Disruptive Disorders Research Articles

Animal mediation support in disruptive disorder with emotional dysregulation (TDDE)

Treating disruptive disorder with emotional dysregulation (DDED) is a challenge in terms of difficulties, objectives and results. In addition to a multi-disciplinary approach involving child psychiatrists, nurses, psychomotricists and educators, the use of animal mediation (dogs) appears relevant. Eight standardized group sessions with eight children aged 6 to 10, assessed by means of a semi-directive interview and several psychometric tools (MDI-C, Kidscreen, parent attachment inventory, child/family star, family/child star, alexithymia questionnaire) revealed improvements in listening skills, empathy, adaptability, socialization, anger and depression management, temper tantrum frequency, school complaints and depressive symptoms.

Autonomic response and attachment style in disruptive mood dysregulation disorder.

Disruptive mood dysregulation disorder (DMDD) is characterised by severe emotion regulation difficulties, particularly anger and irritability, in children. Despite the impact of attachment on emotional and behavioural regulation, the link between attachment style and DMDD is under-researched. This study investigated whether attachment style and parasympathetic regulation differentiate the response profiles to frustrating conditions between children diagnosed with DMDD and controls. Participants were assessed at schools in Johannesburg, Gauteng, South Africa. Thirty participants were divided into two matched groups (n DMDD = 15; n Control = 15) and assessed. Respiratory sinus arrhythmia (RSA) and heart period were measured during an Affective Posner Task, inducing frustration. Attachment style was assessed using the Attachment Style Classification Questionnaire for children. Parents of children with DMDD completed a social interaction problems questionnaire. The DMDD group showed a higher prevalence of avoidant attachment style (p = 0.013) compared to controls. Both groups displayed adaptive vagal withdrawal and recovery during the task (p = 0.005; p = 0.021). Controls had significantly higher heart period throughout the assessment (game 1: p = 0.006; game 2: p = 0.013; game 3: p = 0.007). In the DMDD group, lower vagal tone during frustration correlated with more social interaction problems (p = 0.049). The study demonstrates a potential link between attachment style and altered physiological state in children with DMDD. The findings provide insight into possible atypical vagal regulation of the heart and avoidant attachment styles in DMDD, highlighting potential therapeutic and intervention targets.

Child and adolescent psychiatric disorders and ICD-11.

An important change in ICD-11 is the lifespan approach, whereby previous child and adolescent disorders have been amalgamated with adult disorders. There have been changes in the definition/descriptions of neurodevelopmental and disruptive disorders, some of which may have an impact on service development.

Development and Acceptability of Provider Training to Increase Treatment Engagement of Parents in Their Children's Behavioral Health Care Need.

BACKGROUND: Disruptive, Impulse-Control, and Conduct disorders (DIC) affect 5 million children in the United States and often require comprehensive and long-term behavioral health care for which sustained parental involvement is essential. Our research team is developing an intervention to improve parental engagement in the behavioral health care of their children with DIC. The intervention, which will be a modification of an evidence-based shared decision-making intervention called DECIDE, will include a parent component and a provider component. AIM: To determine the acceptability of the provider component of the modified DECIDE intervention. METHODS: The provider intervention is an asynchronous self-paced online training program made up of five modules: introduction, shared decision-making, perspective-taking, attributional errors, and being a responsive provider. The training was piloted with 41 providers in two public child and adolescent treatment programs. Following completion of the training, semi-structured interviews were conducted with the providers to assess the acceptability of the training. The interviews were analyzed with conventional content analysis. RESULTS: The provider training was well received by providers, and many had made practice changes based on what they had learned. Several offered recommendations for improvement, most notably the need to tailor the training based on provider role, discipline, and level of expertise. CONCLUSIONS: The feedback given by providers will be used to refine future iterations of the provider training component of the modified DECIDE intervention. Psychiatric nurses and other clinicians may draw from strategies incorporated in the training program to improve parent engagement in the treatment of children with DIC.

Evaluation of Frontal QRS-T Angle in Children With ADHD and Healthy Controls.

Conflicting findings exist regarding the link between attention deficit hyperactivity disorder (ADHD) and cardiovascular diseases. This study aimed to evaluate the frontal QRS-T (fQRS-T) angle and its correlation with symptom severity in children diagnosed with ADHD. The study population consisted of 172 patients diagnosed with ADHD (120 drug naive and 52 drug positive) and 82 healthy controls. ADHD symptoms were assessed using the Atilla Turgay DSM-IV-Based Screening and Assessment Scale for Disruptive Conduct Disorders (T-DSM-IV-Scale). The fQRS-T angle and corrected QT (QTc) interval were obtained from the automated reports of 12-lead electrocardiography device for each patient. QTc interval and fQRS-T angle were significantly different among the groups. Post hoc analyses showed that QTc interval and fQRS-T angle of ADHD drug naive and ADHD drug positive patients were significantly higher than the healthy control groups. However, there was no significant difference between drug naive and drug positive patients regarding QTc interval and fQRS-T angle. Both QTc interval and fQRS-T angle showed positive correlations with the severity of ADHD symptoms (r = 0.263, p = .001 and r = 0.175, p = .023 respectively). We found that fQRS-T angle was significantly wider in children with ADHD. Therefore, we suggest that fQRS-T angle may help in cardiovascular risk assessment in children with ADHD.

Current Understandings and Controversies of Disruptive Mood Dysregulation Disorder

Researching DMDD is crucial as it directly impacts clinical diagnosis and treatment strategies for mental illnesses. Understanding and addressing the controversies surrounding DMDD can lead to improved diagnostic criteria and better treatment outcomes for affected individuals. Through a comprehensive and extensive understanding of DMDD through literature search, it is found that there is a great dispute in the academic circle about the rationality and scientificity of DMDD. Based on this, the existing research results of DMDD will be partially introduced, and some existing controversies will be discussed. The main points of contention are the scientificity and rationality of DMDD’s inclusion in the DSM-5; And how the distinction between DMDD and other disorders is more rigorous because it involves different ways of treating different types of mental illness. Understanding these disputes is essential as they have significant implications for clinical practice and the overall approach to diagnosing and treating mental health disorders. Addressing these controversies can lead to improved diagnostic accuracy and more effective, tailored treatment strategies for individuals with DMDD.

Diagnostic accuracy of large language models in psychiatry

IntroductionMedical decision-making is crucial for effective treatment, especially in psychiatry where diagnosis often relies on subjective patient reports and a lack of high-specificity symptoms. Artificial intelligence (AI), particularly Large Language Models (LLMs) like GPT, has emerged as a promising tool to enhance diagnostic accuracy in psychiatry. This comparative study explores the diagnostic capabilities of several AI models, including Aya, GPT-3.5, GPT-4, GPT-3.5 clinical assistant (CA), Nemotron, and Nemotron CA, using clinical cases from the DSM-5. MethodsWe curated 20 clinical cases from the DSM-5 Clinical Cases book, covering a wide range of psychiatric diagnoses. Four advanced AI models (GPT-3.5 Turbo, GPT-4, Aya, Nemotron) were tested using prompts to elicit detailed diagnoses and reasoning. The models' performances were evaluated based on accuracy and quality of reasoning, with additional analysis using the Retrieval Augmented Generation (RAG) methodology for models accessing the DSM-5 text. ResultsThe AI models showed varied diagnostic accuracy, with GPT-3.5 and GPT-4 performing notably better than Aya and Nemotron in terms of both accuracy and reasoning quality. While models struggled with specific disorders such as cyclothymic and disruptive mood dysregulation disorders, others excelled, particularly in diagnosing psychotic and bipolar disorders. Statistical analysis highlighted significant differences in accuracy and reasoning, emphasizing the superiority of the GPT models. DiscussionThe application of AI in psychiatry offers potential improvements in diagnostic accuracy. The superior performance of the GPT models can be attributed to their advanced natural language processing capabilities and extensive training on diverse text data, enabling more effective interpretation of psychiatric language. However, models like Aya and Nemotron showed limitations in reasoning, indicating a need for further refinement in their training and application. ConclusionAI holds significant promise for enhancing psychiatric diagnostics, with certain models demonstrating high potential in interpreting complex clinical descriptions accurately. Future research should focus on expanding the dataset and integrating multimodal data to further enhance the diagnostic capabilities of AI in psychiatry.

Disruptive mood dysregulation disorder, parental stress, and attachment styles

Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnostic entity concerning children with chronic irritability and severe anger outbursts. Currently, there is limited knowledge about the parental factors associated with the disorder. The aim of this study was to compare stress levels and attachment styles in parents of children with DMDD with those of parents of children with other diagnoses. Our sample consisted of 218 children (6–12 years, Mage = 9.68 years) referred to child mental health outpatient clinics. Clinicians used a standardized semi-structured diagnostic interview to identify diagnoses. Parental stress levels and attachment styles were assessed using parent reports. We found that parents of children with DMDD experience significantly higher levels of parenting stress related to factors in the child than parents of children with other diagnoses. Furthermore, parents of children with DMDD show a higher association with insecure adult attachment styles than parents of children without DMDD. Finally, an adult preoccupied-ambivalent attachment style explains the variability in parental stress in the DMDD group to a large degree. We discuss how parental stress and an insecure attachment style can be associated with negative parenting practices. An implication from this study could be that treatment results might be improved by involving parents more in treatment programs for children with DMDD.

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.

Questioning disruptive disorder with emotional dysregulation

Disruptive Emotional Dysregulation Disorder (DEDD) responds to an increase in diagnoses of clastic crises, reactive depression and bipolarity in children and adolescents. Emerging in the 1990s, EDD has become an issue for practitioners, parents and teachers alike, and has become an integral part of the landscape of paediatric and child psychiatric disorders. Its diagnostic complexity is accentuated by criteria that include persistent and disproportionate outbursts of anger, often confused with other pathologies, especially as diagnostic tools are few and far between. Professionals in the field know little about EDD, preferring to diagnose more familiar disorders.

Disruptive mood dysregulation disorder: the relationship between cardiac vagal tone, emotion recognition, and expressive prosody

Children with disruptive mood dysregulation disorder have difficulties with emotion regulation and recognition which impacts their social functioning. Due to its recent definition, there is limited information on the neural mechanisms of this disorder. This exploratory study examined the role of autonomic heart regulation in children with disruptive mood dysregulation disorder, motivated by suggestions of reduced autonomic regulation (measured by heart rate variability) associated with psychiatric disorders in adults and children. The cross-sectional design sampled two groups of children, one with disruptive mood dysregulation disorder ( n = 15; 14 male) and the other with typical development ( n = 15; 14 male). Heart rate variability, facial emotion recognition accuracy and speed, and prosody were measured. There were no significant differences in heart rate variability between the two groups before, or during, the tasks. However, children with disruptive mood dysregulation disorder experienced significantly greater difficulty recognising fear in faces compared to controls and confused other negatively valenced emotions. There was also a significant, negative correlation between heart rate variability and prosody modulation (verbal expression of emotion) in the control group, a relationship that was absent in the disruptive mood dysregulation disorder group. These results suggest that atypical autonomic regulation during emotionally evocative situations and difficulty with facial emotion recognition may contribute to the challenges experienced by children with disruptive mood dysregulation disorder. This is valuable knowledge for psychologists, which can contribute to individualised, effective, and comprehensive care that addresses the child’s emotional, social, and relational well-being.

Prevalence and comorbidities of disruptive mood dysregulation disorder

IntroductionFollowing the release of DSM-5 in 2013, a newly introduced diagnostic category emerged in psychiatric classification—the disruptive mood dysregulation disorder (DMDD). DMDD is a depressive disorder that begins in childhood and is marked by a consistently irritable or angry mood, frequently accompanied by temper outbursts that are notably severe.ObjectivesIt is to study the prevalence and comorbidities of DMDD in Morocco, specifically at Arrazi University Psychiatric HospitalMethodsData were collected from youths aged 6 to 18 years who underwent a systematic assessment of symptoms. This assessment was extended to all patients consulting at Arrazi Hospital in Salé within the pediatric department over a period of four months (sample accrued from July 2023 to October 2023). The diagnosis of DMDD was established utilizing the diagnostic criteria outlined in DSM-5ResultsAbout 31% of the young participants met the operational criteria for DMDD. Those with DMDD exhibited increased comorbidity rates with attention-deficit/hyperactivity disorder (ADHD), another Depressive disorder and conduct disorder compared to those without DMDD. Additionally, they displayed elevated symptoms of aggressive behavior, rule-breaking, social issues, anxiety/depression, attention problems, and thought problems in comparison to all other participants without DMDD. It’s noteworthy that youth with DMDD presented with at least one psychiatric comorbidity.ConclusionsGiven that DMDD is accompanied by other comorbid psychiatric disorders, particularly depression and anxiety, and appears to impact familial and occupational status in adulthood, the early detection and subsequent effective treatment of DMDD symptoms are of utmost importance.Disclosure of InterestNone Declared

Conduct Disorder: An Update

Conduct disorder is a serious mental disorder with a heterogeneous etiology that is frequently encountered in child and adolescent psychiatric clinics, although there are social and international differences. Conduct disorder can be defined as violating the basic rights of others, age-appropriate social norms and values, or existing rules with consistently aggressive behavioral patterns. It has been defined under various headings since DSM-II and most recently in DSM-5 under the heading "Disruptive Disorders, Impulse Control and Conduct Disorders". Genetic, individual, and psychosocial factors play a role in the etiology and constitute a broad etiology. Although its onset dates to childhood, if assistance is not sought, it can lead to more serious mental disorders. Conduct disorders are associated with several mental disorders. Therefore, a differential diagnosis should be made and an effective treatment option should be established. No specific medications were available for treatment. Different disciplines can collaborate for a long time to achieve successful results. In this article, the definition of conduct disorder, DSM-5 diagnostic criteria, epidemiology, etiology, comorbidity, differential diagnosis, prognosis, and treatment approaches are reviewed.

Overview of approved psychiatric medications 2008-2023: A systematic review

Objective: The purpose of this systematic review is to enumerate the psychiatric medications approved by the Food and Drug Administration (FDA) over the past 15 years, from 2008 to 2023, and describe their mechanism of action, approved indications, dosing ranges, and adverse effects. Methods: Studies published from 2008 to 2023 were identified from the PubMed database, using the keywords: ‘psychiatric’ OR ‘psychopharm*” AND ‘medic*’ OR ‘pharm*’. An independent focused analysis was conducted, and a consensus was reached on the studies for approved medications to be included in this systematic review. Key findings were derived from the full-text and tables of the selected studies. Results: From 2008-2023, the FDA approved 118 medications including: 26 for Schizophrenia, 12 for Bipolar Disorders, 16 for Depressive Disorders, two for Anxiety Disorders, one for Feeding and Eating disorders, 13 for Sleep-Wake Disorders, five for Sexual Dysfunctions, 16 for Substance Use Disorders, six for Neurocognitive Disorders, and 18 for Neurodevelopmental Disorders (specifically, Attention-Deficit/Hyperactivity Disorder, ADHD), in addition to three for Psychiatric Medication-Related Movement Disorders. It is important to note that 37 out of the 118 medications were New Drug Application (NDA) approvals by the FDA, i.e., they have not been previously approved for another indication. We also noted that nine medications were discontinued by the manufacturer, with no reported safety or effectiveness concerns. Over the past fifteen years, several novel treatment approaches and modalities have been introduced, such as monoclonal antibodies for the treatment of Alzheimer’s Disease, very long-acting injectable antipsychotic drugs, targeting the glutamate neurochemical system for depression and depressive symptoms in other disorders, medications for conditions without any previously approved medicines (e.g., Binge Eating Disorder), and tablets with sensors to monitor treatment adherence. Of note, no new medications were approved from 2008-2023 for: Anxiety Disorders (with the exception of two extended-release preparations of previously approved agents), Obsessive-Compulsive Disorder, Trauma- and Stressor-Related Disorders, Dissociation Disorders, Somatic Symptom Disorders, and Disruptive, Impulse-Control, and Conduct Disorders. Conclusion: Approved psychiatric medications from 2008-2023 show substantial promise in the treatment of psychiatric conditions. More than 100 psychiatric medications were approved over the past 15 years for the major psychiatric conditions including a combination of newly introduced medications and new indications and drug formulations for already approved medications. It behooves psychiatric clinicians to keep up to date with this ever evolving and fast changing field. As the overview article, this manuscript will be followed by in-depth, disorder-based descriptions of approved medications, as well as those currently under development in Phase III.

Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity.

Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey's clinical implementation and evaluation of validity. Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers' psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. Focus group members (n=17) expressed positive feedback overall about the survey's content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey's impact on the psychiatric and medical management of distress in individuals with DD.

Gender-specific pathways in mental health crisis in adolescents, from consultation to (in)voluntary admission: a retrospective study

BackgroundA strong increase in mental health emergency consultations and admissions in youths has been reported in recent years. Although empirical evidence is lacking, gender differences in risk of admission may have contributed to this increase. A clearer understanding of the relationship, if any, between gender and various aspects of (in)voluntary care would help in more evidence-based service planning.MethodsWe analysed registry data for 2008–2017 on 3770 outpatient emergencies involving young people aged 12 to 18 years from one urban area in the Netherlands, served by outreaching psychiatric emergency services. These adolescents were seen in multiple locations and received a psychosocial assessment including a questionnaire on the severity of their problems and living conditions. Our aims were to (a) investigate the different locations, previous use of mental health service, DSM classifications, severity items, living conditions and family characteristics involved and (b) identify which of these characteristics in particular contribute to an increased risk of admission.ResultsIn 3770 consultations (concerning 2670 individuals), more girls (58%) were seen than boys. Boys and girls presented mainly with relationship problems, followed by disruptive disorders and internalizing disorders. Diagnostic differences diminished in hospitalisation. More specifically, disruptive disorders were evenly distributed. Suicide risk was rated significantly higher in girls, danger to others significantly higher in boys. More girls than boys had recently been in mental health care prior to admission. Although boys and girls overall did not differ in the severity of their problems, female gender predicted admission more strongly. In both boys and girls severity of problems and lack of involvement of the family significantly predicted admission. Older age and danger to others significantly predicted admission among boys, whereas psychosis, suicidality and poor motivation for treatment predicted admission among girls.ConclusionThere are different pathways for youth admission, which can partly be explained by different psychiatric classifications as well as gender-specific differences with regard to age, suicide risk, danger to others and the influence of motivation for treatment. Finally, for both genders, family desire for hospitalisation is also an important predictor.

Prevalence and comorbidity of anxiety disorder in school-attending children and adolescents aged 6–16 years in China

BackgroundThe reported prevalence rate of anxiety disorder in the paediatric population varies widely between different counties. Currently, there is no national epidemiological survey of childhood anxiety disorder in China. This...

Modeling Shared and Specific Variances of Irritability, Inattention, and Hyperactivity Yields Novel Insights Into White Matter Perturbations

Irritability, inattention, and hyperactivity, common presentations of childhood psychopathology, have been associated with perturbed white matter microstructure. However, similar tracts have been implicated across these phenotypes; such non-specificity could be rooted in their high co-occurrence. To address this problem, we employ a bifactor approach parsing unique and shared components of irritability, inattention, and hyperactivity, which we then relate to white matter microstructure. We developed a bifactor model based on the Conners Comprehensive Behavioral Rating Scale in a sample of youth with no psychiatric diagnosis or a primary diagnosis of Attention-Deficit/Hyperactivity Disorder or Disruptive Mood Dysregulation Disorder (N = 521). We applied the model to an independent yet sociodemographically and clinically comparable sample (N = 152), where we tested associations between latent variables and fractional anisotropy (FA). The bifactor model fit well (CFI=.99; RMSEA=.07). The shared factor was positively associated with an independent measure of impulsivity (rS=0.88, pFDR<.001) and negatively related to whole-brain FA (r=-0.20), as well as FA of the corticospinal tract and the anterior thalamic radiation (all pFWE<.05). FA increased with age and deviation from this curve, indicating altered white matter maturation, was associated with the hyperactivity-specific factor (r=-0.16, pFWE<.05). Inattention- and irritability-specific factors were not linked to FA. Perturbed white matter microstructure may represent a shared neurobiological mechanism of irritability, inattention, and hyperactivity related to heightened impulsivity. Further, hyperactivity might be uniquely associated with a delay in white matter maturation.

The Child Behavior Check List Usefulness in Screening for Severe Psychopathology in Youth: A Narrative Literature Review

Objective: This article will review the use of the CBCL to diagnose youth with psychopathological disorders focusing on: ADHD, Mood Disorders, Autism Spectrum disorders, and Disruptive Disorders. Method: Using a narrative review approach, we investigate the usefulness of the CBCL as a screening tool to detect childhood onset psychopathology across different diagnostic syndromes. Results: The available literature supports the use of the CBCL for ADHD screening and as a measure of ADHD severity. While some studies support a specific profile linked with childhood bipolar disorder, replication studies for this profile found mixed results. The CBCL was also found to be useful in screening for patients presenting with Autism Spectrum Disorders, Conduct Disorder, and Childhood Bipolar Disorder all of which presents with more severely impaired scores. Conclusion: The CBCL holds promise as a screening tool for childhood psychopathology.

Antipsychotics in child and adolescent patients with major depressive disorder: A retrospective analysis of prescribing patterns.

Depression rates in children/adolescents in the United States have increased in the last 10 years. Fluoxetine and escitalopram are the only 2 antidepressants approved for the treatment of major depression disorder (MDD) in children/adolescents. In adults, some antipsychotics are approved for augmented treatment of MDD. However, there is limited research on antipsychotic augmentation in child/adolescent MDD. This retrospective chart review evaluated antipsychotic prescribing for MDD in hospitalized patients aged 4 to 17 years to determine the frequency of prescribing antipsychotics for MDD and what factors influence the addition of an antipsychotic. For inclusion, patients were diagnosed with MDD and not on an antidepressant or antipsychotic before admission. Binomial logistic regression was used to analyze variables with prescribed antipsychotics as the dependent variable. There were 6.8% of patients prescribed an antipsychotic. Binomial logistic regression analysis found that increased age (odds ratio [OR] 1.28; 95% CI = 1.045, 1.568; P = .017) and multiple admissions within 1 year (OR 3.277; 95% CI = 2.283, 4.705; P < .001) were associated with the use of antipsychotics in patients with MDD. Posttraumatic stress disorder and disruptive mood dysregulation disorder were also associated with the use of antipsychotics. Careful consideration should be taken when using off-label antipsychotics in children due to limited studies on efficacy. Future research is warranted to assess the efficacy and safety of these agents in children and adolescents.