Disruptive behavior in young children: what does it mean?

OBJECTIVE: To examine how the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3) primary diagnoses, Parent-Infant Relationship Global Assessment Scale, and Child Behavior Checklist/2-3 (CBCL/2-3) externalizing and internalizing symptoms augment the DSM-III-R/IV and guide treatment. METHOD: 82 children aged 18 to 47 months, who presented with disruptive behavior to an early childhood psychiatry clinic, were diagnosed using DSM-III-R/IV, DC 0-3, and the CBCL/2-3. RESULTS: Children with DSM-III-R/IV disruptive disorders or attention-deficit/hyperactivity disorder were diagnosed with DC 0-3 regulatory disorders, disorders of affect, and traumatic stress disorder. Clinically significant externalizing and internalizing symptoms co-presented in 45.1% of the children. Of children with disorders of affect, 41.2% had relationships categorized as disordered, contrasting with 21.1% of those with traumatic stress disorder and 10.3% of those with regulatory disorders. Increasingly disordered relationships were significantly correlated with externalizing and internalizing symptoms, and children with disordered relationships were 3.6 times more likely to have clinically significant levels of internalizing symptoms. CONCLUSION: In these children with disruptive behaviors, co-presentation of externalizing and internalizing symptoms is most common. Those with increased relational risk had more externalizing and internalizing symptoms and more disorders of affect.     

Brain weight: what does it mean?

The weights of the whole and various parts of 8 unfixed normal adult brains were determined at autopsy, and the relative weight of each part as compared with the total brain weight was calculated. On the average, the cerebrum accounted for 87% of the total brain weight, the cerebellum and brain stem for 13%, whereas the contribution of the attached upper spinal cord was negligible (< 2 g). The removed leptomeninges had a mean weight of 34.2 g (2.5% of the total brain weight), but they may reach 50 g. The slices of the cerebrum with removed leptomeninges weighed only 79.2 - 84.4% of the total brain weight. It is concluded that all scientific papers reporting brain weights should state whether the recordings are based upon fresh or fixed specimens and, in the latter case, the fixation procedures must be described accurately. Furthermore, it is of equal importance to indicate exactly the anatomic structures that have been weighed.     

Stimulant rebound: how common is it and what does it mean?

OBJECTIVE: To examine rates and implications of stimulant-induced rebound - the behavioral deterioration that may occur as stimulant medications wear off. METHODS: This study compares nurse observations on evening shifts compared to day shifts in 149 psychiatrically hospitalized children treated with short-acting stimulants, usually methylphenidate, comparing nonmedication and stimulant-treated states. RESULTS: Behavioral deterioration (rebound), was observed in 30% of children on at least one dose of stimulants but was serious enough to discontinue treatment in only 8.7%. Children experiencing rebound did not differ clinically from those who did not. CONCLUSIONS: Rebound exists, occurs significantly in less than 10% of psychiatrically hospitalized children with attention deficit hyperactivity disorder, and does not appear to have specific diagnostic significance.     

Special education participation in children with epilepsy: what does it reflect?

Epilepsy is associated with academic and neurocognitive disorders, with the latter often assumed to explain the former. We examined utilization of special education services (SpES) in relation to neurocognitive test scores in a case-matched sibling control study. In a follow-up assessment 8-9 years after entry into a prospective study of childhood-onset epilepsy, cases and siblings participated in an interview and standardized neurocognitive testing. Analyses included 142 pairs in which both had Full Scale IQ ≥ 80 and the case had normal examination and imaging. Sixty-four (45%) cases and 25 (17.6%) controls reported SpES utilization, (matched odds ratio [mOR]=5.3, P<0.0001). Adjustment for neurocognitive test scores resulted in a mOR of 4.6 (P<0.0001). Types and duration of services were similar in cases and controls. Twenty-four percent of school-aged cases were already receiving services at the time of initial epilepsy diagnosis. Young people with epilepsy have academic difficulties that are not explained simply by cognitive test scores.