The CBCL as a screen for psychiatric comorbidity in paediatric patients with ADHD

Aims: To examine the informativeness of the Child Behavior Checklist (CBCL) as a screening tool to identify comorbid and non-comorbid cases of attention deficit hyperactivity disorder (ADHD) in a paediatrically referred population. It was hypothesised that specific scales of the CBCL would help identify specific comorbidities within ADHD cases in the primary care setting. Methods: The sample consisted of children and adolescents 6–17 years old of both genders with ADHD (n = 121). A receiver operating curve (ROC) approach was used to determine which CBCL scales best differentiated between ADHD cases with and without its comorbidities with conduct, anxiety, and mood disorders. Results: ROC analysis showed that the CBCL Delinquent Behavior and Aggressive Behavior scales predicted the structured interview derived diagnoses of conduct and bipolar disorder, the Anxious/Depressed and Aggressive Behavior scales predicted major depression, and the Anxious/Depressed and Attention problems scales predicted anxiety disorders. Conclusions: These results extend to a paediatrically referred population with previously reported findings in psychiatric samples documenting good convergence between structured interview diagnoses and syndrome congruent CBCL scales. These findings support the utility of the CBCL as a screening tool for the identification of psychiatric comorbidity in ADHD youth in the primary care setting.     

Bullying among children with autism and the influence of comorbidity with ADHD: a population-based study.

OBJECTIVE: Bullying is a significant problem among school-age children. The prevalence and predictors of bullying among children with autism are not known. The objectives of this population-based study were to: (1) estimate the prevalence of bullying among children with autism in the United States, (2) determine whether the presence of attention-deficit/hyperactivity disorder/attention-deficit disorder (ADHD/ADD) increases prevalence of bullying among children with autism, and (3) determine risk factors of bullying behavior among children with autism. METHODS: The National Survey of Children's Health, 2003 (NSCH), provided nationally representative data for children ages 4 to 17. We used multivariate logistic regression and Wald tests to determine whether children with autism were more likely to bully in the presence of ADHD/ADD. Taylor approximations were used to account for the complex sampling design. RESULTS: Children with autism had a high prevalence of bullying (44%, 95% confidence interval, 34-55). Parent report of ADHD/ADD appears to moderate the relationship between bullying and autism. Children with autism who did not have ADHD/ADD were not at greater risk for bullying compared with the general population. Children with autism and ADHD/ADD had increased odds of bullying (odds ratio 4.6, 95% confidence interval 2.4-8.6), even after controlling for household income, age, and gender. In addition to ADHD/ADD, living in a low-income household and younger age were risk factors for bullying among children with autism. Being female, however, did not decrease the risk of bullying in the autistic subpopulation. CONCLUSIONS: Children with autism and ADHD/ADD appear to be at increased risk for bullying behaviors.     

The zebrafish as a model for paediatric diseases

The rapid increase in information about genes and their associations with human diseases has highlighted the need for model organisms suitable for genetic manipulation and drug testing. The zebrafish is a valuable vertebrate animal model that offers many advantages, including the relative ease of husbandry and genetic manipulation and the capacity for high‐throughput screens. In this review, we describe the zebrafish as a model for paediatric diseases, with particular emphasis on haematopoietic and infectious diseases. Conclusion: The zebrafish has become an established vertebrate model in which to elucidate the molecular mechanisms of various human diseases.     

The comorbidity of ADHD in the general population of Swedish school-age children

This study examined patterns of comorbid/associated diagnoses and associated problems in a population sample of children with and without DSM-III-R attention-deficit hyperactivity disorder (ADHD). Half (N = 409) of a mainstream school population of Swedish 7-year-olds were clinically examined, and parents and teachers were interviewed and completed questionnaires. The children were followed up 2-4 years later. Eighty-seven per cent of children meeting full criteria for ADHD (N = 15) had one or more and 67% at least two--comorbid diagnoses. The most common comorbidities were oppositional defiant disorder and developmental coordination disorder. Children with subthreshold ADHD (N = 42) also had very high rates of comorbid diagnoses (71% and 36%), whereas those without ADHD (N = 352) had much lower rates (17% and 3%). The rate of associated school adjustment, learning, and behaviour problems at follow-up was very high in the ADHD groups. We concluded that pure ADHD is rare even in a general population sample. Thus, studies reporting on ADHD cases without comorbidity probably refer to highly atypical samples. By and large, such studies cannot inform rational clinical decisions.     

The yield of surveillance endomyocardial biopsies as a screen for cellular rejection in pediatric heart transplant patients

Endomyocardial biopsy is commonly used to screen for cellular rejection in pediatric heart transplant patients. The yield of EMBs when combined with newly developed immunohistochemical techniques and modern immunosuppression in pediatric heart transplant patients is unknown. After OHT, surveillance biopsies were performed on a routine basis on all pediatric patients. EMBs were also performed on symptomatic OHT patients suspected to have rejection. All positive results (greater than ISHLT grade 1B) were confirmed with immunohistochemical staining. A retrospective review of consecutive EMBs performed in this institution from January 1995 to January 2003 was performed. The echocardiographic results, clinical history and treatment changes at the time of every biopsy were also catalogued. Of the 1093 EMB results from 136 pediatric heart transplant grafts (127 patients, 64 male) reviewed, 825 biopsies were performed on patients managed with tacrolimus and 268 were performed on patients managed with cyclosporine. The patients managed with tacrolimus had an incidence of 0.85% (7/825) for significant rejection (greater than ISHLT grade 1B rejection) vs. an incidence of 4.1% (11/268) for the patients on cyclosporine (p < 0.0005). In the asymptomatic tacrolimus patients, only two screening biopsies (0.26%) manifest significant rejection, and both of these were performed within the first month after transplantation. Of the symptomatic tacrolimus patients, 9.1% (n = 5) had findings on biopsy consistent with significant cellular rejection. There were 25 patients with grade 1B rejection. Twenty-two of these patients were not treated, and all cases of grade 1B rejection resolved without clinical sequelae. For pediatric patients more than 30 days after OHT, EMB has failed to reveal significant episodes of cellular rejection in asymptomatic patients managed with tacrolimus.     

Parental concordance and comorbidity for psychiatric disorder and associate risks for current psychiatric symptoms and disorders in a community sample of juvenile twins

In this report we characterize associations between parental psychiatric disorders and children's psychiatric symptoms and disorders using a population-based sample of 850 twin families. Juvenile twins are aged 8-17 years and are personally interviewed about their current history of DSM-III-R conduct, depression, oppositional-defiant, overanxious, and separation anxiety disorders using the CAPA-C. Mothers and fathers of twins are personally interviewed about their lifetime history of DSM-III-R alcoholism, antisocial personality disorder, generalized anxiety disorder, major depression, panic disorder/agoraphobia, social phobia, and simple phobia using a modified version of the SCID and the DIS. Generalized least squares and logistic regression are used to identify the juvenile symptoms and disorders that are significantly associated with parental psychiatric histories. The specificity of these associations is subsequently explored in a subset of families with maternal plus parental psychiatric histories with a prevalence > 1%. Parental depression that is not comorbid or associated with a different spousal disorder is associated with a significantly elevated level of depression and overanxious disorder symptoms and a significantly increased risk for overanxious disorder. Risks are higher for both symptomatic domains in association with maternal than paternal depression, and highest in association with maternal plus paternal depression. Risks for otherjuvenile symptoms and disorders index the comorbid and spousal histories with which parental depression is commonly associated. Paternal alcoholism that is not comorbid or associated with a maternal disorder is not significantly associated with current psychiatric symptoms or disorders in offspring. Risks for oppositional-defiant or conduct symptoms/disorders in the offspring of alcoholic parents index parental comorbidity and/or other spousal histories.     

Bowel management for paediatric patients with faecal incontinence

This review assesses the incidence and aetiology of faecal incontinence in childhood. We then systematically address the presentation, clinical assessment, investigation and management of these children. Under management, both medical and surgical approaches and their complications are discussed.     

Colectomy in paediatric patients with ulcerative colitis

IntroductionThere are not many studies published in the literature on failure of medical treatment in Ulcerative Colitis (UC) that leads to colectomy.Patients and methodsRetrospective study of patients under 14 years diagnosed with UC from 1984 to 2009, who underwent colectomy due to lack of response to medical treatment. They are divided into urgent or elective surgery.ResultsColectomy performed in 14 paediatric patients (26.9% of total UC patients). Age at diagnosis 7.8 ± 4.0 years, 8 of them younger than 10 years and 5 younger than 5 years. All cases diagnosed on patients less than 5 years of age required colectomy in the first 6 months after diagnosis. Elective colectomy was performed on 5/14 and urgent surgery in 9/14. The reported complications were divided into early (first 30 days after colectomy) and late. Pharmacological treatment in cases with urgent colectomy included methylprednisolone (100%), oral tacrolimus (55.5%), oral/intravenous cyclosporine (33.3%) and infliximab (33.3%). Cases of elective colectomy were all in the 1985–1998 period.ConclusionsThe influence of age is a key factor for prognosis. All patients less than 5 year-old ended up with colectomy. The main indication for urgent surgery was lack of response to treatment with intravenous steroids combined with a potent immunomodulator (tacrolimus, cyclosporine, infliximab). All cases of elective colectomy were performed before 1999, when second line medical treatment was very uncommon, making remission unlikely.     

The stethoscope as a vector of infectious diseases in the paediatric division

AIM: Nosocomial infections are of great concern in hospital settings, and even more so in the paediatric ward. Health professionals and their medical equipment have long been known to act as vectors of infectious diseases. This study aimed at evaluating the presence of bacterial pathogens on the stethoscopes of medical personnel in the paediatric division. METHODS: Forty-three stethoscopes belonging to senior physicians, residents, interns and medical students at the paediatric ward were sampled. Bacterial cultures and antibiotic sensitivity testing were carried out. RESULTS: All but six bacterial cultures were positive (85.7%). Staphylococcal species were the most common contaminants (47.5%). One case of methicillin-resistant Staphylococcus aureus was encountered. Gram-negative organisms were isolated in nine different samples (21%) including one case of Acinetobacter baumannii in the neonatal intensive care unit. CONCLUSION: Most stethoscopes harbour potential pathogens. The isolation of Gram-negative organisms pose a real risk of spreading potentially serious infections, especially in the setting of intensive care departments. Apparently, the current recommendations of regular disinfection of stethoscopes are not carried out by health personnel that participated in the study.     

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??Objective??To estimate the occurrence of attention deficit hyperactivity disorder comorbiding anxiety and depression and to compare the behavior characteristics of ADHD with and without anxiety or depression. Methods??A total of 105 children with ADHD meeting DSM-4 diagnostic criteria aged from 8 to 14 years were involved in this study. They were evaluated with the Screen for Child Anxiety Related Emotional Disorders??SCARED???? Depression Self-Rating Scale for Children??DSRSC?? by self-report and Achenbach’s Child Behavior Checklist ??CBCL?? by their parents. Another 66??without diagnosis of ADHD?? children aged from 8-14 years who were selected from a school as a control group were evaluated too??according to SCARED and DSRSC?? a ormal group ??43 children?? was selected from control group for analysis. Results??Thirty-nine of 105 children with ADHD compared to 13 of 66 controls scored at or beyond the clinical cut off ??25 points?? of SCARED score . Thirty-three of 105 children with ADHD compared to 10 of 66??15.2%?? controls reached the threshold??15 points?? of DSRSC of Chinese Norm ??χ2 = 5.704??P = 0.017??. In ADHD group 16 of 105??15.2%?? ADHD children comorbid both anxiety and depression??but none in controls. In ADHD children?? all scores of social ability were lower while all CBCL behavior scores were higher than normal controls except somaticcomplaint?? ADHD with anxiety had higher score in somatic complaint??ADHD with depression had higher score in anxious/depressed and ADHD with both anxiety and depression had higher score in Withdrawn?? somatic complaint?? Anxious/Depressed?? thought problems??attention problems andinternalizing problems than ADHD without anxiety and depression. Conclusion??The children with ADHD have high occurrence of comorbidity ofanxiety and depression. Children comorbided both anxiety and depression have more behavior and internalizing problems?? which implies that there is a need for further mental health services for this population.