Diagnosis Of Disruptive Disorder Research Articles

Assessment of affective dysregulation in children: development and evaluation of a semi-structured interview for parents and for children

BackgroundChildren with affective dysregulation (AD) show an excessive reactivity to emotionally positive or negative stimuli, typically manifesting in chronic irritability, severe temper tantrums, and sudden mood swings. AD shows a large overlap with externalizing and internalizing disorders. Given its transdiagnostic nature, AD cannot be reliably and validly captured only by diagnostic categories such as disruptive mood dysregulation disorder (DMDD). Therefore, this study aimed to evaluate two semi-structured clinical interviews—one for parents and one for children.MethodsBoth interviews were developed based on existing measures that capture particular aspects of AD. We analyzed internal consistencies and interrater agreement to evaluate their reliability. Furthermore, we analyzed factor loadings in an exploratory factor analysis, differences in interview scores between children with and without co-occurring internalizing and externalizing disorders, and associations with other measures of AD and of AD-related constructs. The evaluation was performed in a screened community sample of children aged 8–12 years (n = 445). Interrater reliability was additionally analyzed in an outpatient sample of children aged 8–12 years (n = 27).ResultsOverall, internal consistency was acceptable to good. In both samples, we found moderate to excellent interrater reliability on a dimensional level. Interrater agreement for the dichotomous diagnosis DMDD was substantial to perfect. In the exploratory factor analysis, almost all factor loadings were acceptable. Children with a diagnosis of disruptive disorder, attention-deficit/hyperactivity disorder, or any disorder (disruptive disorder, attention-deficit/hyperactivity disorder, and depressive disorder) showed higher scores on the DADYS interviews than children without these disorders. The correlation analyses revealed the strongest associations with other measures of AD and measures of AD-specific functional impairment. Moreover, we found moderate to very large associations with internalizing and externalizing symptoms and moderate to large associations with emotion regulation strategies and health-related quality of life.ConclusionsThe analyses of internal consistency and interrater agreement support the reliability of both clinical interviews. Furthermore, exploratory factor analysis, discriminant analyses, and correlation analyses support the interviews’ factorial, discriminant, concurrent, convergent, and divergent validity. The interviews might thus contribute to the reliable and valid identification of children with AD and the assessment of treatment responses.Trial registrationADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963. Registered 27 June 2018.

Association Between Mental and Physical Health Problems in High-Risk Adolescents: A Longitudinal Study

Purpose This longitudinal study examined the relationship between mental and physical health problems in a sample of high-risk youth served in the public sector. Methods Participants included youth aged 9–18 years at baseline, randomly sampled from one of five public service sectors in San Diego County, California, and youths may have been active to more than one sector. Diagnoses for mood, anxiety, and disruptive disorders based on structured diagnostic interviews were determined at baseline and data regarding health-related problems were collected 2 years post-baseline. Results Mood and disruptive behavior disorders were related to cumulative health problem incidence, as well as aggregate measures of health problems and severe health problems. In addition mood disorder diagnosis was associated with higher rates of infectious diseases, respiratory problems, and weight problems. Disruptive disorder diagnosis was related to higher rates of risk behavior–related health problems. Conclusions The present work extends the research on the relationship between mental and physical health problems to adolescents served in the public sector, who are at especially high risk for behavioral and emotional problems. Potential mechanisms by which mental health problems may impact health problems are discussed. We suggest the development of effective interagency cooperation between medical and mental health systems to improve the care of youth with comorbid mental and physical disorders.

Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder (OCD) defined at the diagnostic level encompasses divergent symptoms and is often associated with other psychiatric problems. The present study examines OCD versus co-morbid symptom patterns in OCD in children and adolescents in order to investigate the presence of diagnostic heterogeneity. A total of 113 outpatients with primary OCD participated. The patients' and primary caretakers' responses on semi-structured interviews (child version of Schedule for Affective Disorders and Schizophrenia and the Children's Yale-Brown Obsessive Compulsive Scale) and parents' responses on the Child Behaviour Checklist were used in the study. Psychiatric diagnoses were related to CBCL syndrome scores and CBCL scores were compared with the Swedish normative data. Co-morbid diagnoses were very common and only one out of five patients had only OCD. The most common group was the neuropsychiatric disorders (47%) where tic disorders were most common (27%), especially among boys (40.8%; P = .006, Fisher's exact test). Also anxiety disorders were common (39.8%) as were affective disorders (24.8%) neither with any gender differences. Diagnoses of disruptive disorders were less common (8.8%), almost exclusively of the oppositional kind (ODD) (8.8%). From the dimensional point of view using the CBCL, patients with OCD scored higher than Swedish youngster generally do, and some gender differences were seen in that girls scored higher on anxiety and depression while both girls and boys had high scores on thought problems, attention problems and especially aggressive behaviour. Comorbidities explained from 25 to 50% scores of the CBCL sub-syndrome scales, often with both main effects and through complex patterns of interaction with gender, OCD-severity and other co-morbid problems. While co-morbid problems is an important facet of OCD, sub-syndromal levels of symptoms that can be assessed using a dimensional approach, is a large part of the total symptom burden in these youngsters. Our data indicate contributions of different pathways for girls and for boys for several comorbid problems together with OCD-severity.

DIAGNOSES ASSOCIATED WITH ATYPICAL ANTIPSYCHOTIC USE IN PRIVATELY INSURED CHILDREN.

Background Atypical antipsychotic medications have not been carefully studied in children. Studies, however, have shown a dramatic increase in their use, with a prevalence of 13 per 1,000 children in a Midwestern Medicaid population in 2001 for psychiatric diagnoses such as attention-deficit, conduct, and mood disorders. Objective To evaluate the prevalence of atypical antipsychotics in commercially insured children and the diagnoses associated with treatment. Methods Prescription and medical claims were used to conduct a retrospective cohort study of children 2 to 18 years of age covered by a large private insurance agency in the Midwest. The prevalence of children receiving atypical antipsychotics between January 2002 and December 2005 was determined along with associated diagnoses. We used chi-square tests for statistical comparisons. Results The study population included 198,849 children with a mean age of 10.3 years (SD = 5.0). A total of 2,305 children received at least one prescription for an atypical antipsychotic (11.6 per 1,000 children). Children prescribed atypical antipsychotics were 64% male and had a mean age of 12.3 years (SD = 3.8). Males were 1.7 times more likely to receive atypical antipsychotics than females (95% CI 1.6, 1.9). Children 10 years of age and older were 2.5 times more likely to be prescribed atypical antipsychotics than children less than 10 years (95% CI 2.3, 2.8). The most common diagnoses were disruptive behavior disorders (65%), mood disorders (64%), and anxiety disorders (45%). The majority (74%) of children had more than one diagnosis. Males on atypical antipsychotics were 2.5 times more likely to have a diagnosis of disruptive disorder (95% CI 2.1, 3.0), whereas females were 1.6 times more likely to have a diagnosis of a mood disorder (95% CI 1.4, 2.0) and 1.4 times more likely to have an anxiety disorder (95% CI 1.2, 1.7). Children 10 to 14 years of age on atypical antipsychotics are 2.8 times more likely to have a diagnosis of disruptive disorder than children 15 to 18 years old (95% CI 2.3, 3.4), whereas children 15 to 18 years of age were 1.7 times more likely to have a diagnosis of a mood disorder than children 10 to 14 years old (95% CI 1.4, 2.1). A total of 173 children (7.5%) had no psychiatric diagnosis coded during the study period. Conclusions The rate of atypical antipsychotic use in privately insured youth is similar to that of a Medicaid population (11.6 vs 13 per 1,000). Although disruptive behavior disorders are the primary diagnoses in youth on atypical antipsychotics, the majority of children prescribed an atypical antipsychotic have multiple psychiatric diagnoses. Studies are needed to assess the risk-benefit ratio and long-term safety and efficacy in these patients.

Depression and Anxiety Disorders in Pediatric Epilepsy

This study examined affective disorders, anxiety disorders, and suicidality in children with epilepsy and their association with seizure-related, cognitive, linguistic, family history, social competence, and demographic variables. A structured psychiatric interview, mood self-report scales, as well as cognitive and language testing were administered to 100 children with complex partial seizures (CPSs), 71 children with childhood absence epilepsy (CAE), and 93 normal children, aged 5 to 16 years. Parents provided behavioral information on each child through a structured psychiatric interview and behavior checklist. Significantly more patients had affective and anxiety disorder diagnoses (33%) as well as suicidal ideation (20%) than did the normal group, but none had made a suicide attempt. Anxiety disorder was the most frequent diagnosis among the patients with a diagnosis of affective or anxiety disorders, and combined affective/anxiety and disruptive disorder diagnoses, in those with suicidal ideation. Only 33% received some form of mental health service. Age, verbal IQ, school problems, and seizure type were related to the presence of a diagnosis of affective or anxiety disorder, and duration of illness, to suicidal ideation. These findings together with the high rate of unmet mental health underscore the importance of early detection and treatment of anxiety disorders and suicidal ideation children with CPSs and CAE.

Child Temperament, ADHD, and Caregiver Strain: Exploring Relationships in an Epidemiological Sample

To investigate the relationship between child-reported dimensions of temperament and attention-deficit/ hyperactivity disorder (ADHD), as well as other indicators of child psychopathology, including disruptive disorders, depression, and anxiety. It also examined whether difficult child temperament scores independently predicted caregiver strain. A school-district-wide, two-phase screening design (response rate 70% for phase 2) identified elementary school children at high risk for ADHD. Two hundred high-risk children and their parents completed standardized instruments to assess child temperament, diagnoses of disruptive disorders, children's symptoms of anxiety and depression, and caregiver strain. Relationships were examined using analysis of variance, correlations, and multivariate prediction models, adjusting for child sociodemographic characteristics and psychopathology. All estimates were weighted for sampling design and differential participation. Combined subtype ADHD was associated with lower scores on task orientation and higher scores on general activity level. Depressive symptoms correlated significantly with all but one difficult temperament dimension, in a pattern consistent with clinical symptoms of depression. Child temperament did not vary by ADHD treatment status. Among these high-risk children, maternal caregiver strain experiences were increased by male gender, inattention symptoms, and oppositional defiant disorder, but not by difficult temperament scores. This study provides support for Graham and Stevenson's hypothesis of continuity between specific temperament traits and certain child psychiatric disorders, namely ADHD and depressive disorders.

Quantitative EEG Differences in a Nonclinical Sample of Children with ADHD and Undifferentiated ADD

To use quantitative electroencephalographic (EEG) techniques to identify electrophysiological differences between children with distinct disorders of attention and/or hyperactivity. Forty children from a prescreened community sample were evaluated by means of both spectral EEG and evoked response potential (ERP) techniques. The children were 7 to 13 years of age and were selected on the basis of membership in one of the following DSM-III-R categories: attention-deficit hyperactivity disorder (ADHD) (n = 16), undifferentiated attention deficit disorder (UADD) (n = 12), or no disruptive disorder diagnosis (n = 12). Spectral EEG revealed that UADD subjects had less delta band relative percent power (RPP) (p < .01), more beta band RPP (p < .01), and ERP findings of a decreased rare tone P300 amplitude (p < .02) compared with the control group. ADHD subjects had spectral EEG findings of increased beta band RPP (p < .05) and ERP findings of an increased common tone N100 latency (p < .02) and a decreased rare tone P300 amplitude (p < .02). Interhemispheric asymmetries appeared to distinguish the groups: the UADD group had spectral EEG asymmetries; the ADHD group had only ERP asymmetries; and the control group had no asymmetries. Quantitative EEG techniques may prove useful in differentiating specific subtypes of ADHD.