Rates Of Comorbid Anxiety Disorders Research Articles

A comparison of symptoms of bipolar and unipolar depression in postpartum women

BackgroundDistinguishing postpartum women with bipolar from unipolar depression remains challenging, particularly in obstetrical and primary care settings. The post-birth period carries the highest lifetime risk for the onset or recurrence of Bipolar Disorder (BD). Characterization of differences between unipolar and bipolar depression symptom presentation and severity is critical to differentiate the two disorders. MethodsWe performed a secondary analysis of a study of 10,000 women screened by phone with the Edinburgh Postnatal Depression Scale at 4–6 weeks post-birth. Screen-positive mothers completed the Structured Clinical Interview for DSM-4 and those diagnosed with BD and unipolar Major Depressive Disorder (UD) were included. Depressive symptoms were assessed with the 29-item Structured Interview Guide for the Hamilton Rating Scale for Depression (SIGH-ADS). ResultsThe sample consisted of 728 women with UD and 272 women with BD. Women with BD had significantly elevated levels of depression severity due to the higher scores on 8 of the 29 SIGH-ADS symptoms. Compared to UD, women with BD had significantly higher rates of comorbid anxiety disorders and were twice as likely to report sexual and/or physical abuse. LimitationsOnly women who screened positive for depression were included in this analysis. Postpartum women with unstable living situations, who were hospitalized or did not respond to contact attempts did not contribute data. ConclusionsSeverity of specific symptom constellations may be a useful guide for interviewing postpartum depressed women along with the presence of anxiety disorder comorbidity and physical and/or sexual abuse.

Integrated cognitive-behavioral therapy for comorbid cannabis use and anxiety disorders: The impact of severity of cannabis use.

Cannabis use disorder (CUD) is the most common illicit substance use disorder and individuals with CUD have high rates of comorbid anxiety disorders. Comorbidity between CUD and anxiety disorders is of public health relevance given that although motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for CUD, outcomes are worse for patients with elevated anxiety. Integrated cannabis and anxiety reduction treatment (ICART) was developed based on translational research; it integrates a transdiagnostic CBT for anxiety disorders with MET/cognitive behavior therapy (MET-CBT) for CUD, with outcomes comparable to MET-CBT alone. The current study tested whether ICART is more efficacious than MET-CBT alone for patients with more severe baseline cannabis use and use-related problems. Individuals seeking treatment for CUD (56.4% male, Mage = 23.2, 63.3% non-Hispanic White) with at least one comorbid anxiety disorder were randomly assigned to ICART (n = 27) or MET-CBT (n = 28). Baseline severity of cannabis use and use-related problems moderated the relation between condition and posttreatment outcomes, such that among patients with the greatest baseline cannabis use, ICART was associated with less posttreatment cannabis use than MET-CBT alone. Further, among those with the greatest number of cannabis-related problems, patients in ICART reported fewer posttreatment problems than those in the MET-CBT alone condition. These data suggest that for dually diagnosed patients with more severe cannabis use, ICART may be more efficacious than a gold-standard psychosocial CUD treatment, MET-CBT. MET-CBT may be more efficacious for those with less baseline cannabis use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychometric properties of the Hospital Anxiety and Depression Scale in an inpatient video-monitoring epilepsy cohort

BackgroundPeople with epilepsy (PWE) have high rates of comorbid anxiety disorders and depressive disorders, from 25% in general population cohorts to rates of 55% in people with treatment resistant epilepsy. High rates are also seen in patients with psychogenic nonepileptic seizures (PNES). Depressive disorders and anxiety disorders in PWE are associated with decreased quality of life measures and are the strongest risk factors for increased suicidality, rates of which are markedly elevated in PWE, at 12%, compared to the general Australian population (1.8%). The Hospital Anxiety and Depression Scale (HADS) is one of the more commonly used screening tools in medical populations. Past studies of the HADS in general outpatient populations with epilepsy have demonstrated promising validity for detecting depression. ObjectivesThe following were the objectives of the study:1. To examine the validity of HADS in detecting depressive disorders and anxiety disorders in an inpatient population of patients admitted for video monitoring. 2. To investigate the measurement structure of the HADS across the diagnosis groups of epilepsy subtypes and PNES. MethodsThis was a retrospective cohort study of 485 patients admitted to a tertiary epilepsy video electroencephalography (EEG) monitoring unit. All patients received clinical neurological, neuropsychiatric, and neuroimaging assessments to arrive at consensus epilepsy and psychiatric diagnoses. Clinical psychiatric diagnosis of depressive disorders and anxiety disorders, based on the assessment of a neuropsychiatrist, were compared to accepted HADS cutoff scores for these conditions. FindingsOf the 485 patients, 229 patients were with epilepsy, 28 had both epilepsy and PNES, and 121 had PNES. In 107 cases, no definite diagnosis could be made. At a cutoff score of 7 HADS was able to significantly classify patients with depression (area under the curve [AUC] = 0.79, 95% confidence interval [CI] = 0.72–0.82) with a sensitivity of 70% and a specificity of 83%. A similar result was observed for anxiety disorders; a cutoff score of 7 (AUC = 0.75, 95% CI = 0.72–0.81) was able to significantly classify anxiety disorders in patients with a sensitivity of 88% and specificity of 54%. ConclusionsThis study has found that HADS measures two separate, yet correlated, constructs of anxiety disorders and depressive disorders. Our results indicate that while the HADS is sensitive to distress in this population, relatively low cutoff scores would be required to achieve highly sensitive screening. This sample includes patients with a diagnosis of epilepsy and/or PNES, and thus, the findings have clinical applicability to screening in tertiary epilepsy video-EEG monitoring units where both these conditions frequently co-occur.

Integrated cognitive behavioral therapy for comorbid cannabis use and anxiety disorders: A pilot randomized controlled trial

Cannabis use disorder (CUD) is the most common illicit substance use disorder and individuals with CUD have high rates of comorbid anxiety disorders. Comorbidity between CUD and anxiety disorders is of public health relevance given that although motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for CUD, outcomes are worse for patients with elevated anxiety. The current study tested the acceptability and efficacy of the integration of a transdiagnostic anxiety CBT (i.e., treatment of patients with any anxiety disorder) with MET-CBT (integrated cannabis and anxiety reduction treatment, or ICART) for CUD compared to MET-CBT alone. Treatment-seeking cannabis users (56.4% male, Mage = 23.2, 63.3% non-Hispanic White) with CUD and at least one comorbid anxiety disorder were randomly assigned to ICART (n = 27) or MET-CBT (n = 28). Patients in the ICART condition attended significantly more treatment sessions than those in the MET-CBT condition. Patients in the ICART condition were more likely to be abstinent post-treatment than those in MET-CBT. Further, treatment produced decreases in cannabis use and related problems. Notably, therapy type did not moderate the impact of treatment on frequency of use and related problems. Together, these data suggest that ICART may be at least as efficacious as a gold-standard psychosocial CUD treatment, MET-CBT, for a difficult-to-treat subpopulation of cannabis users.

Diagnostic Prevalence of Common Psychiatric Comorbidities of Alcohol Use Disorders in India: a Systematic Review

The diagnostic prevalence of mood and anxiety disorders in Indian individuals with alcohol use disorders (AUDs) has important implications for clinical decision making and for cross-cultural psychiatry research. Here, we present a systematic review of comorbid mood and anxiety disorders in Indian patients with AUDs. We find rates of comorbid mood disorders ranging from 6 to 65% (estimated overall effect from a linear random effects model of 18.0%, 95% CI [5.6, 45.1]) and rates of comorbid anxiety disorders ranging from 0 to 30% (estimated overall effect of 2.4%, 95% CI [0.9, 5.8]) in Indian populations. These findings are placed in the context of estimated population prevalence of comorbid mood and anxiety disorders in US adults with AUDs who have recently sought treatment of 40.7 (95% CI [32.6, 48.7]) and 33.4% (95% CI [25.2, 41.6]), respectively. Potential causes of these differences include differences in diagnosis, in cultural norms around alcohol use and the acceptance of mental health care, and in the types of studies being compared. The findings highlight the importance of systematic assessments of treatment outcomes in local clinical populations as a complement to an understanding of the medical literature from other cultural contexts.

A Case of Major Depressive Disorder With Mixed Features: Diagnostic and Treatment Issues.

A Case of Major Depressive Disorder With Mixed Features: Diagnostic and Treatment Issues.

EPIDEMIOLOGY AND COURSE OF UNIPOLAR MANIA: RESULTS FROM THE NATIONAL EPIDEMIOLOGIC SURVEY ON ALCOHOL AND RELATED CONDITIONS (NESARC)

Unipolar mania (UM), in which only manic episodes occur during the course of illness, may be an important clinical manifestation of bipolar disorder that is under-recognized and understudied. The aim of this study is, for the first time, to examine the prevalence of UM and its clinical characteristics in the community. Among a total of 1,411 subjects with bipolar I disorder, we evaluated the prevalence of UM using three different criteria proposed in previous studies. We compared the clinical characteristics of subjects with UM to those with a more classic bipolar presentation with mania and lifetime major depressive episode (MDE). We additionally explored the proportion of subjects with UM who later experience at least one MDE during a 3-year follow-up period and determined risk factors for converting from UM to classic bipolar disorder. The prevalence rate of UM among those with bipolar disorder ranged from 5.0 to 7.2% depending on the criteria. UM was more common in male and nonwhite subjects. About half of individuals with UM experienced subthreshold depression. Individuals with UM had lower rates of comorbid anxiety disorders or attention deficit hyperactivity disorder (ADHD). During the follow-up, about 18% of subjects with UM experienced MDEs. Male, nonwhite, comorbid generalized anxiety disorder and ADHD predicted an increased transition from UM to classic bipolar disorder. Subthreshold depression was not associated with the risk of the transition. UM is an infrequent but clinically distinct subtype of bipolar I disorder. Further research delineating the characteristics of UM is warranted.

COMPLICATED GRIEF SYMPTOMS IN ANXIETY DISORDERS: PREVALENCE AND ASSOCIATED IMPAIRMENT

Previous research has identified high rates of comorbid anxiety disorders among individuals presenting with primary CG. In the present study, we examined the prevalence of comorbid CG in bereaved primary anxiety disorder (AD) patients compared to bereaved healthy controls. We also examined the impairment associated with comorbid CG in AD. Participants were 242 bereaved adults (mean (SD) age = 41.5 (13.1), 44.2% women) with a primary AD diagnosis, including generalized anxiety disorder (GAD; n = 57), panic disorder (PD; n = 49), posttraumatic stress disorder (PTSD; n = 29), and generalized social anxiety disorder (GSAD; n = 107), as well as 155 bereaved healthy controls with no current DSM-IV Axis I diagnosis (mean (SD) age = 43.0 (13.6), 51.0% women). CG symptoms were measured using the 19-item inventory of complicated grief (ICG), with threshold CG defined as an ICG score of ≥30. Quality of life and functional impairment were assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Range of Impaired Functioning Tool (LIFE-RIFT), respectively. Participants with primary ADs had significantly higher rates of threshold CG symptoms than bereaved controls (12.0% vs. 0.65%; Fisher's Exact P < 0.001). Rates of threshold CG were significantly elevated for each AD when compared to bereaved controls. After adjustment for age, sex, education, and comorbid major depressive disorder, threshold CG was associated with lower quality of life (β = -0.140, P = 0.023) and greater impairment (β = 0.141, P = 0.035) among individuals with AD. Our findings suggest that threshold CG is of clinical relevance in bereaved individuals with a primary anxiety disorder. Screening for CG in patients with ADs may be warranted.

Clinical patterns and treatment outcome in patients with melancholic, atypical and non-melancholic depressions.

ObjectiveTo assess sociodemographic, clinical and treatment factors as well as depression outcome in a large representative clinical sample of psychiatric depressive outpatients and to determine if melancholic and atypical depression can be differentiated from residual non-melancholic depressive conditions.Subjects/Materials and MethodA prospective, naturalistic, multicentre, nationwide epidemiological study of 1455 depressive outpatients was undertaken. Severity of depressive symptoms was assessed by the Hamilton Depression Rating Scale (HDRS) and the Self Rated Inventory of Depressive Symptomatology (IDS-SR30). IDS-SR30 defines melancholic and atypical depression according to DSM-IV criteria. Assessments were carried out after 6–8 weeks of antidepressant treatment and after 14–20 weeks of continuation treatment.ResultsMelancholic patients (16.2%) were more severely depressed, had more depressive episodes and shorter episode duration than atypical (24.7%) and non-melancholic patients. Atypical depressive patients showed higher rates of co-morbid anxiety disorders and substance abuse. Melancholic patients showed lower rates of remission.ConclusionOur study supports a different clinical pattern and treatment outcome for melancholic and atypical depression subtypes.

Family-Based Cognitive-Behavioral Treatment of Chronic Pediatric Headache and Anxiety Disorders: A Case Study

Background Chronic pediatric headache disorders are pervasive, debilitating, and associated with high rates of comorbid anxiety disorders. The combination of headaches and anxiety presents unique challenges for clinicians. Cognitive behavioral therapy (CBT) is a promising treatment for pediatric headache, however, available treatments fail to adequately address comorbid psychopathology resulting in less than optimal response rates.

Personality prototypes in individuals with compulsive buying based on the Big Five Model

Personality prototypes based on the Big Five factor model were investigated in a treatment-seeking sample of 68 individuals with compulsive buying (CB). Cluster analysis of the NEO Five-Factor Inventory (NEO-FFI) scales yielded two distinct personality clusters. Participants in cluster II scored significantly higher than those in cluster I on neuroticism and lower on the other four personality traits. Subjects in cluster II showed higher severity of CB, lower degree of control over CB symptoms, and were more anxious, interpersonally sensitive and impulsive. Furthermore, cluster II was characterized by higher rates of comorbid anxiety disorders, and cluster B personality disorders. The two personality prototypes did not differ with respect to obsessive–compulsive features. Finally and of considerable clinical significance, participants in cluster II reported lower remission rates after undergoing cognitive-behavioral therapy. Implications of the results for treatment are discussed.

Comparison of clinical features among youth with tic disorders, obsessive–compulsive disorder (OCD), and both conditions

The comorbidity of tic disorders (TD) and obsessive–compulsive disorder (OCD) has long been recognized in the clinical literature and appears to be bidirectional, affecting 20–60% of individuals with each disorder. Coffey et al. (1998) found that adults with TD+OCD had a more severe comorbidity profile than adults with OCD or TD alone. This exploratory study in children attempts to evaluate whether heightened diagnostic severity, increased comorbidity load, and lower functioning is more commonplace in youth with TD+OCD in comparison to either syndrome alone. Participants were 306 children (seeking clinical evaluation) with TD, OCD, or TD+OCD. Assessment consisted of a diagnostic battery (including structured diagnostic interviews and standardized parent-report inventories) to evaluate diagnostic severity, comorbid psychopathology, behavioral and emotional correlates, and general psychosocial functioning. Data from this study sample were not supportive of the premise that youth with both a tic disorder and OCD present with elevated diagnostic severity, higher risk-for or intensity-of comorbidity, increased likelihood of externalizing/internalizing symptomatology, or lower broad-based adaptive functioning. The OCD group had elevated rates of comorbid anxiety disorders and attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) were more prevalent among youth in the TD group. The three groups also differed on key demographic variables. Our findings suggest that, in contrast to adults, TD+OCD in children and adolescents does not represent a more severe condition than either disorder alone on the basis of diagnostic comorbidity, symptom severity, or functional impairment.

Mood and Anxiety Symptoms in Psychiatric Inpatients with Autism Spectrum Disorder and Depression

Recent reports suggest that individuals with autism spectrum disorders (ASD) may experience depression at a high frequency, yet few published studies address this issue, especially among adults. In the current investigation, we reviewed features of depression and comorbid traits among depressed inpatients with intellectual disabilities (ID) as a function of ASD. A retrospective chart review was performed for 53 inpatients meeting criteria for depression (13 individuals with ASD and ID and 40 matched individuals with ID but without ASD), all of whom had received a diagnosis of depression at the time of discharge from a specialty psychiatric unit for adults with ID. The depression diagnoses were based on a comprehensive clinical assessment; specific mood and anxiety symptoms were reported by informants at the time of intake using the Mood and Anxiety Semi-Structured (MASS) Interview for Patients with Intellectual Disabilities (Charlot, Deutsch, Hunt, Fletcher, & McIlvane, 2007). Overall, few qualitative differences were detected between the 2 groups. Both depressed inpatient groups had high rates of comorbid anxiety disorders as well as externalizing behaviors. Inpatients with ASD had a total of 2 more symptoms (out of 29 possible symptom items) than their depressed peers without an ASD diagnosis (mean scores of 12.23 and 9.85, respectively). Anxiety disorders were reported in 62% of individuals with ASD and 38% of those without ASD. Antipsychotic medication was prevalent among the patients with ASD and depression. Over 80% of the inpatients with ASD and depression, compared with 49% of the non-ASD group, were treated with these medications.

Anxiety symptoms and syndromes in bipolar children and adolescents

Anxiety disorders are relatively common in children and adolescents with bipolar disorder. Research to date indicates they may impact the onset, course, and treatment response of bipolar illness in children. Anxiety disorders often precede the onset of pediatric bipolar disorder. Family studies suggest first-degree relatives of bipolar patients are at increased risk for developing mood and anxiety disorders compared with relatives of individuals without mood disorders. Childhood adversity has been associated with higher rates of comorbid anxiety disorders and more severe illness course in bipolar patients. Preliminary study of the neurobiology of bipolar disorder with comorbid anxiety disorders suggests it may be neurophysiologically distinct from bipolar disorder without comorbid anxiety. Bipolar disorder with comorbid anxiety disorders has been associated with greater functional impairment and slower recovery. Prospective, longitudinal studies are needed to help us better understand the relationship between bipolar disorder and comorbid anxiety disorders so that opportunities for early intervention and effective treatment can be realized.

Clinical and research implications of panic-bipolar comorbidity in children and adolescents

A substantial portion of patients with juvenile bipolar disorder (BD) have a comorbid panic disorder (PD). The aim of our study was to analyze the cross-sectional and longitudinal implications of such comorbidity in children and adolescents with BD. The sample comprised 224 referred children and adolescents with BD, 140 males (62.5%) and 84 females (37.5%), mean age 13.8 ± 2.8 years, diagnosed with a clinical interview (K-SADS-PL), and followed up naturalistically for 6 months. Fifty-one BD patients (22.8%) had a lifetime diagnosis of comorbid PD. Subjects with BD + PD and those without BD (BD-noPD) did not differ according to index age, age at onset of BD and bipolar phenotype (episodic vs. continuous course, irritable vs. elated mood). BD + PD was more frequent in females, was less severe at baseline according to the Clinical Global Impression severity score, and was more frequently associated with BD type 2. Moreover, BD + PD presented higher rates of comorbid anxiety disorders (namely separation anxiety disorder) and lower rates of externalizing disorders, namely attention deficit disorder (ADHD) than BD-noPD. However, this different pattern of externalizing comorbidity did not affect severity and improvement. Our findings suggest that PD is frequently comorbid in juvenile BD and can influence severity, pattern of comorbidity and course of BD. The data are compatible with the hypothesis that Panic-BD and ADHD-BD might represent distinct developmental pathways of bipolar disorder. Further research on this question may prove rewarding.

OCD with comorbid OCPD: A subtype of OCD?

Objective The current study examined the validity of using comorbid obsessive–compulsive personality disorder (OCPD) to identify a subtype of individuals with obsessive–compulsive disorder (OCD). Method Data for the current study were drawn from an ongoing, longitudinal study of the course of OCD and include intake assessments for 238 subjects with primary and current DSM-IV OCD who were treatment seeking. Results More than one fourth of the subjects ( N = 65, 27%) met criteria for comorbid OCPD. As compared to OCD − OCPD subjects, the OCD + OCPD subjects had a significantly younger age at onset of first OC symptoms ( p = 0.013), and a higher rate of symmetry and hoarding obsessions, and cleaning, ordering, repeating, and hoarding compulsions (all p’s < 0.01). Individuals with OCD + OCPD had higher rates of comorbid anxiety disorders ( p = 0.007) and avoidant personality disorder ( p = 0.006). The OCD + OCPD subjects also had significantly lower ratings of global functioning ( p = 0.001) and more impaired social functioning ( p = 0.004), despite a lack of significant differences on overall severity of OCD symptoms. Conclusions Our findings indicate that individuals with both OCD and OCPD have distinct clinical characteristics in terms of age at onset of initial OC symptoms, the types of obsessions and compulsions they experience, and psychiatric comorbidity. Our findings, coupled with data from family studies showing a higher than expected frequency of OCPD in first degree relatives of OCD probands, suggest that OCD associated with OCPD may represent a specific subtype of OCD. Additional research is warranted to further establish the validity of this subtype.

Phenomenology of Children and Adolescents With Bipolar Spectrum Disorders

Children and adolescents who present with manic symptoms frequently do not meet the full DSM-IV criteria for bipolar I disorder (BP-I). To assess the clinical presentation and family history of children and adolescents with BP-I, bipolar II disorder (BP-II), and bipolar disorder not otherwise specified (BP-NOS). Subjects and their primary caretaker were assessed by semistructured interview, and family psychiatric history was obtained from interview of the primary caretaker. Outpatient and inpatient units at 3 university centers. A total of 438 children and adolescents (mean +/- SD age, 12.7 +/- 3.2 years) with BP-I (n = 255), BP-II (n = 30), or BP-NOS (n = 153). Lifetime psychiatric history and family history of psychiatric disorders. Youth with BP-NOS were not diagnosed as having BP-I primarily because they did not meet the DSM-IV duration criteria for a manic or mixed episode. There were no significant differences among the BP-I and BP-NOS groups in age of onset, duration of illness, lifetime rates of comorbid diagnoses, suicidal ideation and major depression, family history, and the types of manic symptoms that were present during the most serious lifetime episode. Compared with youth with BP-NOS, subjects with BP-I had more severe manic symptoms, greater overall functional impairment, and higher rates of hospitalization, psychosis, and suicide attempts. Elevated mood was present in 81.9% of subjects with BP-NOS and 91.8% of subjects with BP-I. Subjects with BP-II had higher rates of comorbid anxiety disorders compared with the other 2 groups and had less functional impairment and lower rates of psychiatric hospitalization than the subjects with BP-I. Children and adolescents with BP-II and BP-NOS have a phenotype that is on a continuum with that of youth with BP-I. Elevated mood is a common feature of youth with BP-spectrum illness.

Patterns and Quality of Treatment for Patients With Major Depressive Disorder in Routine Psychiatric Practice

Patterns and Quality of Treatment for Patients With Major Depressive Disorder in Routine Psychiatric Practice

Long-Term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD)

Background Early onset of mood symptoms in bipolar disorder has been associated with poor outcome in many studies; however, the factors that might contribute to poor outcome have not been adequately investigated. Methods The first consecutive 1000 adult bipolar patients enrolled in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder were assessed at study entry to determine details of their age of onset of mood symptoms. Clinical course, comorbidity, and functional status and quality of life were compared for groups with very early (age < 13 years), early (age 13–18 years), and adult (age > 18 years) onset of mood symptoms. Results Of 983 subjects in whom age of onset could be determined, 272 (27.7%) experienced very early onset, and 370 (37.6%) experienced early onset. Earlier onset was associated with greater rates of comorbid anxiety disorders and substance abuse, more recurrences, shorter periods of euthymia, greater likelihood of suicide attempts and violence, and greater likelihood of being in a mood episode at study entry. Conclusions Very early or early onset of bipolar disorder might herald a more severe disease course in terms of chronicity and comorbidity. Whether early intervention might modify this risk merits further investigation.

Four-year follow-up of children with low intelligence and ADHD: a replication

Twenty children with attention deficit hyperactivity disorder (ADHD) and low IQs, who participated in a drug study, were followed up 4.5 years later, when their ages averaged 12.4 years (range: 8–20 years; SD=2.78). Participants were assessed by their parents and teachers on the Aberrant Behavior Checklist—Community (ABC; Aman & Singh, 1994), on the Child Symptom Inventory (CSI; Gadow & Sprafkin, 1994), and on a structured interview. A majority of children continued to screen positive for ADHD at follow-up, as well as display high rates of comorbid anxiety disorders, tics, and elimination disorders. Educational placement became slightly more restrictive over the follow-up interval. Multiple medication trials (30 in all, among 14 participants) were attempted between initial contact and follow-up. Ratings on the ABC by parents and teachers showed significantly lower scores at follow-up on the Hyperactivity subscale. Relatively few associations were found between initial ratings and follow-up ratings on standardized scales.