Comparability of sleep disorders diagnoses using DSM-IV and ICSD classifications with adolescents.

STUDY OBJECTIVES: The use of diagnostic classifications to define sleep disorders is still unusual in epidemiological studies assessing the prevalence of sleep disorders in an adolescent population. DESIGN: Cross-sectional study. Representative samples of general populations in United Kingdom, Germany and Italy were selected and interviewed by telephone about their sleep habits, sleep and mental disorder diagnoses. Overall, 724 adolescents ages 15-18 years and 1447 young adults ages 19 to 24 years were interviewed. ICSD-90 and DSM-IV diagnoses provided by the Sleep-EVAL expert system were used for the comparisons. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: 8% of the adolescents and 12.6% of the young adults had ICSD dyssomnia or sleep disturbances associated with a mental disorder. According to the DSM-IV classification, 5.7% of the adolescents and 8.1% of the young adults had a dyssomnia diagnosis. The comparison between the two classifications show that 73.2% of adolescents and young adults with a DSM-IV dyssomnia diagnosis also had similar ICSD diagnosis. The reverse comparison, ICSD vs. DSM-IV, shows that 39.8% of the subjects with an ICSD diagnosis had a DSM-IV diagnosis. DSM-IV primary insomnia was the most frequent diagnosis. Subjects with such a diagnosis were found in about 10 different ICSD diagnoses, mainly inadequate sleep hygiene, psychophysiological or idiopathic insomnia and insufficient sleep syndrome. CONCLUSIONS: ICSD-90 classification provided higher prevalence of sleep disorder diagnoses than the DSM-IV classification. In adolescents and young adults, DSM-IV primary insomnia is two times more often associated with ICSD inadequate sleep hygiene than with ICSD psychophysiological or idiopathic insomnia.     

An empirical analysis of the BASC Frontal Lobe/Executive Control scale with a clinical sample.

Data from a clinical sample of children and adolescents were used to examine the characteristics of the Frontal Lobe/Executive Control (FLEC) scale of the Behavior Assessment System for Children Parent Rating Scales, including preliminary evidence of the scale's clinical utility and relationship to other behavioral measures of executive function and characteristics of Attention Deficit Hyperactivity Disorder (ADHD). Results indicate that participants in the ADHD and other clinical groups received very similar scores on the FLEC scale, and both groups were rated significantly higher in behaviors associated with executive dysfunction than were participants in the no diagnosis group. Correlational results indicate that scores on the FLEC scale were significantly correlated with scores on the Behavior Rating Inventory of Executive Function-Parent Form and Conners' Parent Rating Scales Revised-Short Form. Based on our results, the FLEC scale appears to be a useful behavioral rating tool in the assessment of executive function that may serve as a supplement to more traditional measures.     

Media influences on children and adolescents: violence and sex

The portrayal of violence, sex, and drugs/alcohol in the media has been known to adversely affect the behavior of children and adolescents. There is a strong association between perceptions of media messages and observed behavior, especially with children. Lately, there has been more of a focus in the public health/medical field on media influences of youth and the role of the pediatrician and/or healthcare worker in addressing this area of growing concern. There is a need to explicitly explore the influences of media violence, sex, and drugs/alcohol on youth within the context of the Social Learning Theory. Implications of these influences are discussed, and recommendations for pediatricians and/or health care workers who interact with children and adolescents are described. Pediatricians and health care workers should incorporate media exposure probes into the developmental history of their patients and become knowledgeable about the effects of medial influences on youth.     

Buffering the effects of violence: communication and problem‐solving skills as protective factors for adolescents exposed to violence

Although many adolescents exposed to violence evidence negative outcomes, some report few deleterious effects, indicating the presence of moderating variables. This study examined the moderating role of family communication and problem solving on positive and negative outcomes in adolescents exposed to school and neighborhood violence. Participants were 90 adolescents and their parents, who completed measures of violence exposure, psychological and behavioral functioning, and communication and problem‐solving skills. Results indicated that after controlling for demographic variables and violence exposure in the home, communication and problem‐solving skills moderated the association between school and neighborhood violence exposure and psychological distress. There was no moderation of the violence exposure‐positive outcome association. The findings suggest that family communication and problem‐solving skills might serve a protective function for adolescents, thereby decreasing psychological distress in the face of school and neighborhood violence exposure. © 2011 Wiley Periodicals, Inc.     

Urban Adolescents' Exposure to Community Violence: The Role of Support,School Safety,and Social Constraints in a School-Based Sample of Boys and Girls

This study examined recent exposure to violence in the community and in other settings, protective factors, and current psychological functioning among 349 young adolescents from 9 urban middle schools. The majority (76%) of adolescents reported witnessing or being victimized by at least 1 violent event in the prior 6 months. Nearly half of adolescents who had talked about their experience of a violent event reported feeling constrained from sharing their thoughts or feelings because of others' reactions. After controlling for daily hassles, more exposure to violence was associated with more self-reported posttraumatic stress disorder (PTSD) and depressive symptoms. Exposure to violence was not a significant predictor of teachers' ratings of adaptive functioning or internalizing symptoms. Support from specific individuals, perceived school safety, and lower constraints for discussing violence showed protective effects in the relation between exposure to violence and specific dimensions of psychological functioning. The implications of this research for school-based interventions are discussed.     

Urban adolescents' exposure to community violence: the role of support, school safety, and social constraints in a school-based sample of boys and girls.

This study examined recent exposure to violence in the community and in other settings, protective factors, and current psychological functioning among 349 young adolescents from 9 urban middle schools. The majority (76%) of adolescents reported witnessing or being victimized by at least 1 violent event in the prior 6 months. Nearly half of adolescents who had talked about their experience of a violent event reported feeling constrained from sharing their thoughts or feelings because of others' reactions. After controlling for daily hassles, more exposure to violence was associated with more self-reported posttraumatic stress disorder (PTSD) and depressive symptoms. Exposure to violence was not a significant predictor of teachers' ratings of adaptive functioning or internalizing symptoms. Support from specific individuals, perceived school safety, and lower constraints for discussing violence showed protective effects in the relation between exposure to violence and specific dimensions of psychological functioning. The implications of this research for school-based interventions are discussed.     

Toward the DSM-V: the Withdrawal-Gate Model versus the DSM-IV in the diagnosis of alcohol abuse and dependence

The Diagtnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) classifies as dependent many cases of mild alcohol problems. DSM-IV diagnoses have modest relationships with predictive and some concurrent validators and often improperly sequence the onset of abuse versus dependence, perhaps due to insufficient emphasis on physiological features. Testing reliability, syndrome prevalence, syndrome sequencing, and concurrent and predictive validity, this study contrasted the DSM-IV with the Withdrawal-Gate Model (WGM), in which alcohol withdrawal is necessary and sufficient for the dependence diagnosis. Clinical samples of adults (baseline n = 318) and adolescents (baseline n = 214) meeting abuse or dependence were assessed for DSM-IV alcohol symptoms and external measures of problem severity and reinterviewed at 6 (adults) and 12 months (adults and adolescents). Among DSM-IV dependent cases, the WGM shifted 32% of adults and 80% of adolescents to the abuse category, making both categories more symptomatically severe, but had a negligible effect on the prevalence of total alcohol diagnoses. The WGM was more reliable than the DSM-IV and temporally sequenced abuse before dependence in a greater number of cases. The WGM was superior to the DSM-IV in concurrent and predictive validity on most measures. Future diagnostic systems may be more reliable and valid if they require evidence of withdrawal for substance dependence.     

Electrocortical indices of selective attention predict adolescent executive functioning

Executive functioning is considered a powerful predictor of behavioral and mental health outcomes during adolescence. Our question was whether executive functioning skills, normally considered “top-down” processes, are related to automatic aspects of selective attention. Event-related potentials (ERPs) were recorded from typically-developing 12–14-year-old adolescents as they responded to tones presented in attended and unattended channels in an auditory selective attention task. Examining these ERPs in relation to parental reports on the Behavior Rating Inventory of Executive Function (BRIEF) revealed that an early frontal positivity (EFP) elicited by to-be-ignored/unattended tones was larger in those with poorer executive functions, driven by scores on the BRIEF Metacognition Index. As is traditionally found, N1 amplitudes were more negative for the to-be-attended rather than unattended tones. Additionally, N1 latencies to unattended tones correlated with parent-ratings on the BRIEF Behavior Regulation Index, where shorter latencies predicted better executive functions. Results suggest that the ability to disengage attention from distractor information in the early stages of stimulus processing is associated with adolescent executive functioning skills.     

Trauma and traumatic loss in pregnant adolescents: the impact of Trauma-Focused Cognitive Behavior Therapy on maternal unresolved states of mind and Posttraumatic Stress Disorder

Pregnant adolescents are a group at high risk for exposure to traumatic experiences. The present study aimed to examine if Trauma-Focused Cognitive Behavior Therapy (TF-CBT) typically applied to Posttraumatic Stress Disorder (PTSD), could also be applied to unresolved states of mind in a sample of socially at-risk pregnant adolescents. Forty-three adolescents who were in their second trimester of pregnancy and who also had positive indices of unresolved states of mind or symptoms of PTSD were randomly assigned to either the treatment as usual (parenting classes) or intervention (parenting classes + TF-CBT) group. Adolescent mother–infant dyads were then re-assessed at infant ages 6 and 12 months on a broad range of measures, including those specific to attachment, as well as to PTSD, and adolescent behavioral adjustment. Twenty-six of the 43 (60%) recruited subjects completed all components of the study protocol. Although there were no significant effects of the TF-CBT intervention on maternal attachment, infant attachment, PTSD diagnosis and adolescent behavioral adjustment, several study limitations restrict our ability to draw firm conclusions about the efficacy of TF-CBT for use in pregnant adolescents with complex trauma. The discussion offers insight and guidance for clinical work and future intervention research efforts with this vulnerable population.     

Validity of the pediatric inpatient behavior scale in an inpatient psychiatric setting.

Standardized assessment of children's behavior during psychiatric hospitalization is increasingly important for evaluation, chart documentation, treatment planning, and outcome monitoring, yet little research has been done to validate the use of behavior checklists developed specifically to assess in-hospital behavior. The Pediatric Inpatient Behavior Scale (PIBS) was evaluated for its validity as a measure of behavior of children hospitalized on a psychiatric unit. Nurses completed the PIBS for 41 children, based on behavior observed during the first week of hospitalization. DSM-IV diagnoses and major symptoms were coded based on chart review, and children completed self-report measures of depression and anxiety. The Pediatric Inpatient Behavior Scale subscale scores were related significantly to diagnosis, as well as to major symptoms, correctly classifying 75 to 85% of cases. The Pediatric Inpatient Behavior Scale subscale scores also significantly correlated with self-reported symptoms of depression, but not symptoms of state anxiety. Results support the use of the PIBS as a behavioral instrument for hospitalized children with severe psychopathology.     

The Chernobyl accident and cognitive functioning: a study of Norwegian adolescents exposed in utero

The results of investigations on the cognitive outcomes of adolescents exposed prenatally to radiation from Chernobyl are inconsistent. In 2005 through 2006, we assessed individuals exposed prenatally (N = 84) and controls (N = 94) using a broad neuropsychological test battery. Neuropsychological performance was significantly weaker in the 84 adolescents exposed prenatally compared to the 94 controls on measures of verbal working memory, verbal memory, and executive functioning when controlling for possible confounders. Our findings add new and important support to the hypothesis that the Chernobyl accident had a specific effect on the neuropsychological functioning of those exposed prenatally.     

Cognitive performance and electrophysiological indices of cognitive control: a validation study of conflict adaptation

Psychiatric and neurologic disorders are associated with deficits in the postconflict recruitment of cognitive control. The primary aim of this study was to validate the relationship between cognitive functioning and indices of conflict adaptation. Event-related potentials were obtained from 89 healthy individuals who completed an Eriksen flanker task. Neuropsychological domains tested included memory, verbal fluency, and attention/executive functioning. Behavioral measures and N2 amplitudes showed significant conflict adaptation (i.e., previous-trial congruencies influenced current-trial measures). Higher scores on the attention/executive functioning and verbal fluency domains were associated with larger incongruent-trial N2 conflict adaptation; measures of cognitive functioning were not related to behavioral indices. This study provides initial validation of N2 conflict adaptation effects as cognitive function-related aspects of cognitive control.     

The neuropsychological phenotype of velocardiofacial syndrome (VCFS): relationship to psychopathology.

Children with velocardiofacial syndrome (VCFS; N=14) and a comparison group of siblings (N=8) underwent comprehensive neuropsychological assessment to examine the relationship between cognitive functioning and psychopathology. Significant group differences were obtained on tests of full scale and verbal intellectual functioning and perceptual-motor skills. With the exception of performance on tests of attention and executive functioning, children with VCFS displayed a profile consistent with nonverbal learning disability (NLD). However, within group comparisons revealed significantly poorer visuospatial intellectual and nonverbal memory functioning in sibling controls as well. No significant group differences were obtained on tests of motor speed, academic, language, attention, memory, or executive functioning, with significant variability in children with VCFS frequently accounting for the lack of robust differences. Parent-report measures revealed profiles consistent with ADHD. No clinically significant symptoms of psychosis, depression or anxiety were noted on either self- or parent-report measures. Wisconsin Card Sorting Test performance was found to be highly and negatively correlated with the Thought Problems subscale of the Child Behavior Checklist (CBCL) for VCFS children only, suggesting a possible at-risk indicator for later onset psychopathology.     

Daily Record of Severity of Problems (DRSP): reliability and validity

Summary The Daily Record of Severity of Problems (DRSP) form was developed to aid in the diagnosis and evaluation of DSM-IV Premenstrual Dysphoric Disorder (PMDD). The reliability and validity of the procedure was tested in two studies. Study A included 27 subjects who ranged from having few or no premenstrual problems to those who met criteria for PMDD. Study B included 243 subjects, all of whom met criteria for PMDD. Individual items and Summary Scores had high test–retest reliability in both studies. Internal consistency of Summary Scores was also high in both studies. Summary Scores had moderate to high correlations with other measures of severity of illness. In addition, items and Summary Scores have been shown to be sensitive to change and to treatment differences in Study B. The DRSP provides sensitive, reliable, and valid measures of the symptoms and impairment criteria for PMDD.     

Alcohol dependence, disinhibited behavior and variation in the prodynorphin gene

The results of the current analyses present preliminary evidence of an association between putatively functional variation in the prodynorphin (PDYN) gene and a dimensional measure of disinhibited behavior. A 68 bp sequence in the core promoter region of the PDYN gene was genotyped in a community sample of 1021 adults aged 30-54. Participants were interviewed for lifetime history of DSM-IV alcohol dependence and completed two self-report measures of sensation seeking and impulsiveness. Fifteen percent (n = 151) of the sample met DSM-IV criteria for alcohol dependence and while results did not support an association between the PDYN polymorphism and the diagnosis of alcohol dependence, we did observe an association between the “low” expressing L allele of the PDYN gene and a preference for engaging in disinhibited behavior. Additionally, people who had both a history of alcohol dependence and higher scores on this Disinhibited Behavior scale were most likely to carry an L allele. These results indicate that variation in the PDYN gene is associated with a dimensional trait or intermediate phenotype that reflects a preference for heavy drinking and engaging in related risky behaviors (e.g., drug use, sexual activity).     

Family-based association study of serotonin transporter promoter in suicidal adolescents: no association with suicidality but possible role in violence traits

The serotonin transporter-linked promoter region polymorphism (5-HTTLPR) is thought to be associated with some serotonin dysfunction-related psychopathologies such as depression and anxiety disorders. Suicide and suicide-related behaviors such as violence, aggression, and impulsivity have been reproducibly associated with serotonin dysfunction and are partially genetic. This study examined the association of 5-HTTLPR with suicidal behavior and related traits in Israeli suicidal adolescent inpatients using the haplotype relative risk (HRR) method that controls for artifacts caused by population stratification. Forty-eight inpatient adolescents who recently attempted suicide were assessed by structured interviews for detailed clinical history, diagnoses, suicide intent, suicide risk, impulsivity, violence, and depression. Blood samples were collected and DNA extracted from patients and their biological parents. The 5-HTTLPR allele frequencies were tested for association with suicidality by the HRR method. In addition, the relationship between genotypes and phenotypic severity of several clinical parameters was analyzed. No significant allelic association of the 5-HTTLPR polymorphism with suicidal behavior was found (chi square = 0.023; P = 0.88). Analysis of variance of the suicide-related trait measures for the three genotypes demonstrated a significant difference in violence measures between patients carrying the LL and LS genotypes (9.50+/-4.04 vs. 5.36+/-4.03; P = 0.029). This study suggests that the 5-HTTLPR polymorphism is unlikely to have major relevance to the pathogenesis of suicidal behavior in adolescence but may contribute to violent behavior in this population.     

Community violence exposure in a young adult sample: II. Psychophysiology and aggressive behavior

Research has shown a relationship between community violence exposure and heightened aggression in young adults (Scarpa, in press). This study tests the role of psychophysiological functioning in mediating this relationship. Fifty-four university students (mean age = 20.25) were selected from a screening sample (N= 476) based upon high- and low-violence exposure. Salivary cortisol, heart rate (HR), and heart rate variability (HRV) were obtained before and after two stressor tasks. Aggression was reported before the tasks. Aggression was significantly correlated with reduced baseline HR, increased baseline HRV, and increased poststressor cortisol. However, exposed groups did not differ psychophysiologically, suggesting that psychophysiological functioning does not serve as a mediator. Instead, violence exposure and psychophysiological functioning have independenteffects on aggressive behavior. © 2000 John Wiley & Sons, Inc.     

Atypical antipsychotic medications in the management of disruptive behaviors in children: safety guidelines and recommendations

Use of atypical antipsychotic medications (AAMs) in the treatment of Disruptive Behavior (DB) in children and adolescents has increased dramatically worldwide. However, with exception of using risperidone (i.e., for the management of irritability associated with Autism, manic and mixed episodes associated with Bipolar I Disorder, and Schizophrenia) and aripiprazole (i.e., for manic and mixed episodes associated with Bipolar I Disorder and Schizophrenia), the Food and Drug Administration (FDA) has not approved the use of AAMs in children and adolescents. Although research on use of these medications in children and adolescents has increased, mechanisms of action and long-term outcomes remain poorly understood or unknown. Particularly concerning is that use of these medications in children and adolescents may impact cognitive, social, and physical development, as side effects may interfere with activities in their educational setting, peer networks, and recreational settings. Overall, AAMs frequently are prescribed off label, control DB through sedation rather than targeting actual causes of DB, and lead to many negative side effects with unknown long-term effects. Reconsidering the use of AAMs in managing DB is encouraged strongly.     

The Relations Among Abuse,Depression, and Adolescents' Autobiographical Memory

This study examined the relations among early and recent experiences with abuse, depression, and adolescents' autobiographical memory in a longitudinal study of family violence. Participants' (N = 134) exposure to violence was documented when they were 6 to 12 years old and again when they were 12 to 18 years old. The second assessment included measures of depression and autobiographical memory for childhood experiences. Memory problems were more consistently related to current circumstances than childhood abuse history. For instance, depressive symptoms were associated with increased rates of "overgeneral" childhood memories. Recent exposure to family violence predicted more overgeneral memories, shorter memories, and lower rates of negative memories. The patterns suggest that adolescents currently stressed by depression or family violence might strategically avoid the details of past experiences to regulate affect.     

The relations among abuse, depression, and adolescents' autobiographical memory.

This study examined the relations among early and recent experiences with abuse, depression, and adolescents' autobiographical memory in a longitudinal study of family violence. Participants' (N = 134) exposure to violence was documented when they were 6 to 12 years old and again when they were 12 to 18 years old. The second assessment included measures of depression and autobiographical memory for childhood experiences. Memory problems were more consistently related to current circumstances than childhood abuse history. For instance, depressive symptoms were associated with increased rates of "overgeneral" childhood memories. Recent exposure to family violence predicted more overgeneral memories, shorter memories, and lower rates of negative memories. The patterns suggest that adolescents currently stressed by depression or family violence might strategically avoid the details of past experiences to regulate affect.