Impaired social functioning has been well documented in individuals with attention-deficit/hyperactivity disorder (ADHD). Existing treatments for ADHD are effective for managing core symptoms, but have limited effectiveness at improving social skills, suggesting that social deficits in ADHD may not be directly related to core symptoms of the disorder. Language problems are also common in ADHD, with accumulating evidence of pragmatic language difficulties. Pragmatic deficits are associated with social impairment in several neurodevelopmental disorders. This study systematically examined pragmatic language functioning in children with ADHD and whether social impairment in ADHD is mediated by pragmatic deficits.
Sixty-three children (28 ADHD; 35 typically developing), ages 7–11 years, underwent a comprehensive assessment of pragmatic language, including parent ratings, standardized tests, and a narrative task. Parents also rated children's social skills on the Social Skills Improvement System.
Children with ADHD had poorer pragmatic language skills relative to peers across all measures, even after controlling for general language abilities. Furthermore, pragmatic abilities as measured by parent ratings, mediated the relation between ADHD and social skills.
Pragmatic language skills are impaired in many children with ADHD and may partially account for high rates of social impairment. Implications for treatment and possible prevention of social problems in children with ADHD are discussed.
Children with attention deficit hyperactivity disorder (ADHD) are characterised by developmentally inappropriate levels of hyperactivity, impulsivity and/or inattention and are particularly impaired when performing tasks that require a high level of cognitive control. Methylphenidate (MPH) and motivational incentives may help improve cognitive control by enhancing the ability to monitor response accuracy and regulate performance accordingly.
Twenty-eight children with DSM-IV ADHD (combined type) aged 9–15 years and pairwise-matched typically developing children (CTRL) performed a go/no-go task in which the incentives attached to performance on no-go trials were manipulated. The ADHD group performed the task off and on their usual dose of MPH. CTRL children performed the task twice but were never medicated. EEG data were recorded simultaneously and two electrophysiological indices of error monitoring, the error-related negativity (ERN) and error positivity (Pe) were measured. Amplitudes of each ERP were compared between diagnostic groups (CTRL, ADHD), medication days (Off MPH, On MPH) and motivational conditions (baseline – low incentive, reward, response cost).
Error rates were lower in the reward and response cost conditions compared with baseline across diagnostic groups and medication days. ERN and Pe amplitudes were significantly reduced in ADHD compared with CTRL, and were significantly enhanced by MPH. Incentives significantly increased ERN and Pe amplitudes in the ADHD group but had no effect in CTRL. The effects of incentives did not interact with the effects of MPH on either ERP. Effect sizes were computed and revealed larger effects of MPH than incentives on ERN and Pe amplitudes.
The findings reveal independent effects of motivational incentives and MPH on two electrophysiological markers of error monitoring in children with ADHD, suggesting that each may be important tools for enhancing or restoring cognitive control in these children.
Growing research on children's traits as moderators of links between parenting and developmental outcomes has shown that variations in positivity, warmth, or responsiveness in parent–child relationships are particularly consequential for temperamentally difficult or biologically vulnerable children. But very few studies have addressed the moderating role of children's callous-unemotional (CU) traits, a known serious risk factor for antisocial cascades. We examined children's CU traits as moderators of links between parent–child Mutually Responsive Orientation (MRO) and shared positive affect and future externalizing behavior problems.
Participants included 100 two-parent community families of normally developing children, followed longitudinally. MRO and shared positive affect in mother–child and father–child dyads were observed in lengthy, diverse naturalistic contexts when children were 38 and 52 months. Both parents rated children's CU traits at 67 months and their externalizing behavior problems (Oppositional Defiant Disorder and Conduct Disorder) at 67, 80, and 100 months.
Children's CU traits moderated links between early positive parent–child relationships and children's future externalizing behavior problems, even after controlling for strong continuity of those problems. For children with elevated CU traits, higher mother–child MRO and father–child shared positive affect predicted a decrease in mother-reported future behavior problems. There were no significant associations for children with relatively lower CU scores.
Positive qualities for early relationships, potentially different for mother–child and father–child dyads, can serve as potent factors that decrease probability of antisocial developmental cascades for children who are at risk due to elevated CU traits.
Developmental disorders of language and communication present considerable diagnostic challenges due to overlapping of symptomatology and uncertain aetiology. We aimed to further elucidate the behavioural and linguistic profile associated with impairments of social communication occurring outside of an autism diagnosis.
Six to eleven year olds diagnosed with pragmatic language impairment (PLI), high functioning autism (HFA) or specific language impairment (SLI) were compared on measures of social interaction with peers (PI), restricted and repetitive behaviours/interests (RRBIs) and language ability. Odds ratios (OR) from a multinomial logistic regression were used to determine the importance of each measure to diagnostic grouping. MANOVA was used to investigate differences in subscale scores for the PI measure.
Greater degrees of PI difficulties (OR = 1.22, 95% CI = 1.05–1.41), RRBI (OR = 1.23, 95% CI = 1.06–1.42) and expressive language ability (OR = 1.16, 95% CI = 1.03–1.30) discriminated HFA from PLI. PLI was differentiated from SLI by elevated PI difficulties (OR = 0.82, 95% CI = 0.70–0.96) and higher expressive language ability (OR = 0.88, 95% CI = 0.77–0.98), but indistinguishable from SLI using RRBI (OR = 1.01, 95% CI=0.94–1.09). A significant effect of group on PI subscales was observed (θ = 1.38, F(4, 56) = 19.26, p < .01) and PLI and HFA groups shared a similar PI subscale profile.
Results provide empirical support for a conceptualisation of PLI as a developmental impairment distinguishable from HFA by absence of RRBIs and by the presence of expressive language difficulties. PI difficulties appear elevated in PLI compared with SLI, but may be less pervasive than in HFA. Findings are discussed with reference to the proposed new category of ‘social communication disorder’ in DSM-5.
Most gene-environment interaction (GXE) research, though based on clear, vulnerability-oriented hypotheses, is carried out using exploratory rather than hypothesis-informed statistical tests, limiting power and making formal evaluation of competing GXE propositions difficult.
We present and illustrate a new regression technique which affords direct testing of theory-derived predictions, as well as competitive evaluation of alternative diathesis-stress and differential-susceptibility propositions, using data on the moderating effect of DRD4 with regard to the effect of childcare quality on children's social functioning.
Results show that (a) the new approach detects interactions that the traditional one does not; (b) the discerned GXE fit the differential-susceptibility model better than the diathesis-stress one; and (c) a strong rather than weak version of differential susceptibility is empirically supported.
The new method better fits the theoretical ‘glove’ to the empirical ‘hand,’ raising the prospect that some failures to replicate GXE results may derive from standard statistical approaches being less than ideal.
We prospectively followed an ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD) (n = 140) and a matched comparison sample (n = 88) from childhood through young adulthood to evaluate developmental trajectories of executive functions (EF) and associations between EF trajectories and dimensional measures of ADHD symptoms. We hypothesized that (a) EF trajectories would be similar in girls both with and without childhood ADHD, with the ADHD group showing greater impairment across time; and (b) changes in EF abilities would predict changes in ADHD symptoms across time, consistent with the theory that ADHD symptom reductions partially result from prefrontally mediated EF development.
Latent growth curve models were used to evaluate development of sustained attention, response inhibition, working memory, and global EF abilities, and associations between EF trajectories and ADHD symptom trajectories.
Girls with childhood-diagnosed ADHD showed greater improvement across development on measures of sustained attention and global EF, but similar rates of improvement on measures of working memory and response inhibition. Changes in the global EF measure predicted changes in both inattentive and hyperactive-impulsive symptoms across time, whereas changes in response inhibition predicted changes in hyperactive-impulsive symptoms; associations between changes in other EF variables and symptoms were not significant.
Findings suggest variability in patterns of EF improvement over time in females with ADHD histories and indicate that EF development may play a role in symptom change.
To examine the relation of caregiver ratings of psychiatric symptom-induced impairment with number and severity of symptoms and informant agreement in consecutive child psychiatry outpatient referrals.
Parents and teachers completed a broadband DSM-IV-referenced rating scale with disorder-specific impairment for 636 youth (6–18 years). Illness parameters included impairment, number and severity of symptoms, and their combination (symptom + impairment) as well as categorical (cut-off) and dimensional scoring.
Agreement between impairment and other illness parameters showed considerable variation as a function of type of parameter, disorder, and informant, but to lesser extent age and gender. Many youth who met impairment cut-off for specific disorders did not meet symptom cut-off. Conversely, most youth who met symptom cut-off were impaired. Symptom cut-off evidenced greater convergence with impairment cut-off than combined symptom + impairment cut-offs. Severity of impairment was moderately to highly correlated with number and severity of symptoms. Parents' and teachers' ratings indicated little disorder-specific agreement about youth who met impairment cut-off, symptom cut-off, or combined symptom + impairment cut-off. Therefore, sole reliance on one informant greatly underestimates the pervasiveness of impairment.
Findings are consistent with the notion that each illness parameter represents a unique conceptual construct, which has important clinical and research implications.
Many children with autism spectrum disorders (ASD) struggle to understand familiar words and learn unfamiliar words. We explored the extent to which these problems reflect deficient use of probabilistic gaze in the extra-linguistic context.
Thirty children with ASD and 43 with typical development (TD) participated in a spoken word recognition and mapping task. They viewed photographs of a woman behind three objects and simultaneously heard a word. For word recognition, the objects and words were familiar and the woman gazed ahead (neutral), toward the named object (facilitative), or toward an un-named object (contradictory). For word mapping, the objects and words were unfamiliar and only the neutral and facilitative conditions were employed. The children clicked on the named object, registering accuracy and reaction time.
Speed of word recognition did not differ between groups but varied with gaze such that responses were fastest in the facilitative condition and slowest in the contradictory condition. Only the ASD group responded slower to low frequency than high-frequency words. Accuracy of word mapping did not differ between groups, but accuracy varied with gaze with higher performance in the facilitative than neutral condition. Both groups scored above single-trial chance levels in the neutral condition by tracking cross-situational information. Only in the ASD group did mapping vary with receptive vocabulary.
Under laboratory conditions, children with ASD can monitor gaze and judge its reliability as a cue to word meaning as well as typical peers. The use of cross-situational statistics to support word learning may be problematic for those who have weak language abilities.
Cognitive processes and mechanisms underlying the strong link between attention-deficit/hyperactivity disorder (ADHD) and social problems remain unclear. Limited knowledge also exists regarding a subgroup of youth with ADHD who do not have social problems. This study investigated the extent to which executive function (EF) mediated the association between ADHD and social problems and compared ADHD symptoms, comorbidities, and EF among ADHD youth with and without social problems and controls.
The sample consisted of 279 youth with ADHD and 173 controls without ADHD (11–17 years of age) in Taiwan. Among youth with ADHD, two subgroups were further identified: 70 ADHD youth with social problems and 31 ADHD youth without social problems. EF was assessed with four subtests from the Cambridge Neuropsychological Test Automated Battery (Spatial span, Spatial working memory, Intra-dimensional/extra-dimensional shifts, Stockings of Cambridge). Social problems were assessed by mother and child reports.
Executive function measures in working memory and planning mediated the effect of ADHD on social problems, independent of age, gender, and IQ. The two ADHD groups with and without social problems did not differ in ADHD severity or comorbidities; however, ADHD youth without social problems performed better on certain measures of EF such as working memory, planning, and response inhibition.
These findings suggest that deficits in some aspects of EF may account for social problems often experienced by youth with ADHD.
Children who have been exposed to intimate partner violence (IPV) experience a wide variety of short-term social adjustment and emotional difficulties, including externalizing behavioral problems such as aggression. While children are affected by IPV at all ages, little is known about the long-term consequences of IPV exposure at younger ages. Because early experiences provide the foundation for later development, children exposed to IPV as an infant or toddler may experience worse negative outcomes over time than children never exposed.
Using the National Survey of Child and Adolescent Well-Being (NSCAW), latent growth curve modeling was conducted to examine whether early IPV exposure occurring between birth and age three (n = 107), compared with no exposure (n = 339), affects the development of aggressive behavior over 5 years. This modeling allowed for empirical exploration of developmental trajectories, and considered whether initial social development trajectories and change over time vary according to early IPV exposure.
Children who were exposed to more frequent early IPV did not have significantly different aggressive behavior problems initially than children who were never exposed. However, over time, the more frequently children were exposed between birth and 3 years, the more aggressive behavior problems were exhibited by age eight.
Results indicate a long-term negative behavioral effect on children who have been exposed to IPV at an early age. An initial assessment directly following exposure to IPV may not be able to identify behavior problems in young children. Because the negative effects of early IPV exposure are delayed until the child is of school age, early intervention is necessary for reducing the risk of later aggressive behavior.
Language has been shown to play a critical role in social cognitive reasoning in preschool and school-aged children, but little research has been conducted with adolescents. During adolescence, the ability to understand figurative language becomes increasingly important for social relationships and may affect social adjustment. This study investigated the contribution of structural and figurative language to social cognitive skills in adolescents who present for mental health services and those who do not.
One hundred and thirty-eight adolescents referred to mental health centers (clinic group) and 186 nonreferred adolescents (nonclinic group) aged 12–17 were administered measures of structural and figurative language, working memory, and social cognitive problem solving.
We found that adolescents in the clinic group demonstrated less mature social problem solving overall, but particularly with respect to anticipating and overcoming potential obstacles and conflict resolution compared with the nonclinic group. In addition, results demonstrated that age, working memory, and structural and figurative language predicted social cognitive maturity in the clinic group, but only structural language was a predictor in the nonclinic group.
Social problem solving may be particularly difficult for adolescents referred for mental health services and places higher demands on their cognitive and language skills compared with adolescents who have never been referred for mental health services.
Early childhood malnutrition is associated with cognitive and behavioral impairment during childhood and adolescence, but studies in adulthood are limited.
Using the NEO-PI-R personality inventory, we compared personality profiles at 37–43 years of age (M 40.3 years, SD 1.9) of Barbadian adults who had experienced moderate-to-severe protein-energy malnutrition (PEM) in the first year of life (n = 77) with healthy controls, who were former classmates of the index cases and were matched for age, gender, and handedness in childhood (n = 57). The previously malnourished participants had been rehabilitated, with good health and nutrition documented up to 12 years of age, and study participants were followed longitudinally from childhood to 40 years. Group comparisons were adjusted for childhood and adolescent standard of living, with and without correcting for IQ.
At the broad domain or factor level, previously malnourished participants had higher scores on Neuroticism and lower scores on Extraversion, Openness, Agreeableness, and Conscientiousness than did the healthy controls. At the subdomain or facet level, previously malnourished participants reported more anxiety, vulnerability, shyness and lowered sociability, less intellectual curiosity, greater suspiciousness of others, a more egocentric than altruistic orientation, and a lowered sense of efficacy or competence.
Malnutrition limited to the first year of life with good health and nutrition documented up to 12 years of age is associated with a significant overrepresentation of adult personality trait scores outside of the average range. This outcome has important implications for a variety of important life and mental health outcomes.
Psychopathic traits are associated with increases in antisocial behaviors such as aggression and are characterized by reduced empathy for others' distress. This suggests that psychopathic traits may also impair empathic pain sensitivity. However, whether psychopathic traits affect responses to the pain of others versus the self has not been previously assessed.
We used whole-brain functional magnetic resonance imaging to measure neural activation in 14 adolescents with oppositional defiant disorder or conduct disorder and psychopathic traits, as well as 21 healthy controls matched on age, gender, and intelligence. Activation in structures associated with empathic pain perception was assessed as adolescents viewed photographs of pain-inducing injuries. Adolescents imagined either that the body in each photograph was their own or that it belonged to another person. Behavioral and neuroimaging data were analyzed using random-effects analysis of variance.
Youths with psychopathic traits showed reduced activity within regions associated with empathic pain as the depicted pain increased. These regions included rostral anterior cingulate cortex, ventral striatum (putamen), and amygdala. Reductions in amygdala activity particularly occurred when the injury was perceived as occurring to another. Empathic pain responses within both amygdala and rostral anterior cingulate cortex were negatively correlated with the severity of psychopathic traits as indexed by PCL:YV scores.
Youths with psychopathic traits show less responsiveness in regions implicated in the affective response to another's pain as the perceived intensity of this pain increases. Moreover, this reduced responsiveness appears to predict symptom severity.
Clinic and community-based epidemiological studies have shown an association between child psychopathology and language impairment. The demands on language for social and academic adjustment shift dramatically during adolescence and the ability to understand the nonliteral meaning in language represented by higher order language becomes essential.
This article reports on the association between difficulties in higher order language skills, reading, cognition, and social-emotional adjustment in adolescents.
144 clinic-referred and 186 comparison youth aged 12–18 years were administered a battery of standardized tests of intelligence, working memory, structural and higher order language, and reading achievement. Parent ratings on the Child Behavior Checklist were used as a measure of severity of social-emotional problems.
Clinic-referred youth scored significantly lower than comparison youth on measures of structural and higher order language, working memory, and reading. Of the clinic-referred youth, 45% had some type of higher order language impairment, whereas this was the case for 15% of youth in the comparison group. Lower levels of nonverbal ability and working memory as well as lower level of mothers’ education were associated with greater risk of having higher order language impairment.
Findings have implications for practitioners’ seeking to understand and treat adolescents since therapeutic techniques rely on skills where higher order language is at play including the ability to discuss opinions flexibly and to weigh interpretations. Therapists must be aware that there are areas that have potential for miscommunication with some adolescents and where inaccurate inferences may be made about their behavior. Furthermore, educators must consider resources for youth who may increasingly struggle in high school because of such difficulties.
Inhibitory control (IC) has been regarded as a neuropsychological basic deficit and as an endophenotype of attention deficit/hyperactivity disorder (ADHD). Implicated here are mediation processes between etiological factors and ADHD symptoms. We thus analyze whether and to what extent executive IC and delay aversion (DA; i.e., reward-related IC) performance mediate the associations of familial, prenatal, and psychosocial risks with ADHD symptoms.
The study sample consisted of 130 preschool children (3–6 years; 50% boys), including 20% (n = 26) with a positive family history of ADHD (familial risk). Prenatal risks were mainly taken from medical records. Psychosocial risks were assessed by a structured interview. ADHD symptoms were assessed by structured interviews and questionnaires completed by parents and teachers. A set of neuropsychological tasks on IC and DA was conducted with the children.
Familial, prenatal, and psychosocial risks were significantly associated with ADHD symptoms. IC and DA also correlated significantly with ADHD symptoms. While the familial risk significantly correlated with IC and DA, psychosocial and prenatal risks were only weakly associated with these measures. The link between the familial risk and ADHD symptoms was partially mediated by IC and DA.
The results indicate different neuropsychological pathways related to ‘positive family history of ADHD’ and prenatal risks. Given a cross-validation in future studies, the results underscore the endophenotypic character of IC and DA in preschool ages.
Quantifying diagnostic transitions across development is needed to estimate the long-term burden of mental illness. This study estimated patterns of diagnostic transitions from childhood to adolescence and from adolescence to early adulthood.
Patterns of diagnostic transitions were estimated using data from three prospective, longitudinal studies involving close to 20,000 observations of 3,722 participants followed across multiple developmental periods covering ages 9–30. Common DSM psychiatric disorders were assessed in childhood (ages 9–12; two samples), adolescence (ages 13–18; three samples), and early adulthood (ages 19 to age 32; three samples) with structured psychiatric interviews and questionnaires.
Having a disorder at an early period was associated with at least a threefold increase in odds for having a disorder at a later period. Homotypic and heterotypic transitions were observed for every disorder category. The strongest evidence of continuity was seen for behavioral disorders (particularly ADHD) with less evidence for emotional disorders such as depression and anxiety. Limited evidence was found in adjusted models for behavioral disorders predicting later emotional disorders. Adult substance disorders were preceded by behavioral disorders, but not anxiety or depression.
Having a disorder in childhood or adolescence is a potent risk factor for a range of psychiatric problems later in development. These findings provide further support for prevention and early life intervention efforts and suggest that treatment at younger ages, while justified in its own right, may also have potential to reduce the risk for disorders later in development.
Solution focused brief therapy (SFBT) is a strengths-based therapeutic approach, emphasizing the resources that people possess and how these can be applied to a positive change process. The current study provides a systematic review of the SFBT evidence base and a critical evaluation of the use and application of SFBT in clinical practice with children and families.
Between 21 December 2010 and 12 May 2011 forty-four database searches (including, PsychInfo, ISI Web of Knowledge, ASSIA, British Education Index, Medline and Scopus), web searches and consultation with experts in the field were used to identify reports of SFBT studies published between 1990 and 2010. Studies were then screened according to trialled qualitative and quantitative assessment frameworks and reported according to the PRISMA guidelines.
A total of 38 studies were included in the review. Of these, 9 applied SFBT to internalizing child behaviour problems, 3 applied SFBT to both internalizing and externalizing child behaviour problems, 15 applied the approach to externalizing child behaviour problems and 9 evaluated the application of SFBT in relation to a range of other issues.
Although much of the literature has methodological weaknesses, existing research does provide tentative support for the use of SFBT, particularly in relation to internalizing and externalizing child behaviour problems. SFBT appears particularly effective as an early intervention when presenting problems are not severe. Further well-controlled outcome studies are needed. Studies included in the review highlight promising avenues for further research.
A deficit in affective rather than cognitive empathy is thought to be central to psychopathic traits. However, empirical evidence for empathy deficits in adolescents with psychopathic traits is limited. We investigated the concurrent and prospective effects of psychopathic traits on affective and cognitive trait empathy in late adolescence.
A community sample of 107 males and 126 females who were approximately 16-year olds at Time 1 participated in four annual waves. Sex-specific classes of adolescents' psychopathic traits were created using Latent Class Analyses. Subsequently, we investigated class differences in level and development of empathy.
For both sexes, Latent Class Analyses produced two classes: one class with low and one with moderate levels of psychopathic traits. Consistent with our hypothesis, for both sexes, adolescents with moderate levels of psychopathic traits reported lower mean levels of affective empathy than adolescents with low levels of psychopathic traits. In addition, female adolescents with moderate psychopathic traits reported lower mean levels of cognitive empathy. Male adolescents showed a trend in this direction. No differences between classes were found in development of empathy, which increased over years.
This is the first study to show that male and female adolescents with higher levels of psychopathic traits have lower levels of affective empathy not only concurrently but also prospectively over a 3-year period. Females additionally showed a similar pattern on cognitive empathy. In this community sample, developmental results suggest that adolescents with higher levels of psychopathic traits have relative rather than absolute empathy deficits.
Bisphenol A (BPA) has been shown to affect brain and behavior in rodents and nonhuman primates, but there are few studies focusing on its relationship to human neurobehavior. We aimed to investigate the relationship between environmental exposure to BPA and childhood neurobehavior.
Urinary BPA concentrations and behavioral and learning characteristics were assessed in a general population of 1,089 children, aged 8–11 years. The main outcome measures were the Child Behavior Checklist (CBCL) and the Learning Disability Evaluation Scale (LDES).
Urinary levels of BPA were positively associated with the CBCL total problems score and negatively associated with the learning quotient from the LDES. The linear association with the CBCL anxiety/depression score and the quadratic association with the LDES listening score were significant after correction for multiple comparisons.
Environmental exposure to BPA might be associated with childhood behavioral and learning development. The results suggest possible nonmonotonic relationships.
Approximately one in ten children aged 5–15 in Britain has a conduct, hyperactivity or emotional disorder.
The British Child and Adolescent Mental Health Surveys (BCAMHS) identified children aged 5–15 with a psychiatric disorder, and their use of health, education and social care services. Service costs were estimated for each child and weighted to estimate the overall economic impact at national level.
Additional health, social care and education costs associated with child psychiatric disorders totalled £1.47bn in 2008. The lion's share of the costs falls to frontline education and special education services.
There are huge costs to the public sector associated with child psychiatric disorder, particularly the education system. There is a pressing need to explore ways to reduce these costs while improving health and well-being.
It is well documented that friends' externalizing problems and negative parent–child interactions predict externalizing problems in adolescence, but relatively little is known about the role of siblings. This four-wave, multi-informant study investigated linkages of siblings' externalizing problems and sibling–adolescent negative interactions on adolescents' externalizing problems, while examining and controlling for similar linkages with friends and parents.
Questionnaire data on externalizing problems and negative interactions were annually collected from 497 Dutch adolescents (M = 13.03 years, SD = 0.52, at baseline), as well as their siblings, mothers, fathers, and friends.
Cross-lagged panel analyses revealed modest unique longitudinal paths from sibling externalizing problems to adolescent externalizing problems, for male and female adolescents, and for same-sex and mixed-sex sibling dyads, but only from older to younger siblings. Moreover, these paths were above and beyond significant paths from mother–adolescent negative interaction and friend externalizing problems to adolescent externalizing problems, 1 year later. No cross-lagged paths existed between sibling–adolescent negative interaction and adolescent externalizing problems.
Taken together, it appears that especially older sibling externalizing problems may be a unique social risk factor for adolescent externalizing problems, equal in strength to significant parents' and friends' risk factors.
Background: There are few evaluations of very early intervention for the prevention of internalising disorders and those that exist generally evaluate outcomes to a maximum of 12 months. The current study evaluated the very long term effects (11 years) of a brief internalising prevention program presented to parents of preschool aged children.
Methods: The original sample comprised 146 preschool-aged children who scored high on measures of inhibited temperament. Half of the parents were given a brief educational program (six-sessions) to assist them to help their children reduce anxiousness. Over 70% of the original sample (n = 103) was assessed for the current study, which occurred when the sample was approximately 15 years. They were assessed on current diagnoses of anxiety and depression, as well as symptoms of anxiety, depression, negative thoughts, and life interference.
Results: Compared with controls, girls whose parents had been through the early intervention program showed significantly fewer internalising disorders, maternally reported anxiety symptoms and self-reported life interference, and trends toward lower self-reported anxiety symptoms and self reported thoughts of loss and failure. Boys showed few differences.
Conclusions: A brief early intervention program delivered to parents of preschool-aged children who are at risk for later internalising distress shows lasting benefits for girls into the high-risk period of middle adolescence. Given the low costs associated with this program, these results show promise for strong public health benefits.
Background: Different dimensions of oppositional defiant disorder (ODD) have been found as valid predictors of further mental health problems and antisocial behaviors in youth. The present study aimed at testing the construct, concurrent, and predictive validity of ODD dimensions derived from parent- and self-report measures.
Method: Confirmatory factor analyses were performed to test a three-dimensional model (ODD-irritability, ODD-headstrong, and ODD-hurtful) and a two-dimensional model (ODD-irritability, ODD-headstrong/hurtful) based on items of the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) collected in a Swiss community study of 1,031 adolescents (519 boys, 512 girls) aged between 10.7 and 17.9 (M = 13.85, SD = 1.63) years. Logistic regression analyses were applied to predict scores in the clinical range of concurrent CBCL/YSR-anxiety/depression, CBCL/YSR-attention problems, and CBCL/YSR-delinquent behavior and depression as measured by the Center for Epidemiological Studies Depression Scale (CES-D) as well as to predict the presence of adult criminal convictions.
Results: CFA findings were in favor of a three-dimensional model rather than a two-dimensional model of ODD. The CBCL/YSR-ODD-irritability scale was related to concurrent self-reported depression, but also to attention problems and delinquent behavior. CBCL/YSR-ODD-hurtful and less strongly also the combined YSR-headstrong/hurtful scale predicted adult criminal outcomes.
Conclusions: As proposed by the DSM-5 workgroup, different ODD-dimensions were confirmed by the present study. ODD-irritability predicts psychiatric comorbidity and ODD-hurtful symptoms should be specifically considered in youth at risk for criminal outcomes.
Background: Uncertainty remains about the rate of specific psychiatric disorders and associated predictive factors for very preterm (VPT) children. The aims of this study were to document rates of psychiatric disorders in VPT children aged 7 years compared with term born children, and to examine potential predictive factors for psychiatric diagnoses in VPT children.
Methods: Participants were 177 VPT and 65 term born children. Perinatal medical data were collected, which included brain abnormalities detected using magnetic resonance imaging. The Infant-Toddler Social-Emotional Assessment (ITSEA) and Strengths and Difficulties Questionnaire (SDQ) were administered at 2 and 5 years respectively. At 7 years of age, the Developmental and Well-being Assessment (DAWBA) was used to indicate psychiatric diagnoses.
Results: Compared with term born children, VPT children had three times the odds of meeting criteria for any psychiatric diagnosis at age 7 years (odds ratio 3.03; 95% confidence interval 1.23, 7.47, p = .02). The most common diagnoses were anxiety disorders (11% VPT, 8% term), attention-deficit/hyperactivity disorder (10% VPT, 3% term) and autism spectrum disorder (4.5% VPT, 0% term). For VPT children, those with severe global brain abnormalities (p = .02), those who displayed social-emotional problems at age 5 (p = .000) and those with higher social risk at age 7 (p = .001) were more likely to meet criteria for a psychiatric illness at age 7.
Conclusions: Compared with term born children, VPT children have higher rates of psychiatric diagnoses at early school age, predicted by neonatal brain abnormalities, prior social-emotional problems and social factors.
Background: Although prior studies have shown that detained females are marked by significant adverse circumstances, little is known about their adult outcomes.
Method: Prospective follow-up study of 184 (80.4% of original sample of 229) detained adolescent females who were reassessed 4.5 (SD = 0.6) years later in young adulthood (mean age = 20.0, SD = 1.4) on mental health and adjustment outcomes. Associations between these outcomes and detained females’ behavior problems and offense history were examined.
Results: In the total sample, 59.0% had one or more mental health problems at follow-up, whereas 96.2% were facing at least one adjustment problem. Subjects with a personality disorder (PD) reported more adjustment problems compared to subjects without PD. Mental health and adjustment problems in young adulthood were predicted by detained adolescent females’ behavior problems and offense history.
Conclusion: Detained adolescent females suffered from multiple mental health and adjustment problems in young adulthood. Females who developed PD were most impaired. Results of this study underline the compelling need for continued and gender-specific interventions. The identification of predictors during detention for poor adult outcomes can serve as targets for intervention.
Background: Sensory over-responsivity (SOR) affects many individuals with autism spectrum disorders (ASD), often leading to stressful encounters during daily routines.
Methods: This study describes the associations between early SOR symptoms and the longitudinal course of restrictions in family life activities and parenting stress across three time-points in families raising a child with ASD (n = 174). Covariates were child diagnostic severity, emotional problems, and maternal affective symptoms. At time 1 mean chronological age was 28.5 months. Children were administered the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL). Parents completed the Infant Toddler Sensory Profile (ITSP), Infant-Toddler Social Emotional Assessment (ITSEA), Beck Anxiety Index (BAI), and the Center for Epidemiologic Studies Depression Inventory (CES-D) at time 1; and the Parenting Stress Index (PSI) and Family Life Impairment Scale (FLIS) at the three annual time-points.
Results: Latent Growth Curve Models indicated that higher SOR scores on the ITSP at time 1 were associated with higher initial levels of family life impairment and parenting stress and with a smaller magnitude of change over time. These associations were independent of severity of ADOS social-communication symptoms, MSEL composite score, ITSEA externalizing and anxiety symptoms, and maternal affective symptoms as measured by the BAI and CES-D. On average FLIS and PSI did not change over time, however, there was significant individual variability. Concurrently, SOR at time 1 explained 39–45% of the variance in family stress and impairment variables.
Conclusions: An evaluation of SOR should be integrated into the assessment of toddlers with ASD considering their role in family life impairment and stress.
Background: Randomized prevention trials provide a unique opportunity to test hypotheses about the interaction of genetic predispositions with contextual processes to create variations in phenotypes over time.
Methods: Using two longitudinal, randomized prevention trials, molecular genetic and alcohol use outcome data were gathered from more than 900 youths to determine whether prevention program participation would, across 2 years, moderate genetic risk for increased alcohol use conferred by the dopaminergic and GABAergic systems.
Results: We found that (a) variance in dopaminergic (DRD2, DRD4, ANKK1) and GABAergic (GABRG1, GABRA2) genes forecast increases in alcohol use across 2 years, and (b) youths at genetic risk who were assigned to the control condition displayed greater increases in alcohol use across 2 years than did youths at genetic risk who were assigned to the prevention condition or youths without genetic risk who were assigned to either condition.
Conclusions: This study is unique in combining data from two large prevention trials to test hypotheses regarding genetic main effects and gene × prevention interactions. Focusing on gene systems purported to confer risk for alcohol use and abuse, the study demonstrated that participation in efficacious prevention programs can moderate genetic risk. The results also support the differential susceptibility hypothesis that some youths, for genetic reasons, are more susceptible than others to both positive and negative contextual influences.
Background: There is increasing interest in error-related brain activity in anxiety disorders. The error-related negativity (ERN) is a negative deflection in the event-related potential approximately 50 ms after errors compared to correct responses. Recent studies suggest that the ERN may be a biomarker for anxiety, as it is positively associated with anxiety disorders and traits in adults and older youth. However, it is not known if the ERN in young children is related to risk for anxiety disorders. We addressed this by examining the association of six-year olds' ERNs with two established risk factors for anxiety: parental anxiety disorder and child temperamental negative emotionality (NE).
Method: The ERN was assessed using a Go/No-Go task in a community sample of 413 six-year olds. In a prior assessment at age 3, child temperament was evaluated using a laboratory observational measure and parental psychopathology was assessed using semi-structured diagnostic interviews.
Results: Children of mothers with anxiety disorders and children with greater temperamental NE (particularly fearfulness) exhibited significantly smaller ERNs than their peers. Paternal psychopathology, maternal mood and substance use disorders, and child positive emotionality were not associated with children's ERNs.
Conclusion: Both maternal anxiety disorders and child NE (particularly fearfulness) were significantly associated with children's ERNs. However, the direction of these associations was opposite to the relations between ERNs and anxiety in older youth and adults. These results suggest that there may be a difference between risk and disorder status in the relation of error-related brain activity to anxiety between early childhood and late childhood/ early adolescence.
Background: The differential susceptibility hypothesis states that some genetic variants that confer risk in adverse environments are beneficial in normal or nurturing environments. The cholinergic system is promising as a source of susceptibility genes because of its involvement in learning and neural plasticity. The cholinergic receptor gene CHRNA4 has been linked to characteristics related to the personality traits Neuroticism and Openness/Intellect.
Methods: The effects of interaction between CHRNA4 genotype and maltreatment status on child personality were examined in a well matched sample of 339 maltreated and 275 non-maltreated children (aged 8–13 years).
Results: Variation in CHRNA4 interacted with childhood maltreatment to predict personality in a manner indicating differential susceptibility. The interaction of CHRNA4 and maltreatment status predicted Neuroticism and Openness/Intellect. Maltreated children with the rs1044396 T/T genotype scored highest on Neuroticism and showed no effect of genotype on Openness/Intellect. Non-maltreated children with this genotype scored lowest on Neuroticism and highest on Openness/Intellect.
Conclusion: Variation in CHRNA4 appears to contribute to personality by affecting degree of developmental sensitivity to both normal and adverse environments.
Background: Recent models of the early emergence of autism spectrum disorder (ASD) propose that infant intrinsic risk susceptibilities in behaviour may be amplified by interaction within the early social environment into an increasingly atypical developmental trajectory. This study examines whether 6- and 12-month parent–infant interactions in at-risk siblings differ from those with low-risk and whether – in at-risk siblings – such interactions predict later 3-year classification of ASD or no ASD.
Method: Within the British Autism Study of Infant Siblings (BASIS), 6-min videotaped episodes of parent–infant free play in infants at 6–10 months (45 at-risk siblings and 47 low-risk siblings) and 12–15 months (43 at-risk siblings and 48 low-risk siblings) in a laboratory setting were rated on the Manchester Assessment of Caregiver-Infant Interaction (MACI), blind to participant information. Standard tests were administered for concurrent behavioural signs of ASD features and developmental level. Systematic consensus diagnostic classification of ASD was made at 3 years for the at-risk siblings.
Results: Parent nondirectiveness and sensitive responsiveness differed in relation to ASD/risk status (at-risk ASD, at-risk no-ASD and low-risk) at both 6 and 12 months. At 6 months, infant liveliness was lower in the at-risk groups; at 12 months, infant attentiveness to parent and positive affect were lower in the at-risk group later diagnosed with ASD. Dyadic mutuality and intensity of engagement showed a group effect at 12 months. Dyadic mutuality, infant positive affect and infant attentiveness to parent at 12 months (but not 6 months) predicted 3-year ASD outcome, whereas infant ASD-related behavioural atypicality did not.
Conclusions: This is the first prospective evidence that early dyadic interaction between at-risk infants and their parents is associated with later diagnostic outcome in ASD. Possible explanations for these findings and their theoretical implications are considered.
The social motivation hypothesis (SMH) suggests that individuals with autism spectrum disorders (ASD) are less intrinsically rewarded by social stimuli than their neurotypical peers. This difference in social motivation has been posited as a factor contributing to social deficits in ASD. Social motivation is thought to involve the neuropeptide oxytocin. Here, we review the evidence for oxytocin effects in ASD, and discuss its potential role in one important social cognitive behavior.
Systematic searches were conducted using the PsychINFO and MEDLINE databases and the search terms ‘oxytocin’ and ‘autism’; the same databases were used for separate searches for ‘joint attention’, ‘intervention’, and ‘autism’, using the same inclusion criteria as an earlier 2011 review but updating it for the period 2010 to October 2012.
Several studies suggest that giving oxytocin to both individuals with ASD and neurotypical individuals can enhance performance on social cognitive tasks. Studies that have attempted to intervene in joint attention in ASD suggest that social motivation may be a particular obstacle to lasting effects.
The review of the evidence for the SMH suggests a potential role for oxytocin in social motivation deficits in ASD. Because of its importance for later communicative and social development, the focus here is on implications of oxytocin and social motivation in the development of and interventions in joint attention. Joint attention is a central impairment in ASD, and as a result is the focus of several behavioral interventions. In describing this previous research on joint attention interventions in ASD, we pay particular attention to problems encountered in such studies, and propose ways that oxytocin may facilitate behavioral intervention in this area. For future research, integrating behavioral and pharmacological interventions (oxytocin administration) would be a worthwhile experimental direction to improve understanding of the role of oxytocin in ASD and help optimize outcomes for children with ASD.
Background: The notion that ADHD constitutes a heterogeneous disorder is well accepted. However, this study contributes with new important knowledge by examining independent effects of a large range of neuropsychological deficits. In addition, the study investigated whether deficits in emotional functioning constitute a dissociable component of ADHD.
Method: The study included children with ADHD (n = 102; 7–13 years) and a control sample individually matched with regard to age and gender. The administered tasks were designed to tap into three different neuropsychological domains: executive functions (i.e., working memory, inhibition, and shifting), delay aversion, and reaction time variability. Parent ratings of emotion regulation and a test of emotion recognition were also included.
Results: Children with ADHD differed significantly from controls on all measures, except for delay aversion and recognition of disgust. No main effects of gender or interaction effects of gender and group were found. More importantly, executive functioning, reaction time variability, and emotional functioning all contributed independently to distinguishing between children with ADHD and controls.
Conclusions: The current study supports the view of ADHD as a heterogeneous disorder related to multiple neuropsychological deficits. In addition, emotional functioning appears to be an area of importance for ADHD that needs to be incorporated into future theoretical models.
Background: The sociocommunicative problems in autism spectrum disorder (ASD) are traditionally linked to impairments in Theory of Mind (ToM), the ability to ascribe mental states to others. Although ToM impairments are consistently reported in young children with ASD, findings on more advanced ToM understanding in older individuals with high-functioning ASD (HFASD) are less straightforward. Therefore, we assessed the advanced ToM abilities of a large sample of school-aged children and adolescents with HFASD (n = 194; 6–20 years) and compared them to a typically developing (TD) comparison group (n = 60).
Methods: Participants’ advanced ToM was assessed with five social stories containing second-order false beliefs, display rules, double bluff, faux pas, and sarcasm.
Results: Participants with HFASD performed equally well on each of the ToM stories as their TD peers. Consistent age effects were noticed with adolescents outperforming the children. Furthermore, advanced ToM was positively associated with participants’ age, verbal abilities, and general reasoning abilities.
Conclusions: Counter to what the ToM theory of ASD would predict, school-aged children and adolescents with HFASD seem to be able to master the theoretical principles of advanced mental state reasoning. However, they may still fail to apply these theoretical principles during everyday social interactions.
Background: The attentional blink (AB) phenomenon was used to assess the effect of emotional information on early visual attention in typically developing (TD) children and children with autism spectrum disorders (ASD). The AB effect is the momentary perceptual unawareness that follows target identification in a rapid serial visual processing stream. It is abolished or reduced for emotional stimuli, indicating that emotional information has privileged access to early visual attention processes.
Methods: We examined the AB effect for faces with neutral and angry facial expressions in 8- to 14-year-old children with and without an ASD diagnosis.
Results: Children with ASD exhibited the same magnitude AB effect as TD children for both neutral and angry faces.
Conclusions: Early visual attention to emotional facial expressions was preserved in children with ASD.
Background: Prenatal stress has been shown to predict persistent behavioural abnormalities in offspring. Unknown is whether prenatal stress makes children more vulnerable to peer victimisation.
Methods: The current study is based on the Avon Longitudinal Study of Parents and Children, a prospective community-based study. Family adversity, maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period. Parenting, partner conflict and temperament were measured at preschool age. Peer victimisation was assessed using multiple informants (child, parent, teacher) at primary school age (between ages 7 and 10).
Results: Prenatal severe family adversity and maternal mental health directly increased the risk of victimisation at school even when controlled for postnatal family adversity and maternal mental health, parenting, partner conflict and temperament. Effects were found to be independent of sources of information of peer victimisation. Partner conflict and maladaptive parenting also independently increased the risk of peer victimisation.
Conclusions: Experiences in pregnancy may affect the developing foetus and increase vulnerability to be victimised by peers. Conflict between parents and their parenting further increase the risk of being victimised by peers at school.
Background: Parenting and children’s adjustment were examined in 30 surrogacy families, 31 egg donation families, 35 donor insemination families, and 53 natural conception families.
Methods: Parenting was assessed at age 3 by a standardized interview designed to assess quality of parenting and by questionnaire measures of anxiety, depression, and marital quality. Children’s adjustment was assessed at ages 3, 7, and 10 using the Strengths and Difficulties Questionnaire (SDQ).
Results: Although children born through reproductive donation obtained SDQ scores within the normal range, surrogacy children showed higher levels of adjustment difficulties at age 7 than children conceived by gamete donation. Mothers who had kept their child’s origins secret showed elevated levels of distress. However, maternal distress had a more negative impact on children who were aware of their origins.
Conclusions: The absence of a gestational connection to the mother may be more problematic for children than the absence of a genetic link.
Background: Aggression is one of the more stable characteristics of child and adolescent development, and violent behavior in early adulthood is often foreshadowed by aggressive behavior in childhood and early adolescence. Considerable evidence has linked coercive family interactions to aggressive behavior in childhood, but less research has been conducted on the joint role of family and peer interaction in the escalation of aggression to violence in adulthood.
Methods: We coded family interactions at age 12–13 and friendship interaction at age 16–17 in a multiethnic sample of youth and families. Violence in young adulthood (age 22–23) was measured using self-report, criminal records, and parent report. We tested the hypothesis that a process of ‘coercive joining’ in friendship interactions mediated the relationship between coercive family interactions and serious violence.
Results: We found that observed coercive joining in friendships at age 16–17 predicted early-adulthood violent behavior over and above an established tendency toward antisocial behavior. We also found that observed coercive family interactions at age 12 predicted early-adulthood violence, and that coercive joining with friends fully mediated this link.
Conclusions: These results significantly extend coercion theory by suggesting that coercive joining in the context of peer groups is an additional mechanism by which coercive processes in the family are extended and amplified to violent behavior in early adulthood. Our findings suggest the importance of addressing both individual interpersonal skills and self-organizing peer groups when intervening to prevent violent behavior.
Background: Subthreshold-depression and anxiety have been associated with significant impairments in adults. This study investigates the characteristics of adolescent subthreshold-depression and anxiety with a focus on suicidality, using both categorical and dimensional diagnostic models.
Methods: Data were drawn from the Saving and Empowering Young Lives in Europe (SEYLE) study, comprising 12,395 adolescents from 11 countries. Based on self-report, including Beck Depression Inventory-II (BDI-II), Zung Self-Rating Anxiety Scale (SAS), Strengths and Difficulties Questionnaire (SDQ) and Paykel Suicide Scale (PSS) were administered to students. Based on BDI-II, adolescents were divided into three groups: nondepressed, subthreshold-depressed and depressed; based on the SAS, they were divided into nonanxiety, subthreshold-anxiety and anxiety groups. Analyses of Covariance were conducted on SDQ scores to explore psychopathology of the defined groups. Logistic regression analyses were conducted to explore the relationships between functional impairments, suicidality and subthreshold and full syndromes.
Results: Thirty-two percent of the adolescents were subthreshold-anxious and 5.8% anxious, 29.2% subthreshold-depressed and 10.5% depressed, with high comorbidity. Mean scores of SDQ of subthreshold-depressed/anxious were significantly higher than the mean scores of the nondepressed/nonanxious groups and significantly lower than those of the depressed/anxious groups. Both subthreshold and threshold-anxiety and depression were related to functional impairment and suicidality.
Conclusions: Subthreshold-depression and subthreshold-anxiety are associated with an increased burden of disease and suicide risk. These results highlight the importance of early identification of adolescent subthreshold-depression and anxiety to minimize suicide. Incorporating these subthreshold disorders into a diagnosis could provide a bridge between categorical and dimensional diagnostic models.
Background: Twin studies in children reveal that familial aggregation of anxiety disorders is due to both genetic and environmental factors. Cognitive biases for threat information are considered a robust characteristic of childhood anxiety. However, little is known regarding the underlying aetiology of such biases and their role in anxiety disorders.
Method: A face version of the dot-probe task measuring attentional biases for negative (anger, fear, sad, disgust) and positive (happy) facial expressions was completed by 600, 8-year-old twins; the largest study of its kind. Twin correlations for attentional bias scores were compared to estimate genetic and environmental effects. Parent-report diagnostic interviews identified children with an anxiety disorder. Indices of inferred genetic and familial risk for anxiety disorders were created for each child. Data were analysed using a series of logistic regressions.
Results: Anxious children showed greater attentional avoidance of negative faces than nonanxious children; t (548) = 2.55, p < .05. Attentional avoidance was not under genetic or shared environmental influence. Risk for anxiety disorders was predicted by familial factors. Both attentional avoidance and inferred familial risk were significant but independent predictors of anxiety disorders (ORs = .65 and 3.64, respectively).
Conclusions: Anxiety-related attentional biases and familial risk play important but independent roles in childhood anxiety disorders. If replicated, these findings indicate that links between genetic risk and anxiety disorders lie outside the domain of attentional processes.
Background: The relationship between phoneme awareness, rapid automatized naming (RAN), verbal short-term/working memory (ST/WM) and diagnostic category is investigated in control and dyslexic children, and the extent to which this depends on orthographic complexity.
Methods: General cognitive, phonological and literacy skills were tested in 1,138 control and 1,114 dyslexic children speaking six different languages spanning a large range of orthographic complexity (Finnish, Hungarian, German, Dutch, French, English).
Results: Phoneme deletion and RAN were strong concurrent predictors of developmental dyslexia, while verbal ST/WM and general verbal abilities played a comparatively minor role. In logistic regression models, more participants were classified correctly when orthography was more complex. The impact of phoneme deletion and RAN-digits was stronger in complex than in less complex orthographies.
Conclusions: Findings are largely consistent with the literature on predictors of dyslexia and literacy skills, while uniquely demonstrating how orthographic complexity exacerbates some symptoms of dyslexia.
This randomized clinical trial of methylphenidate in children with intellectual disability (ID) by Simonoff et al. (2013) advances the field in several ways useful to clinicians. The three-figure widely representative sample more definitively confirms findings previously reported from smaller studies and studies with a differently selected sample. The medium placebo-controlled effect size found is in line with previous more tentative suggestions for ID, such as those summarized by Aman et al. This sample, selected for ID but coincidentally including some children with autism (a third of the sample), nicely complements the RUPP Autism Network (2005) study of 72 children with autism, most of whom also had ID (mean IQ 62.6, range 16-135). Similar effect was found in both studies, suggesting that one might expect a medium effect widely in the intellectual & developmental disability (IDD) population, with a 40-50% response rate.
]]>The commentary by Arnold (2013) raises a number of interesting issues and speculations about the action of methylphenidate in children with intellectual disability (ID) and associated neurodevelopmental disorders, such as autism spectrum disorders. In our article (Simonoff et al., 2013), we were careful to stick closely to the statistical analysis plan drawn up (and approved by the Data Monitoring Committee) during data collection and prior to any exploratory analysis. However, a number of the issues raised by Arnold warrant further response, with the aim of clarifying the lessons that can reasonably be drawn for clinical practice.
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