Factor structure and cultural factors of disruptive behaviour disorders symptoms in Italian children.

OBJECTIVE: Poor parent and teacher awareness for attention-deficit/hyperactivity disorder (ADHD) and the scepticism of many clinicians on the prevalence of the disorder, make Italy an interesting environment in which to verify neuropsychological constructs generated in a predominantly Northern American cultural contest. The aim of the study was to verify, by factor confirmatory analysis, the empirical validity of the DSM constructs underlying the diagnostic criteria for developmental disruptive behaviour disorders in Italian school-age children. METHODS: Scores for DSM-IV inattention and hyperactivity/impulsivity, for oppositional defiant disorder (ODD) and for conduct disorder (CD) symptoms in 6-12 years old Italian children were analysed from 1575 parent and 1085 teacher forms of the disruptive behaviour disorders questionnaires collected in four different Italian regions. RESULTS: Reliability indicates high internal consistencies for both parent and teacher rating of inattention, hyperactivity/impulsivity, and oppositionality, but not for conduct problems. In accordance with the literature, a relatively low inter-rater convergent and discriminant validity correlation was observed comparing measures obtained by between parents and teachers. Confirmatory factor analysis of both parent and teacher data showed a better fit for a four-factor model, indicating a factor structure in accordance with the DSM-IV taxonomy. When completed by parents and teachers of clinically assessed ADHD, dyslexic or normal children, the disruptive behavioural disorder questionnaires showed a significant predictive diagnostic value. CONCLUSION: Although an informant variance higher that dimensional (trait) variance was observed, the study provides support for DSM-IV taxonomy for developmental disruptive disorders, showing construct validity of ADHD. ODD and CD could also be distinguished from each other.     

Self-referral: Social and demographic determinants of consulting behaviour

This report, which is one of a series, is concerned with socio-demographic correlates of self-referral, and the extent to which the observed associations can be explained by variations in symptom prevalence and severity. Social class, marital status, employment status, and distance from health centre, all show small but significant associations with self-referral. For social class the effect appears to be mediated by symptoms.People in social classes IV and V, women who are widowed, divorced or separated, and people who live near the health centre are more likely to visit their general practitioner.     

A survey of factors related to mental hospital readmissions.

The authors followed up 107 patients selected at random from those discharged from a southern state mental hospital in fiscal year 1972-73. They attempted to differentiate those who were readmitted to the hospital from those who were not on the basis of 52 factors, both personal and environmental, and also compared those who misused alcohol with those who did not. In their sample, 36 of the patients returned to theinstitution, and 71 did not. One of the findings was that in both the total sample and in the nonalcoholic subsample, those readmitted more often received income ffrom sources other than their own employment or the employment of someone in their household. They also tended to be single, separated, or divorced. In both the alcoholic and nonalcoholic subsamples, those readmitted reported more contacts with the community mental health center after their discharge than those not readmitted. In the total sample, the readmitted patients engaged in fewer leisure-time activities and were more likely to report a drinking problem.     

Treatment of vocally disruptive behaviour of multifactorial aetiology.

OBJECTIVE: To describe the treatment of vocally disruptive behaviour (VDB) of multifactorial aetiology. METHOD: Three case reports were used to illustrate the treatment of multifactorial VDB. RESULTS: A biopsychosocial assessment is required to identify the different aetiologies involved and the way they interact. Acute medical and psychiatric factors may demand that interventions are introduced simultaneously rather than in succession. CONCLUSION: Successful interventions require the combination of biopsychosocial strategies tailored to the individual case with realistic goals that include the acceptance of a residual level of VDB as a reasonable outcome.     

Functional MRI studies in disruptive behaviour disorders

Aggressive or antisocial behaviours with violations of social rules are the main features of disruptive behaviour disorders (DBDs), which are developmental diseases and include conduct disorder and oppositional defiant disorder. In the last decade, several efforts have been made to shed light on the biological underpinnings of DBDs. In this context, the main findings of functional magnetic resonance imaging studies in DBD are reported here. There are indications of neural dysfunctions in response to affective stimuli, especially regarding medial and orbitofrontal prefrontal cortex and connected subcortical structures.     

破坏性行为障碍的性别差异

通过比较４５７例男性，１０８例女性破坏性行为的障碍患儿的诊断，伴发症状，临床特征家庭背景，个人生长发育史，家庭史等，发现女孩有着更多的母孕期不利因素，分娩不利因素，阳性家族史，使用ＣＢＣＬ，ＴＲＦ，Ｐｉｅｒｓ－Ｈａｒｒｉｓ自我意识量表，发现男孩的外显性行为问题更严重，社会功能损害更多；而女孩则存在较多的情绪和心身问题。     

Health Related Quality of Life in children with Autism Spectrum Disorders: The clinical and demographic related factors in Turkey

We aimed to investigate the Health Related Quality of Life and related clinical variables (HRQoL) of children with Autism Spectrum Disorders (ASD). We included 102 children with ASD (46 with autism, 38 with pervasive developmental disorder not otherwise specified (PDD-NOS) and 18 with Asperger's syndrome (AS)) and 39 typically developing children as a control (TDC), between 3 and 18 years of age. The mothers scored the Pediatric Quality of Life Inventory 4.0 (PedsQLTM 4.0). The physical health, psychosocial health and total summary score of ASD group were significantly lower than TDC. Within ASD group, psychosocial (p < 0.001), social, school functioning and total summary score (p < 0.001) of the autism group were lower than AS, and PDD-NOS. The scores of AS and PDD-NOS were similar. PedsQL scores differed between the groups who take psychotropic medication and continue to special and formal education in ASD. PedsQL scores were negatively correlated with the Childhood Autism Rating Scale (CARS) score and positively correlated with the age that first signs appeared (p < 0.01). Within ASD group the children with autism had the poorer HRQoL than AS and PDD-NOS. The correlation between HRQoL and CARS scores was moderate. The severity of ASD has negative effects on HRQoL.     

Parasuicides in a general hospital psychiatric unit: their demographic and clinical characteristics

This study presents a profile of 89 patients admitted to the psychiatric unit of a general hospital for a deliberate but not fatal self-inflicted injury. The role of selected demographic clinical and psychosocial characteristics in the hospital admission of these parasuicide patients and their use of available services during the acute phase of their period of distress are discussed.     

Social and cultural factors related to eating problems among adolescents in Norway

A randomly selected and nationally representative sample of 11,315 Norwegian adolescents (aged 13 to 20) was surveyed for eating problems, as measured by a brief version of the Eating Attitudes Test (EAT). The adolescents' EAT scores showed only minor variations according to social class, and none according to urbanization and region. Adolescent girls involved in aesthetic sports dieted marginally more than other sporting girls. Non-Western immigrant adolescents had higher scores on EAT as compared to other immigrating adolescents and Norwegian adolescents.     

Factors contributing to nursing home admission because of disruptive behaviour

The key relative of 417 nursing home residents was interviewed to determine reasons for admission and patient behaviour before admission using the Psychogeriatric Dependency Rating Scale (PGDRS). Families stated that 25% of new nursing home admissions were due to disruptive behaviour but there were nearly always other reasons for admission as well. A receiver operating characteristic curve and cluster analysis showed that a greater amount of generalized behaviour problems predicted admission in the 74% of new residents. Admission because of disruptive behaviour was associated with greater cognitive impairment, possible Alzheimer’s disease, delusions or hallucinations, a psychiatric diagnosis, admission from home, requiring help from others before admission and a permanent move to a nursing home. Both psychiatric and social factors are important determinants of nursing home admission for disruptive behaviour.     

Social and demographic factors that influence the diagnosis of autistic spectrum disorders

Purpose  

Recent studies in epidemiology have highlighted the existence of children with autistic difficulties who remain undiagnosed. Other studies have identified ‘access barriers’ to clinics which include factors mediated by parents as well as health and education services. The purpose of this study was to examine whether social and demographic factors play a role in receiving a diagnosis of autistic spectrum disorder (ASD) independently of symptom severity.     

Elevated platelet MAO is related to impulsivity in disruptive behavior disorders

Platelet monoamine oxidase (MAO) activity was measured in 32 drug-free prepubertal boys with externalizing symptoms of disruptive behavior disorders and 47 boys with no DSM-III-R diagnoses, and correlated to questionnaire and laboratory performance measures of impulsivity. A subgroup of boys with high MAO activity exhibited significantly poorer performance (i.e., more impulsivity) than a subgroup of low MAO activity on laboratory tasks requiring response inhibition. High MAO patients were more impulsive than high MAO controls on some performance tasks and elevated platelet MAO was unrelated to personality questionnaire measures of impulsivity or to patient status. These data suggest that biological markers such as MAO activity may correlate better with performance than clinical questionnaire measures. Abnormally high platelet MAO activity may not be sufficient to produce externalizing symptoms in children, perhaps interacting with an underlying behavioral dimension of impulsivity.     

Prevalence, comorbidity, risk factors and service utilisation of disruptive behaviour disorders in a community sample of children in Valencia (Spain)

Background: The importance of cultural and adverse family-environment variables as risk factors for Disruptive Behaviour Disorder has been repeatedly shown, and hence a variation in rates and risk factors between cultures could be expected. Lower rates should be found in countries with strong and stable family ties, such as Spain. Objective: Prevalence rate, severity and comorbidity of Disruptive Behaviour Disorder, as well as risk factors and help-seeking behaviour relating to this disorder, were studied in a general population random sample of 387 10 year-old children living in Valencia (Spain). Methods: DSM-III-R diagnosis was established by means of the KIDDY-SADS (Kiddy Schedule for affective diseases and Schizophrenia (epidemiological version)) interview and severity of the disorder was evaluated with the General Assessment Functioning (GAF) Scale. Other variables measured were: sex, number of siblings, parental occupation, single-parent home, school failure, socioeconomic level, chronic somatic ailments and use of mental health services. Results: Prevalence and severity parameters were low (for GAF<70, prevalence = 11.1; for GAF<60, prevalence = 4.9), albeit falling within the range reported in other countries. Morbidity profile and use of services did not substantially depart from the findings reported in other cultures. Different risk factors were associated with Attention Deficit Hyperactivity Disorder, Conduct Disorder and Oppositional Defiant Disorder, thus confirming the validity of considering them as separate dimensions. Conclusions: The findings did not support the hypothesis of lower rates and different risk factors and morbidity patterns in the Spanish sample studied. Accepted: 8 October 1998     

The association between short sleep and obesity after controlling for demographic,lifestyle, work and health related factors

ObjectiveThe relationship between short sleep and obesity remains unclear, and a possible explanation is that many studies have not included sufficient control variables in the analyses. We examined the association between sleep and being overweight or obese after adjusting for the confounding contributions of 17 variables.MethodsA random sample of 1162 Australian adults from three regional cities in central Queensland, Australia, participated in a telephone survey. A series of increasingly complex multinomial logistic regression models were employed to assess the association between short sleep (⩽6 h) being overweight (body mass index [BMI] 25–29.99 kg/m²) and obesity (BMI, ⩾30 kg/m²), while controlling for several demographic, lifestyle, work, and health-related variables.ResultsThe results suggested obesity was significantly associated with short sleep, age, male gender, lower education level, less physical activity, more sitting time, working longer hours, drinking more alcohol, having diabetes mellitus (DM), and having hypertension. Being overweight was significantly associated with age, male gender, smoking, and working more than 43 hours per week.ConclusionsAfter adjustment of several confounding variables, a significant association between short sleep and obesity was obtained, but there was no association between short sleep and being overweight. Additional studies applying comprehensive analytic models and stronger research designs are needed to confirm our findings.     

Psychosocial interventions for disruptive and aggressive behaviour in children and adolescents

Background

The effects of psychotherapy in reducing aggressive behaviours in children and adolescents using meta-analysis were estimated.

Method

Sixty-five studies were included, covering 4,971 cases. Teacher reported change in aggression, change in social functioning, and changes in parental distress were calculated.

Results

The mean effect size (ES) of change in aggression in studies with untreated controls was 0.62 and in studies without untreated controls the ES was 0.95. In studies with or without untreated controls, the ESs in teacher reported aggression was 0.41 and 0.63, the ESs in changes in social functioning was 0.42 and 0.49, and the ESs in changes in parental distress was 0.39 and 0.47, respectively.

Conclusion

Psychosocial treatments aimed at reducing aggressive behaviour have positive effects and additional treatment effects are moderate. In the moderator analysis, studies with untreated controls obtained significantly larger ESs if the sample size was small. Similarly, in studies without untreated controls, studies presenting diagnostic information, and studies with younger children resulted in significantly larger ESs, and studies applying behavioural interventions obtained significantly larger ESs as compared to studies applying family therapeutic interventions. There is still a need to further develop effective outpatient interventions for children being disruptive, and especially for adolescents.     

Inpatient treatment of severe disruptive behaviour disorders with risperidone and milieu therapy.

OBJECTIVES: To evaluate the therapeutic impact of adding risperidone to milieu therapy of latency-aged inpatients with severe disruptive disorders. METHODS: The charts of 90 latency-aged patients consecutively admitted to a psychiatry ward were reviewed retrospectively. Fifteen of these patients received risperidone treatment, were nonpsychotic, and did not suffer from pervasive developmental disorder (12 male, 3 female; mean age 9.99 years, SD 1.76). Their scores on the Children's Global Assessment Scale (CGAS) were compared at admission, before risperidone treatment, and at discharge. RESULTS: All subjects were diagnosed with a disruptive behavioural disorder. Ten (66.67%) had additional learning difficulties, and 13 (86.7%) had pathological personality traits. The characteristics of the sample suggested borderline pathology or multiple complex developmental disorder. Following a mean of 38 days after admission (SD 22.3), the patients received risperidone for a mean of 46 days (SD 28.2) before being discharged. The mean maintenance dose of risperidone was 1.27 mg daily (SD 0.36). Mean CGAS scores increased from admission (21.9, SD 7.0) to before risperidone treatment (26.8, SD 7.6, P < 0.0001) and to discharge (50.3, SD 5.3, P < 0.0001). Only 2 patients had documented side effects. CONCLUSIONS: Low-dose risperidone used adjunctively to milieu therapy led to statistically and clinically significant additional improvement in the functioning of hospitalized latency-aged children with severe behavioural disorders. Low-dose risperidone is a safe and effective adjunct to milieu therapy for treating this population in inpatient settings. Prospective randomized controlled trials are needed to confirm these findings.