the role of genetic influences in ADHD, we used latent class analysis (LCA) to identify subtypes of ADHD taking into account its comorbidity with separation anxiety, oppositional defiant disorder (ODD), and three major depression symptoms. A structured interview was used to collect diagnostic data from a population sample of 2,904 adolescent female twins and their parents. LCA was applied to ADHD. separation anxiety. ODD symptom profiles obtained from the twins' parents, and major depression symptom profiles obtained from the twins' self-report. Odds ratios were used to test for familiality of class membership by examining the effect of zygosity on twin concordance within and between latent classes. Structural equation modeling was used to compute heritabilities for latent class membership. LCA revealed three ADHD categories of clinical interest: an inattentive subtype without comorbidity, a second inattentive subtype with increased number of ODD symptoms. and a combined inattentive/hyperactive-impulsive type with elevated levels of ODD, separation anxiety, and depressive symptoms. LCA also distinguished an ODD class and a separation anxiety class, each without increased levels of other comorbid symptoms; a second ODD class co-occurring with increased separation anxiety and depression symptoms; and a pure depression class. Odds ratios for MZ contrasted with DZ twin concordance for individual latent class membership ranged from 2.5 to 19.4. Overall, 66% of MZ pairs, but only 36% of DZ pairs, were assigned to the same latent class, consistent with a genetic hypothesis for latent class membership. Individual class membership was shown to have high heritability ranging from .34-.85. The pattern of latent classes suggested that in the general female adolescent population, there are three highly heritable ADHD subtypes, two of which are comorbid with other disorders. These classes were consistent with a genetic hypothesis for ADHD, with each class potentially reflecting a unique genetic subtype.     

Psychiatric features and parenting stress profiles of subtypes of attention-deficit/hyperactivity disorder: results from a clinically referred Taiwanese sample

OBJECTIVE: This study attempts to evaluate whether there are attention deficit/ hyperactivity disorder (ADHD) subtype differences regarding psychiatric features, comorbidity pattern and parenting stress profiles in an Asian population. METHODS: A total of 182 ADHD children and their primary caretakers recruited from a university-affiliated hospital were surveyed. Subjects were two groups of preadolescent (6 to 12 years old) ADHD children: children with ADHD-inattentive subtype (n=58) and ADHD-combined subtype (n=124). Various information was collected and compared, including the child's characteristics (current age, gender, number of family members, age at ADHD diagnosis, duration of pharmaceutical intervention, psychiatric comorbidities, and intelligence quotient); the primary caretaker's characteristics, and profiles obtained with the Parenting Stress Index (PSI). RESULTS: Group comparison showed that these two subtypes were statistically distinguishable from each other in total scores on the PSI, four subscale scores on the PSI, the child's age at diagnosis, and comorbidity profiles (all p<.05). Parents of children of the combined subtype experienced higher parenting stress and felt their children displayed qualities that made it difficult for them to fulfill their parenting roles. School failure (p=.001) and anxiety disorders (p=.022) were significantly more prevalent in the inattentive subtype children, while oppositional defiant disorder was significantly more present in the combined subtype children (p=.000). CONCLUSIONS: Our findings supported the cross-cultural equivalence of the nosological distinction in ADHD subtypes. The need for specific clinical intervention according to the subtype difference was stressed.     

Differences between subtypes of children with ADHD and simple attentional difficulties during an initial assessment

OBJECTIVE: To examine differences between subtypes of children with attention-deficit/hyperactivity disorder (ADHD), simple attentional difficulties and situational ADHD during an initial assessment. METHOD: In a single-centre study examination data of 205 children who had an initial assessment between January 1, 2002 and December 31, 2003 were retrospectively analyzed. The groups of children were compared with respect to their history features, neuromotor deficits, neuropsychological performance, and comorbid behavioural and developmental deficits by standardized test procedures and questionnaires. RESULTS: Children with ADHD more frequently have a positive family history of attentional symptoms than non-ADHD children. There is no difference between these groups with respect to the associated behavioural problems. Children classified as ADHD show more neuromotor problems and neuropsychological deficits than children with non-ADHD attentional problems. Children with ADHD subtype hyperactive/impulsive demonstrate better neuropsychological performance than children with subtypes inattentive and combined. Children with situational home-only or school-only ADHD show no clear differences in neuromotor behaviour, comorbid problems or neuropsychological performance. CONCLUSIONS: There are clear neuropsychological differences between children who fulfil the classification criteria of The Diagnostic and Statistical Manual of Disease, Fourth Revision (DSM-IV) for ADHD and children who are confronted daily with attentional difficulties, but do not fulfil the criteria for ADHD. In contrast, differences in behavioural comorbidities were not found, nor were differences found between home-only and school-only ADHD children.     

Family psychiatric history evidence on the nosological relations of DSM-IV ADHD combined and inattentive subtypes: new data and meta-analysis

BACKGROUND: A key issue in the nosology of attention deficit hyperactivity disorder (ADHD) has concerned whether the DSM-IV combined (ADHD-C) and primarily inattentive (ADHD-PI) subtypes are in fact distinct disorders, or instead are fairly closely related, perhaps differing only in severity. Pertinent to this question, but in short supply, are data on family psychiatric history. METHOD: We present new data followed by a meta-analysis. For the new data 210 children were well-characterized via structured interview and multi-informant ratings as ADHD-C or ADHD-PI. Three hundred and thirty-five parents completed structured diagnostic interviews to determine whether they had ADHD-C or ADHD-PI. Comorbid disorders were also assessed. For the meta-analysis, 6 existing family-history data sets using DSM-IV subtypes were pooled and analyzed (total N = 4120). RESULTS: The new family study found support for subtype-specific transmission, but the effect was small. Girls with ADHD-C had more severe family psychiatric histories (non-ADHD disorders in parents) than girls with ADHD-I, but this subtype effect did not occur for boys. The meta-analysis of 6 data sets implemented a model-fitting methodology. Despite inconsistent results across individual studies, the pooled data consistently suggested that (1) some degree of subtype specific transmission is occurring, (2) the effect is small, (3) non-specific (gradient) transmission also occurs, specifically in families of children with ADHD-C. CONCLUSION: The much-debated relation between these two most prevalent ADHD subtypes is best modeled via two processes transmitting in families. One process is distinct for the two syndromes, and the other is shared. We briefly suggest neuropsychological models that would account for this state of affairs and suggest future research to refine the nosology with these findings in mind.     

The factor structure of autistic traits

BACKGROUND: Although DSM-IV requires symptoms in three criterion domains for a diagnosis of autistic disorder, the extent to which those domains are phenotypically independent is an unanswered and important question. The identification of 'endophenotypes' of the autistic syndrome may be very useful for genetic and neurobiologic studies of autism, but only if they represent truly independent sub domains of the disorder. METHODS: In this study we examined the factor structure of autistic traits using data from 226 child psychiatric patients with and without pervasive developmental disorders, employing cluster analysis of data from the Autism Diagnostic Interview-Revised (ADI-r) and principal components factor analysis of data from the Social Responsiveness Scale (SRS, a quantitative genetic measure of autistic traits formerly known as the Social Reciprocity Scale). RESULTS: The results were consistent with the existence of a singular, continuously distributed underlying factor, resulting in disparate phenotypic manifestations across the three criterion domains for autistic disorder (social deficits, language deficits, and repetitive/stereotypic behaviors). CONCLUSION: The analyses generally failed to support the existence of independent sub domains of dysfunction in autism spectrum conditions. Future studies of the association between genetic/neurobiologic markers and autistic symptomatology may be enhanced by approaches which consider autistic symptoms as quantitative traits, and which are informed by ongoing research on the development and phenomenology of core deficiencies in reciprocal social behavior.     

Collaborative analysis of DRD4 and DAT genotypes in population-defined ADHD subtypes

BACKGROUND: It has been proposed that some of the variability in reporting of associations between attention deficit hyperactivity disorder (ADHD) and candidate genes may result from mixing of genetically heterogeneous forms of ADHD using DSM-IV criteria. The goal of the current study is to test whether population-based ADHD subtypes defined by latent class analysis help resolve issues of variable findings across individual gene association studies. METHODS: Three studies which had previously reported no associations between polymorphisms of the DRD4 and DAT genes and DSM-IV defined ADHD were reanalyzed using population-based and DSM-IV defined ADHD subtypes. RESULTS: Across studies no significant associations were found for either DRD4 or DAT polymorphisms using DSM-IV ADHD subtypes. In contrast, a significant association was found between the combined data set for the 440 base pair 3' DAT VNTR polymorphism and population-defined severe combined ADHD (OR=1.25, p=.01). A marginally significant association was also found between the 7 repeat DRD4 allele and population-defined severe combined ADHD. CONCLUSION: Use of alternative population-based defined ADHD subtypes may help resolve some of the variable results presented for candidate gene association studies in ADHD.     

Predictive validity of DSM-IV and ICD-10 criteria for ADHD and hyperkinetic disorder

BACKGROUND: The goal of this study was to compare the predictive validity of the two main diagnostic schemata for childhood hyperactivity - attention-deficit hyperactivity disorder (ADHD; Diagnostic and Statistical Manual- IV) and hyperkinetic disorder (HKD; International Classification of Diseases- 10th Edition). METHODS: Diagnostic criteria for ADHD and HKD were used to classify 419 children ages 6 to 16 years referred to a clinic for behavioral problems into one of four groups: HKD, ADHD combined subtype (ADHD-C), ADHD hyperactive-impulsive subtype (ADHD-HI), ADHD inattentive subtype (ADHD-IA). These groups were compared on clinical characteristics including total symptom severity, overall impairment, exposure to psychosocial and neuro-developmental risks, family history of ADHD in first-degree family members, rate and type of comorbidity, intelligence, academic achievement, and on laboratory tests of motor response inhibition and working memory with each other and with normal controls (47). RESULTS: Of the 419 cases, there were 46 HKD (11.0%), 200 ADHD-C (47.7%), 60 ADHD-HI (14.3%) and 113 ADHD-IA (27.0%) cases. The HKD group had more symptoms and was more impaired on teachers' ratings than were the other groups. The ADHD-C and HKD groups had poorer inhibitory control than the ADHD-IA, ADHD-HI and control groups, and all four clinic groups showed inhibition deficit compared to controls. Groups did not differ in working memory. Compared to controls, the HKD, ADHD-C, ADHD-HI and ADHD-IA groups had higher familial risk of ADHD, greater psychosocial risk exposure, lower intellectual level and poorer academic attainment. However, we observed no differences among the clinic groups in these characteristics. CONCLUSIONS: Like earlier versions, ICD-10 and DSM-IV continue to delineate diagnostic entities with substantially different prevalence in clinic samples. However, HKD, ADHD-C, ADHD-IA and ADHD-HI groups overlap substantially in terms of important clinical characteristics, although HKD and ADHD-C may be somewhat more severe variants of the condition than ADHD-IA and ADHD-HI.     

Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study

The purpose of this study was to offer detailed information about stimulant medication treatment provided throughout childhood to 379 children with research-identified attention-deficit hyperactivity disorder (ADHD) in the 1976-1982 Rochester, MN, birth cohort. Subjects were retrospectively followed from birth until a mean of 17.2 years of age. The complete medical record of each subject was reviewed. The history and results of each episode of stimulant treatment were compared by gender, DSM-IV subtype of ADHD, and type of stimulant medication. Overall, 77.8% of subjects were treated with stimulants. Boys were 1.8 times more likely than girls to be treated. The median age at initiation (9.8 years), median duration of treatment (33.8 months), and likelihood of developing at least one side effect (22.3%) were not significantly different by gender. Overall, 73.1% of episodes of stimulant treatment were associated with a favorable response. The likelihood of a favorable response was comparable for boys and girls. Treatment was initiated earlier for children with either ADHD combined type or ADHD hyperactive-impulsive type than for children with ADHD predominantly inattentive type and duration of treatment was longer for ADHD combined type. There was no association between DSM-IV subtype and likelihood of a favorable response or of side effects. Dextroamphetamine and methylphenidate were equally likely to be associated with a favorable response, but dextroamphetamine was more likely to be associated with side effects. These results demonstrate that the effectiveness of stimulant medication treatment of ADHD provided throughout childhood is comparable to the efficacy of stimulant treatment demonstrated in clinical trials.     

The incidence of autism in Olmsted County, Minnesota, 1976-1997: results from a population-based study

OBJECTIVE: To determine the incidence of autism among children in Olmsted County, Minnesota. DESIGN: Through the Rochester Epidemiology Project, all inpatient and outpatient diagnoses are indexed for computerized retrieval. This computerized diagnostic index was used to identify children with any developmental disorder. A glossary of symptoms of autism was used to review medical and school records of these children for symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for autistic disorder. SETTING: Olmsted County, Minnesota.Subjects All residents of Olmsted County 21 years or younger between 1976 and 1997.Main Outcome Measure The incidence of research-identified autism based on DSM-IV criteria for autistic disorder. RESULTS: The age-adjusted incidence of research-identified autism was 5.5 (95% confidence interval, 1.4-9.5) per 100 000 children from 1980 to 1983 and 44.9 (95% confidence interval, 32.9-56.9) from 1995 to 1997 (8.2-fold increase). This increase was confined to children younger than 10 years who were born after 1987. CONCLUSIONS: The incidence of research-identified autism increased in Olmsted County from 1976 to 1997, with the increase occurring among young children after the introduction of broader, more precise diagnostic criteria, increased availability of services, and increased awareness of autism. Although it is possible that unidentified environmental factors have contributed to an increase in autism, the timing of the increase suggests that it may be due to improved awareness, changes in diagnostic criteria, and availability of services, leading to identification of previously unrecognized young children with autism.     

Comparison of male adolescent-report of attention-deficit/hyperactivity disorder (ADHD) symptoms across two cultures using latent class and principal components analysis

BACKGROUND: The goal of this study is to gauge the consistency of Attention Deficit/Hyperactivity Disorder (ADHD) latent class models that are generated by different informants such as adolescents and parents. The consistency of adolescent-derived latent classes from two different samples was assessed and these results were then compared to the class structure generated by parent-report ADHD information. METHODS: Self-reported DSM-IV Criterion A ADHD symptoms of 497 adolescent males from a population-based twin study in the state of Missouri (USA) were subjected to principal components and latent class analysis, and findings were compared to previous results obtained from identical analyses using an adolescent sample from Porto Alegre, Brazil (N = 483). RESULTS: The bi-dimensional structure of self-reported ADHD symptoms was similar for both male adolescent groups, but explained less than 40% of the symptom variance in either sample. Two factors, one with loadings on inattention symptoms only and the other with loadings on hyperactive-impulsive symptoms only, were identified in the Missouri sample. Specific ADHD latent classes did not replicate well across the Missouri and Brazilian samples, and both groups were characterized by the presence of several combined symptom classes but few inattentive or hyperactive-impulsive classes. CONCLUSIONS: While adolescent-report information across two different cultures can at least in part reproduce the two-factor structure of ADHD, results from latent class analysis suggest that adolescent reporting on their own symptoms is markedly different from the type of information parents provide about ADHD symptoms in their offspring. The current findings indicate that if male adolescents endorse any ADHD symptoms there is a tendency for them to report combined type problems.     

Developmental trajectories of DSM-IV symptoms of attention-deficit/hyperactivity disorder: genetic effects, family risk and associated psychopathology

Background: DSM‐IV specifies three ADHD subtypes; the combined, the hyperactive‐impulsive and the inattentive. Little is known about the developmental relationships underlying these subtypes. The objective of this study was to describe the development of parent‐reported hyperactivity‐impulsivity and inattention symptoms from childhood to adolescence and to study their associations with genetic factors, family risk, and later adjustment problems in early adulthood. Method: Data in this study comes from 1,450 twin pairs participating in a population‐based, longitudinal twin study. Developmental trajectories were defined using parent‐ratings of hyperactivity‐impulsivity and inattention symptoms at age 8–9, 13–14, and 16–17. Twin methods were used to explore genetic influences on trajectories. Family risk measures included low socioeconomic status, large family size and divorce. Self‐ratings of externalizing and internalizing problems in early adulthood were used to examine adjustment problems related to the different trajectory combinations. Results: We found two hyperactivity‐impulsivity trajectories (low, high/decreasing) and two inattention trajectories (low, high/increasing). Twin modeling revealed a substantial genetic component underlying both the hyperactivity‐impulsivity and the inattention trajectory. Joint trajectory analyses identified four groups of adolescents with distinct developmental patterns of hyperactivity‐impulsivity and inattention: a low/low group, a primarily hyperactive, a primarily inattentive and a combined (high/high) trajectory type. These trajectory combinations showed discriminant relations to adjustment problems in early adulthood. The hyperactive, inattentive and combined trajectory subtypes were associated with higher rates of family risk environments compared to the low/low group. Conclusion: Study results showed that for those on a high trajectory, hyperactivity decreased whereas inattention increased. The combinations of these trajectories lend developmental insight into how children shift from (i) a combined to inattentive subtype, and (ii) a hyperactive‐impulsive to a combined subtype. This study suggests that ADHD subtypes cannot be viewed as discrete and stable categories.     

心理行为干预联合生物反馈对学龄前注意缺陷多动障碍患儿的疗效分析

目的 探讨心理行为干预联合生物反馈治疗对学龄前注意缺陷多动障碍（ADHD）患儿的疗效。方法 选择注意力缺陷型、多动-冲动型及复合型学龄前ADHD患儿各60例作为研究对象。按照干预措施前瞻性随机分为对照组、心理行为组、生物反馈组和综合组，治疗4个月后评估注意力集中时间及Conners父母量表（PSQ量表）的冲动-多动、多动指数评分。结果 治疗后心理行为组、生物反馈组和综合组中，三种类型患儿注意力集中时间均明显增加（P < 0.05）。对于三种类型的患儿，采用生物反馈及综合治疗均可降低冲动-多动评分（P < 0.05）；注意力缺陷型及复合型患儿采用心理行为及综合治疗可降低多动指数评分，多动-冲动型患儿采用心理行为、生物反馈及综合治疗均可降低多动指数评分（均P < 0.05）。结论 心理行为干预联合生物反馈治疗可提高ADHD患儿注意力集中水平，改善冲动-多动及多动的行为症状，不同ADHD类型患儿治疗效果略有不同。     

儿童注意缺陷多动障碍共患病及功能损害研究

目的 评估注意缺陷多动障碍(ADHD)患儿共患病及功能损害发生情况,并探讨其与核心症状(注意缺陷、多动冲动)的相关性。方法 疑诊为ADHD 的319例儿童作为研究对象,由父母完成Vanderbilt父母评定量表(VADPRS),根据美国精神病学会制定的《精神障碍诊断和统计手册》第四版(DSM-IV)进行诊断及分型,根据VADPRS进行共患病筛查及功能损害评估。同时对各型ADHD患儿共患病和功能损害情况进行比较,对其与核心症状的关系进行相关性分析。结果 319例儿童中,196例诊断为ADHD,其中注意缺陷型(ADHD-I)84例,多动冲动型(ADHD-HI)35例,混合型(ADHD-C)77例。123例不满足ADHD诊断标准。ADHD儿童共患病(对立违抗性障碍、品行障碍、情绪障碍)发生率显著高于非ADHD儿童(63.8% vs 37.4%, P<0.05)。ADHD-C组对立违抗和品行障碍发生率高于ADHD-I组(P<0.05)。对立违抗、品行障碍及情绪障碍的阳性条目数与两个核心症状群阳性条目数有弱相关性(P<0.01)。ADHD组总功能损害发生率显著高于非ADHD组(89.8% vs 74.8%, P<0.05)。ADHD-C组功能损害发生率显著高于ADHD-I组和ADHD-HI组(P<0.05)。注意缺陷阳性症状条目数与学习问题、同胞关系损害及组织活动问题有弱相关性(P<0.01),多动冲动阳性症状条目数仅与同胞关系损害有弱相关性(P<0.01)。结论 ADHD组儿童共患病及功能损害发生率高,以ADHD-C组最显著。ADHD核心症状严重程度可以影响共患病及功能损害的发生。未达到ADHD诊断标准的疑诊儿童也有较高的其他精神障碍和功能损害发生率,临床上也要重视对此类儿童的干预。     

Comparison of ADHD symptom subtypes as source-specific syndromes

BACKGROUND: This study examines differences between the three subtypes of attention-deficit/hyperactivity disorder (ADHD), inattentive (I), hyperactive-impulsive (H), and combined (C), in a heterogeneous sample of 248 boys (ages 6 to 10 years) with emotional and behavioral problems who were recruited for participation in a diagnostic study. METHOD: The boys and their mothers participated in an extensive evaluation that involved multiple assessments of cognitive, behavioral, academic, and family functioning. ADHD subtypes were defined on the basis of teacher alone, mother alone, and mother/teacher ratings of DSM-IV symptoms. RESULTS: Results indicated ADHD symptom groups showed a differential pattern of impairment socially (H,C>I) and cognitively (I,C>H). The C and H groups were the most and least impaired overall, respectively, and all subtypes were differentiated from the nonADHD clinical control or NONE (N) group in a manner consistent with the primary findings. External validation of group differences was limited, and there were marked inconsistencies in the pattern of findings depending on how groups were defined. For the most part, although the mother/teacher grouping strategy (compared with either alone) captured a greater diversity of differences between subtypes, it also obscured some. CONCLUSIONS: Observed findings are consistent with the notion that mothers and teachers interpret symptom statements in terms of behaviors that are most relevant for their daily concerns.     

孤独症患儿发育倒退特征的研究

目的：大约30%左右孤独症的患儿在2岁左右出现发育倒退。“倒退型”患儿的病程发展、临床表现尚不十分清楚,因此该研究对一组有发育倒退特征的孤独症患儿进行了研究。方法：符合DSM-IV孤独症诊断标准的孤独症患儿152例, 年龄2.5～6.5岁,根据有无语言发育倒退进行分组。调查患儿的围产期情况、发育史及发育倒退的特征,并对两组患儿的症状进行比较。结果：33例(21.7％)患儿在生后16~21个月时出现语言及社交功能的倒退。CARS量表(Childhood Autism Rating Scale)的评分比较显示倒退组明显高于非倒退组（P<0.05）;倒退组中重症患儿所占比例（66.7%）明显高于非倒退组（45.4%）（P<0.05）。结论：发育倒退在孤独症中占有一定的比例,对于孤独症的诊断具有意义。倒退型患儿的症状程度比非倒退型患儿更为严重,提示倒退型可能为孤独症的一类特殊表型。［中国当代儿科杂志,2010,12（10）：781-783］     

不同亚型注意力缺陷多动障碍患儿的临床特征分析

目的：研究不同亚型注意力缺陷多动障碍(ADHD)患儿的临床特征。方法：将符合美国《精神障碍诊断与统计手册(第4版)》ADHD诊断标准的175名患儿,分为注意缺陷型（ADHD-I,n=82）、多动-冲动型（ADHD-HI,n=24）和混合型（ADHD-C,n=69）,分别进行性别构成、危险因素、共患疾病、智力水平和Conners父母症状问卷的比较。结果：各亚型男女性别构成差异无统计学意义;ADHD-I组和ADHD-C组分娩异常的比率高于ADHD-HI组,ADHD-HI组和ADHD-C组家庭教育方式不当的比率高于ADHD-I组;3组言语智商、操作智商和总智商差异无统计学意义,ADHD-I组智力发展不平衡比率高于其他两组;ADHD-HI组和ADHD-C组对立违抗障碍、抽动障碍的共患率高于ADHD-I组,ADHD-I组和ADHD-C组学习困难的共患率高于ADHD-HI组;ADHD-HI组和ADHD-C组品行问题、冲动-多动、多动指数均高于ADHD-I组,而ADHD-I组学习问题最显著。结论：ADHD-C和ADHD-HI患儿对立违抗障碍和抽动障碍共患率较高,多动-冲动等破环性行为突出,ADHD-I患儿学习问题和智力发展不平衡显著。［中国当代儿科杂志,2010,12（9）：704-708］     

Autism and attachment: a meta-analytic review

METHOD: Sixteen studies on attachment in children with autism were reviewed, and ten studies with data on observed attachment security (N = 287) were included in a quantitative meta-analysis. RESULTS: Despite the impairments of children with autism in reciprocal social interaction, the majority of the studies found evidence for attachment behaviours in these children. In four samples using the Strange Situation procedure the average percentage of secure attachments amounted to 53% (n = 72). Meta-analytic results showed that children with autism were significantly less securely attached to their parents than comparison children, and the combined effect size for this difference was moderate (r =.24). Children with autism displayed less attachment security than comparisons without autism, but this difference disappeared in samples with children with higher mental development, and in samples in which autism was mixed with less severe symptoms of autistic spectrum disorders. CONCLUSIONS: It is concluded that attachment security is compatible with autism, and can be assessed with Strange Situation type of procedures. The co-morbidity of autism and mental retardation appears to be associated with attachment insecurity.     

Diagnostic labelling of autism spectrum disorders in NSW

Aim:   To describe the use of diagnostic labels by clinicians for children with autism spectrum disorders (ASD) and calculate the label-specific and overall agreement between diagnostic labels and Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) diagnoses provided by the same clinician.
Methods:   State-wide active surveillance was used to ascertain children newly recognised with one or more DSM-IV criteria for autistic disorder aged 0–15 years (incident cases) in New South Wales (NSW) between July 1999 and December 2000. Clinicians were asked to supply a diagnostic label and then complete DSM-IV criteria for each child reported.
Results:   Questionnaires with diagnostic label and DSM-IV criteria were returned for 348 children. The agreement between labels used and diagnosis based on DSM-IV classification system was the highest for autism (97%) and lower for labels of Asperger disorder, pervasive developmental disorder – not otherwise specified or atypical autism (27%). Kappa overall agreement was 0.31. Level of agreement between label and DSM-IV diagnosis was similar for questionnaires completed by multidisciplinary teams, psychiatrists, paediatricians and psychologists working as part of a team.
Conclusion:   A lack of agreement between the diagnostic labelling used by clinicians and diagnosis based on DSM-IV criteria indicates a lack of consistency in diagnostic communication that is necessary to provide best clinical care, appropriate services and relevant information to parents and carers.