Pediatric Behavior Scale Research Articles

Oppositional Defiant Disorder in Autism and ADHD.

Our study compared oppositional defiant disorder (ODD) in children with autism to ADHD-Combined presentation and ADHD-Inattentive presentation. Mothers of 2,400 children 3-17years old with autism and/or ADHD completed the Pediatric Behavior Scale. ADHD-Combined was most strongly associated with ODD, with an ODD prevalence of 53% in children with ADHD-Combined only. When autism was added to ADHD-Combined, prevalence increased to 62% and the ODD score increased significantly. Autism+ADHD-Inattentive, Autism Only, and ADHD-Inattentive Only had ODD prevalences of 28%, 24% and 14%. In each diagnostic group, ODD had the same two factors (irritable/angry and oppositional/defiant); demographic differences between children with and without ODD were few; and correlations between ODD and conduct problems were large, correlations with depression were medium, and correlations with anxiety were small. However, ODD scores differed significantly between groups (Autism+ADHD-Combined > ADHD-Combined Only > Autism+ADHD-Inattentive and Autism Only > ADHD-Inattentive Only). The irritable/angry ODD component was greater in Autism+ADHD-Combined than in ADHD-Combined Only, whereas the oppositional/defiant component did not differ between the two groups. Autism was a significant independent risk factor for ODD, particularly the irritable/angry ODD component, but ADHD-Combined was the strongest risk factor. Therefore, the high co-occurrence of ADHD-Combined in autism (80% in our study) largely explains the high prevalence of ODD in autism. ADHD-Combined, autism, and ODD are highly comorbid (55-90%). Clinicians should assess all three disorders in referred children and provide evidence-based interventions to improve current functioning and outcomes for children with these disorders and reduce family and caretaker stress.

Prevalence and Correlates of Poor Safety Awareness and Accidental Injury in ASD, ADHD, ASD + ADHD, and Neurotypical Youth Samples.

The purpose of the present study is to compare risk and predictors of poor safety awareness and accidental injuries in ASD, ADHD, and neurotypical samples. Neurodivergent groups (ADHD-I n = 309; ADHD-C n = 747; ASD-only n = 328; ASD + ADHD n = 1,108) were 2-17 years old. The neurotypical group (n = 186) was 6-12 years of age. Maternal ratings on the Pediatric Behavior Scale examined safety awareness, accidental injury, and psychological problems. Children with ASD + ADHD had significantly poorer safety awareness and accidental injury ratings than all other groups. Predictors of poor safety awareness in the total ASD and/or ADHD sample were: impulsivity, younger age, lower IQ, and hyperactivity. Predictors of accidental injuries were: incoordination, hyperactivity, and conduct problems. Clinicians working with children who have ASD and ADHD are encouraged to screen for poor safety awareness, discuss child safety measures, and provide evidence-based intervention to improve safety awareness and mitigate the risk of injury.

Relationship between cognitive disengagement syndrome (CDS) (formerly sluggish cognitive tempo) and social functioning in child autism, ADHD, and elementary school samples

Background and aimsNo studies have compared relationships between specific social functioning deficits and cognitive disengagement syndrome/CDS (formerly sluggish cognitive tempo) in autism, ADHD, and general population child samples. MethodsMothers rated 1177 children with autism, 725 with ADHD-Combined, and 307 with ADHD-Inattentive (4–17 years) and 665 elementary school children (6–12 years) on the Pediatric Behavior Scale. ResultsIn all four groups, children with CDS had significantly greater frequencies of rejection by peers than children without CDS, and in the three clinical groups, withdrawn/shy behavior was significantly more prevalent in children with CDS. Low prosocial behavior did not differ between children with and without CDS. CDS contributed significantly and independently to predicting withdrawn/shy behavior and peer rejection, although its contribution was small compared with some other psychological problems. Overall, autism symptoms were the most powerful predictors of withdrawn/shy behavior and peer rejection. Conclusions and implicationsCDS studies sometimes control for ADHD and other psychopathology in multivariate analyses, but autism is usually overlooked. This is a critical oversight because CDS is as common in autism as in ADHD and because social problems, autism symptoms, and CDS are significantly interrelated.

Agreement between mother, father, and teacher ratings of cognitive disengagement syndrome (sluggish cognitive tempo) in children with autism and children with ADHD.

No studies have analyzed differences between mother, father, and teacher ratings of cognitive disengagement syndrome (CDS; formerly sluggish cognitive tempo). The sample included 1,115 children with autism and/or attention-deficit/hyperactivity disorder (ADHD) 4-16 years of age who were rated by mothers on the Pediatric Behavior Scale. Subsets of these children were also rated by fathers and/or teachers, resulting in 896 mother/father, 964 mother/teacher, and 745 father/teacher dyads. The CDS factor comprised four items assessing the core features of CDS: cognitive disengagement (in a fog/confused and stares/preoccupied/in own world) and hypoactivity (sluggish/slow moving/low energy and drowsy/sleepy/not alert). Overall, 37% of teachers, 22% of mothers, and 16% of fathers rated the children as significantly elevated on CDS symptoms. Teacher scores were significantly higher than mother scores, whose scores exceeded those of fathers. Agreement on whether a child had CDS was fair-moderate for mothers and fathers but poor for parents and teachers. Findings of more severe CDS teacher than parent ratings are in marked contrast to the opposite pattern found in studies of anxiety, depression, ADHD, oppositional behavior, conduct problems, autism, bullying, and victimization. Children may display fewer behavior problems at school than at home, and parents may be more aware of their child's internal state than teachers. However, teachers may be more aware of the cognitive component of CDS that might interfere with functioning in the classroom more so than at home. Cognitive demands in school may reveal and intensify CDS symptoms. Findings highlight the importance of multi-informant ratings in research and clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cognitive Disengagement Syndrome (CDS) (Formerly Sluggish Cognitive Tempo), Autism, and Insomnia Symptoms in Childhood Predict CDS in Adolescence: A Longitudinal Population-Based Study.

Our study is the first using multiple variables to compare concurrent with longitudinal predictors of cognitive disengagement syndrome (CDS). The population-based sample comprised 376 youth (mean baseline age 8.7 and follow-up 16.4years) rated by parents on the Pediatric Behavior Scale. The baseline CDS score was the strongest predictor of follow-up CDS. Baseline autism and insomnia symptoms also predicted follow-up CDS above and beyond baseline CDS. Autism, insomnia, inattention, somatic complaints, and excessive sleep were concurrently related to CDS at baseline and follow-up. Additionally, follow-up depression was associated with follow-up CDS, and baseline hyperactivity/impulsivity was negatively associated with baseline CDS. Oppositional defiant/conduct problems and anxiety were nonsignificant. Age, sex, race, and parent occupation were unrelated to CDS, and correlations between baseline CDS and 15 IQ, achievement, and neuropsychological test scores were nonsignificant. Results indicate childhood CDS is the strongest risk factor for adolescent CDS, followed by autism and insomnia symptoms.

0769 Multidimensional Sleep Health in Adolescents from the General Population: Definition, Thresholds and Construct Validity

Abstract Introduction The RU-SATED model – regularity, satisfaction, alertness, timing, efficiency, and duration – captures the 24-hour experience of sleep to asses multidimensional sleep health (MSH). However, most prior evidence comes from middle-aged adults. We provide updated MSH data in adolescents by leveraging objective and self-reported sleep measures. Methods We studied 377 adolescents (16.4±2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Each MSH domain was categorized as “good” or “poor” using cut-offs informed by prior studies and expert consensus. Good cut-offs, assigned a score of 1, that were derived from actigraphy-measured data included: the standard deviation of sleep midpoint ≤1-h (RU), mean of sleep midpoint 2:00-4:00 (T), mean value of sleep efficiency ≥85% (E), and mean total sleep time ≥7.5-h (D). Good cut-offs derived from self-reported rating scales included the absence of insomnia symptoms (S) or excessive daytime sleepiness (A). Values considered poor based on these cut-offs were assigned a score of 0. Scores were summed across all domains to obtain a composite score ranging from 0 to 6, with higher scores indicating better MSH. Morningness and Tanner staging were self-reported, while Sleep and Arousal clusters scores on the Pediatric Behavior Scale were parent-reported. Results The mean composite score was 3.03 ± 1.30 and domains A and D were most commonly rated as poor (64.5% and 65.3%, respectively). Younger age (r=-0.13, p< 0.05) and identifying as non-Hispanic white (r=-0.14, p< 0.01) were significantly associated with higher MSH scores, while sex (r=-0.04, p=0.40), Tanner staging (r=-0.06, p=0.29) or BMI percentile (r=-0.07, p=0.15) were not. Greater morningness (r=-0.29, p< 0.01), less disturbed sleep (r=-0.28, p< 0.01) and higher arousal (r=-0.21, p< 0.01) scores were associated with higher MSH scores. Conclusion Our data-driven approach can be used to assess MSH in the adolescent population. Our definition captures previously identified health disparities in MSH in adults and shows optimal construct validity against self-reports of circadian preference and parent observations of adolescents’ degree of sleep disturbance and arousal. Improving sleep duration and daytime alertness appear to continue to be the most relevant domains impacting overall MSH in adolescents. Support (if any) NIH (R01HL136587,UL1TR000127)

0759 Multidimensional Sleep Health is Associated with Emotional Well-being in Adolescents

Abstract Introduction Multidimensional sleep health (MSH) is a population-based approach to capture the 24-hour experience of sleep by incorporating measures of nighttime sleep and daytime functioning that promote physical and mental well-being. We have updated the existing adolescent MSH model to incorporate objective and subjective sleep measures and, in the present study, examined its utility in identifying associations between MSH and behavioral and emotional well-being. Methods We studied 377 adolescents (16.4 ± 2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Using the RU-SATED framework – regularity, satisfaction, alertness, timing, efficiency, and duration – we derived an MSH composite score based on actigraphy-measured and self-reported sleep data. We examined the associations between MSH and scores on both the adolescent version of the Child Behavior Checklist (CBCL) and on the Pediatric Behavior Scale (PBS). CBCL’s internalizing, externalizing, thought and attention problems scores were self-reported, while similar behavioral and emotional cluster scores on the PBS were parent-reported. Results Higher MSH scores were associated with lower thought (r=-0.21, p< 0.001), externalizing (r=-0.18, p< 0.001), attention (r=-0.16, p< 0.01) or internalizing (r=-0.12, p< 0.05) problems. Higher MSH scores were associated with lower scores on the rule-breaking (r=-0.27, p< 0.001) and aggressive (r=-0.21, p< 0.001) externalizing subscales. For the internalizing subscales, higher MSH scores were associated with lower anxious-depressed (r = -0.17, p< 0.01), withdrawn-depressed (r=-0.14, p< 0.01), and somatic complaints (r=-0.12, p< 0.05) scores. Analyses based on parent reports on the more fine-grained PBS cluster scores replicated CBCL’s associations; for example, higher MSH scores were associated with lower depression (r=-0.19, p< 0.01) and inattention (r=-0.12, p< 0.05) as observed by parents. Conclusion Optimal sleep health, when considered as a multidimensional construct, is associated with emotional well-being and better behavioral outcomes in adolescents. Our MSH model, derived from objective and subjective sleep metrics, is able to capture similar trends from self-report and parent-report measures of emotion and behavior. Support (if any) National Institutes of Health (R01HL136587, UL1TR000127)

Comparison of the Cognitive Disengagement and Hypoactivity Components of Sluggish Cognitive Tempo in Autism, ADHD, and Population-Based Samples of Children.

An international Sluggish Cognitive Tempo (SCT) Work Group proposed a new term for SCT, "cognitive disengagement syndrome," that more accurately describes the syndrome than does SCT. According to the Work Group, symptoms of SCT represent a cognitive dimension (cognitive disengagement) and a motor dimension (hypoactivity). Our study determined (1) if distinct factors representing cognitive disengagement and hypoactivity emerged when SCT items were factor analyzed and (2) the degree of differences in cognitive disengagement and hypoactivity within diagnostic groups. Mothers rated 1,177 children with autism, 725 with ADHD-Combined, and 307 with ADHD-Inattentive (4-17years) and 665 elementary school children (6-12years) on the Pediatric Behavior Scale (PBS). SCT prevalence rates were autism 32%, ADHD-Inattentive 27%, ADHD-Combined 18%, and elementary school students 7%. Factor analysis of the SCT items yielded two factors reflecting cognitive disengagement (in a fog/confused and stares/preoccupied/in own world) and hypoactivity (sluggish/slow moving/low energy, drowsy/sleepy/not alert, and tires easily) in all diagnostic groups. Cognitive disengagement prevalence rates and scores were significantly higher than hypoactivity in the autism and ADHD-C groups and in the autism and ADHD-C subgroups of children with SCT (but not in the ADHD-I and elementary school total groups and SCT subgroups). Our findings factor analyzing five SCT items support two SCT subfactors: cognitive disengagement and hypoactivity.

Sluggish cognitive tempo: Association with neuropsychological test scores, motor incoordination, and dysgraphia in elementary school children.

Research on the relationship between sluggish cognitive tempo (SCT) and scores on neuropsychological tests (such as those measuring processing speed and reaction time) is inconclusive, and the association between SCT and motor incoordination and dysgraphia has not been objectively investigated. Mothers of 413 elementary school children (6-12years of age) rated their children on the Pediatric Behavior Scale (PBS), which yields psychological problem scores, including SCT. Children were administered an extensive battery of neuropsychological tests assessing processing and performance speed, working memory, immediate and delayed recall, sustained attention, response inhibition, cognitive flexibility, fine motor manipulative skill, verbal fluency and retrieval, set shifting, and interference control, as well as intelligence and reading and math achievement. Only three of the 19 correlations between SCT and neuropsychological scores were significant, and all involved graphomotor tests (two timed and one untimed). In regression analysis, the strongest independent predictor of SCT was the maternal PBS incoordination factor score, followed by ratings of autism, inattention, and depression. Neuropsychological test scores did not contribute significantly more to predicting SCT. Among the incoordination PBS factor items, clumsy and draws or writes poorly were significant SCT predictors. Our novel and unexpected findings showed that motor incoordination was a stronger correlate of SCT than other variables assessed in our study, including those previously linked with SCT. Future SCT research needs to include measures of incoordination and dysgraphia in order to replicate and expand upon the current findings. Our results suggest that SCT traits are not reliably measured by currently available neuropsychological tests.

Behavioral features in child and adolescent huntingtin gene-mutation carriers.

IntroductionWe compared neuropsychiatric symptoms between child and adolescent huntingtin gene‐mutation carriers and noncarriers. Given previous evidence of atypical striatal development in carriers, we also assessed the relationship between neuropsychiatric traits and striatal development.MethodsParticipants between 6 and 18 years old were recruited from families affected by Huntington's disease and tested for the huntingtin gene expansion. Neuropsychiatric traits were assessed using the Pediatric Behavior Scale and the Behavior Rating Inventory of Executive Function. Striatal volumes were extracted from 3T neuro‐anatomical images. Multivariable linear regression models were conducted to evaluate the impact of group (i.e., gene nonexpanded [GNE] or gene expanded [GE]), age, and trajectory of striatal growth on neuropsychiatric symptoms.ResultsThere were no group differences in any behavioral measure with the exception of depression/anxiety score, which was higher in the GNE group compared to the GE group (estimate = 4.58, t(129) = 2.52, FDR = 0.051). The growth trajectory of striatal volume predicted depression scores (estimate = 0.429, 95% CI 0.15:0.71, p = .0029), where a negative slope of striatal volume over time was associated with lower depression/anxiety.ConclusionsThe current findings show that GE children may have lower depression/anxiety compared to their peers. Previously, we observed a unique pattern of early striatal hypertrophy and continued decrement in volume over time among GE children and adolescents. In contrast, GNE individuals largely show striatal volume growth. These findings suggest that the lower scores of depression and anxiety seen in GE children and adolescents may be associated with differential growth of the striatum.

Relationship between IQ and Internalizing and Externalizing Symptoms in Children with Autism and Children with ADHD

ABSTRACT Introduction Findings regarding the relationship between IQ and comorbidity in autism and ADHD are inconsistent. Methods Mothers rated 1,436 children with autism and 1,056 with ADHD without autism (IQs 9–149, ages 2–17) on the Pediatric Behavior Scale. Results Children with IQs < 70 (vs. ≥ 70) had less oppositional behavior, irritability, tantrums, conduct problems, generalized anxiety, and depression and more separation anxiety. Children with ADHD-Inattentive had less comorbidity than children with autism and children with ADHD-Combined. For autism, 80% had ADHD-Combined symptoms and 9% had ADHD-Inattentive symptoms. Most children with autism and with ADHD-Combined with IQs ≥ 70 had oppositional defiant disorder, as did almost half with IQs < 70. For autism, 45% with IQs ≥ 70 had generalized anxiety and 47% with IQs < 70 had separation anxiety. Conclusions Given high rates of comorbid symptoms in autism and ADHD, clinicians should be alert to and assess for psychiatric comorbidity.

28.4 Relationship Between Sluggish Cognitive Tempo, IQ and Academic Achievement Test Scores, and Academic Impairment in Autism Spectrum Disorder, ADHD, and Elementary School Samples

Sluggish cognitive tempo (SCT) symptoms include spacey, staring, daydreaming, in own world, slow thinking and responding, sluggish, underactive, and drowsy. SCT has strong convergent and divergent validity. This study investigates correlations between SCT and IQ and academic functioning and determines if SCT is a significant independent predictor of academic functioning. The sample comprised 1443 children (6-16 years old); among those, there were 218 with autism spectrum disorder (ASD), 489 with ADHD-Combined, 187 with ADHD-Inattentive, and 549 elementary school students. All children had an IQ ≥80. Children were rated by their mothers on the Pediatric Behavior Scale (PBS), and children with ASD/ADHD were also rated by teachers. The PBS assesses SCT, ADHD, ODD and conduct disorders, anxiety, depression, somatic complaints, and cognitive and learning problems. Children in the ASD/ADHD sample were administered the Wechsler Intelligence Scale for Children (WISC) and Wechsler Individual Achievement Test (WIAT). Children in the elementary school sample were administered the Wechsler Abbreviated Scale of Intelligence, Digit Span, Coding, and Wide Range Achievement Test. Correlations between SCT and IQ (verbal, nonverbal, working memory, and processing speed) and reading, math, and written expression achievement scores were all negative, with a pattern of decreasing scores with increasing SCT. Correlations were small (r = –0.01 to –0.15) and nonsignificant, except for processing speed and timed math, but the explained variance for these was only 2%. In regression analysis, SCT was not a significant predictor of achievement scores or academic impairment ratings. The strongest predictors were IQ for achievement scores and mother and teacher ratings of cognitive impairment for mother and teacher academic impairment ratings, respectively (explained variance = 23%-63%; p < 0.0001). Mother and teacher inattention ratings predicted mother and teacher academic impairment ratings, respectively. Ratings of SCT, impulsivity, hyperactivity, anxiety, depression, and ODD and conduct disorder were nonsignificant. SCT was not an independent predictor of achievement scores or mother and teacher academic impairment ratings when other variables were controlled. Inattention is more strongly related to academic functioning than is SCT.

Relationship between sluggish cognitive tempo, IQ and academic achievement test scores, and academic impairment in autism, ADHD, and elementary school samples

ABSTRACT Sluggish cognitive tempo (SCT) is of renewed interest. The relationship between SCT, IQ and achievement scores, and academic impairment ratings was investigated in 218 students with autism and 676 with ADHD (6–16 years) and 549 elementary school students (IQ ≥ 80). Mothers rated their children on the Pediatric Behavior Scale. Children in the autism/ADHD sample were also rated by teachers. Correlations between SCT and IQ and achievement scores (Verbal Comprehension, Perceptual Reasoning, Working Memory, Processing Speed, reading, math, and written expression) were all negative and were nonsignificant in the total autism/ADHD and elementary school samples, except for small correlations with Processing Speed and a timed math test. In contrast, mother and teacher SCT ratings were significantly related to mother and teacher academic and cognitive impairment ratings. SCT was not a significant predictor of achievement scores or academic impairment ratings in regression analysis. The strongest predictor of achievement test scores was IQ, and the strongest predictors of academic impairment were mother and teacher cognitive impairment ratings. Teacher inattention ratings predicted teacher academic impairment ratings in autism/ADHD and mother inattention ratings predicted mother academic impairment ratings in elementary school children. Therefore, inattention was more predictive of academic functioning than was SCT. Research shows a weak link between SCT and processing speed (contrary to what is implied by the term sluggish cognitive tempo), and other neuropsychological test scores are not consistently associated with SCT. It remains to be determined if neuropsychological tests can be developed to measure and further our understanding of SCT.

Cross-Sectional Age Analysis of Sleep Problems in 2 to 17 Year Olds with ADHD Combined, ADHD Inattentive, or Autism.

Sleep problems are common in autism and ADHD. No study has compared sleep problems by age in 2 to 17 year olds with autism versus ADHD-Combined versus ADHD-Inattentive type. Mothers rated 1415 youth with autism and 1041 with ADHD on 10 Pediatric Behavior Scale sleep items. Nighttime sleep problems were most severe in autism, followed by ADHD-Combined, and then ADHD-Inattentive. Difficulty falling asleep, restless during sleep, and waking during the night were the most common problems. Adolescents slept more at night than other age groups, and youth who slept more at night were sleepier during the day. Sleep problems declined with age, but correlations were small. In adolescence, 63% with autism, 53% with ADHD-Combined, and 57% with ADHD-Inattentive had difficulty falling asleep. Given that the majority of children in all age groups had one or more sleep problem, developmentally appropriate interventions are needed to address sleep difficulties and limit their adverse effects.

Relationship between sluggish cognitive tempo and sleep, psychological, somatic, and cognitive problems and impairment in children with autism and children with ADHD.

Sluggish cognitive tempo (SCT) is a topic of renewed interest. Much remains to be learned about its association with symptoms and diagnoses that have received little research attention, particularly sleep disturbance, somatic complaints, and autism. Our study is the first to explore the relationship between SCT and sleep, internalizing, externalizing, somatic, and cognitive problems, impairment, and demographics in large samples of children with autism, ADHD-Combined, and ADHD-Inattentive. Mothers rated 1,436 children with autism and 1,056 with ADHD without autism, 2 to 17 years, on the Pediatric Behavior Scale (PBS). Factor analysis yielded a 6-item SCT factor (sluggish/slow moving/low energy, stares/preoccupied/in own world, tires easily, in a fog/confused, drowsy/sleepy/not alert, and apathetic) plus 10 additional factors. SCT was distinct from but related to several factors and was associated with social and academic impairment. The strongest independent predictors of SCT were depression, sleeping more than normal, cognitive problems, autism, and somatic complaints. Scores on the remaining factors (sleep disturbance, attention deficit, impulsivity, hyperactivity, oppositional defiant disorder, conduct disorder, and anxiety) increased explained variance by less than 2%. Findings suggest that SCT is not simply sluggish cognitive tempo, as the name implies, and is a complex construct with behavioral, affective, emotional, cognitive, and somatic components and associations. Given that 49% of children with autism had SCT, SCT symptoms should be considered in all children being evaluated for autism, as well as for ADHD-C and ADHD-I (with SCT percentages of 31% and 40%). Assessing and treating SCT is especially important because of its association with impairment.

Sluggish cognitive tempo in autism, ADHD, and neurotypical child samples

BackgroundSluggish cognitive tempo (SCT) recently experienced a resurgence of interest in children with ADHD, but only three small studies have investigated SCT in autism. MethodMothers rated 1,436 children with autism, 1,056 with ADHD without autism, and 186 typical controls, 2-17 years, on six SCT items from the Pediatric Behavior Scale. ResultsAlmost half (49%) of children with autism scored 1.5 standard deviations or more above the typical SCT mean, as did 40% with ADHD-Inattentive and 31% with ADHD-Combined. The significantly greater prevalence in autism versus ADHD is largely explained by the high frequency of ADHD in autism and the increased risk of SCT when both disorders are present. However, the higher than normal prevalence of SCT in autism is not accounted for by co-occurring ADHD because SCT scores were higher than the norm in children with autism who did not have ADHD and SCT scores did not differ significantly between children with autism without ADHD and children with ADHD without autism. ConclusionsPrevious research indicated SCT was associated with ADHD-Inattentive type, but our findings show that SCT is even more prevalent in autism. SCT is most common when autism and ADHD co-occur. Because autism without ADHD is rare (whereas ADHD without autism is not), it is important to assess both SCT and ADHD in children referred for autism evaluations and rule-out autism in children referred for ADHD. SCT may be another neurocognitive problem shared by children with autism and children with ADHD in need of assessment and intervention.

Behavioral Deficits in Juvenile Onset Huntington's Disease.

Reports of behavioral disturbance in Juvenile-Onset Huntington’s Disease (JOHD) have been based primarily on qualitative caregiver reports or retrospective medical record reviews. This study aims to quantify differences in behavior in patients with JOHD using informant- and self-report questionnaires. Informants of 21 children/young adults (12 female) with JOHD and 115 children/young adults (64 female) with a family history of Huntington’s Disease, but who did not inherit the disease themselves (Gene-Non-Expanded; GNE) completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Pediatric Behavior Scale (PBS). Mixed linear regression models (age/sex adjusted) were conducted to assess group differences on these measures. The JOHD group had significantly higher scores, indicating more problems, than the GNE group on all BRIEF subscales, and measures of Aggression/Opposition and Hyperactivity/Inattention of the PBS (all p < 0.05). There were no group differences in Depression/Anxiety. Inhibit, Plan/Organize, Initiate, and Aggression/Opposition had significant negative correlations with Cytosine-Adenine-Guanine (CAG) repeat length (all p < 0.05) meaning that individuals with higher CAG repeats scored lower on these measures. There was greater discrepancy between higher informant-vs. lower self-reported scores in the JOHD group, supporting the notion of lack of insight for the JOHD-affected group. These results provide quantitative evidence of behavioral characteristics of JOHD.

0920 Behavioral Profiles Associated with the Development of Insomnia Symptoms in Children with Known Mental Health Disorders

Abstract Introduction Mental health disorders (MHD) are a known risk factor for the development of insomnia symptoms in youth. However, a number of children with MHD do not go on to develop insomnia symptoms later on in life. Little is known about possible childhood factors that exacerbate or mitigate the risk of developing adolescent insomnia symptoms (AIS) among children with MHD. The present study examined, in an at-risk group of children with MHD, the behavioral profiles associated with the development of AIS. Methods The Penn State Child Cohort is a random, population-based sample of 700 children (5-12y), of whom 421 were followed up as adolescents (12-23y). Absence of childhood insomnia symptoms was ascertained by parent-reports (n=312), while presence of AIS in this subgroup was ascertained by self-reports (n=97). Presence of MHD was ascertained based on the clinical history and physical exam at baseline (n=52). The Pediatric Behavior Scale (PBS) assessed multiple parent-reported behavioral domains. Results Children with MHD at baseline had greater levels of difficulty across a variety of internalizing (e.g., anxiety, depression) and externalizing (e.g., impulsivity, hyperactivity) behavioral domains than those without MHD, regardless of whether they developed AIS. However, children with MHD who went on to develop AIS had significantly greater levels of aggressive (p&amp;lt;0.001) and oppositional (p=0.006) behaviors relative to children with MHD who did not develop AIS. In fact, these latter children did not differ from peers without any history of MHD or AIS on levels of aggressive (p=0.820) or oppositional (p=0.436) behaviors. Conclusion Children with MHD who present with normative aggressive and oppositional behaviors are less likely to develop AIS. Healthcare providers should consider providing preventative sleep interventions to youth with MHD who are exhibiting comorbid externalizing behaviors. Support National Institutes of Health (R01HL136587, R01HL97165, R01HL63772, UL1TR000127)

Symptom scores and medication treatment patterns in children with ADHD versus autism

Most children with autism have ADHD, and children with ADHD-Combined and children with autism have high rates of irritable, oppositional, and aggressive behavior. Despite similar symptoms, prescribing practices may differ between autism and ADHD, which has not been examined in a single study. 1407 children with autism and 1036 with ADHD without autism, 2–17 years, were compared with 186 typical peers. Symptom scores were maternal Pediatric Behavior Scale ratings in eight areas (ADHD, oppositional/aggressive, irritable/angry, anxious, depressed, and social, writing, and learning problems). Psychotropics were prescribed to 38.0% with ADHD-Combined, 33.3% with autism, and 20.2% with ADHD-Inattentive, most often an ADHD medication (22.1% stimulant, 2.3% atomoxetine), antipsychotic (7.8%), SSRI (5.5%), and alpha agonist (4.9%). ADHD medications were more often prescribed than other medications in all diagnostic groups. Compared to autism, children with ADHD-Combined were more likely to be prescribed an ADHD medication, whereas antipsychotics and SSRIs were more likely to be prescribed in autism than in ADHD-Combined. Children with ADHD-Inattentive were least impaired and least likely to be medicated. More severely impaired children were more often medicated regardless of diagnosis. Symptom scores were far worse for treated and untreated children with ADHD and with autism than for typical peers.

Sex Differences in Externalizing and Internalizing Symptoms in ADHD, Autism, and General Population Samples

Oppositional behavior, irritability, and aggression are common in autism and ADHD-Combined presentation (but less frequent in ADHD-Inattentive), and children with autism are at high risk for anxiety. No study has compared sex differences in externalizing and internalizing symptoms between ADHD-Combined, ADHD-Inattentive, autism, and general population samples. The samples comprised 1436 children with autism (with or without ADHD), 1056 with ADHD without autism, and 665 from the general population, 2–17 years. Nine externalizing, four internalizing, and nine somatic symptoms rated by mothers on the Pediatric Behavior Scale did not differ significantly between girls and boys in the autism, ADHD-Combined, and ADHD-Inattentive samples. In the general population, boys had more externalizing problems than girls (particularly hyperactivity, inattention, and aggression), whereas anxiety, depression, and somatic complaints did not differ, with the exception of more stomachaches in girls. The finding that boys have more externalizing problems than girls in the general population has implications for interpreting rating scales. Raw score to standard score conversions for most scales are based on general population sex- and age-specific norms. Therefore, standard scores mask sex differences, and the same standard score for a girl and a boy is not equivalent. A boy must have more severe externalizing problems to earn the same elevated standard score as a girl. When making diagnostic and treatment decisions, clinicians should take into consideration both symptom raw scores (e.g., “often a problem” reflecting symptom severity and the DSM threshold for clinical significance) and standard scores (symptom severity adjusted for sex and age effects).