Teacher Report Form Research Articles

Managing precocious puberty: A necessity for psychiatric evaluation.

Precocious puberty (PP) is one of the most common endocrine disorders in school-age girls. It has been reported that there is an increased tendency for psychiatric disorders for early maturing girls. The aim of this study was to determine the prevalence of psychiatric problems and to investigate depression and anxiety levels, and self-concept characteristics in girls with PP. Girls with PP (n = 41) and controls (n = 45) aged 7-11 years participated in this study. Psychiatric evaluations were conducted with semi-structured interviews. Behavioral and emotional problems were assessed using Child Behavior Check List and Teacher Report Form. Children's Depression Inventory, State-Trait Anxiety Inventory for Children and Piers-Harris Children's Self Concept Scale were administered, respectively. Girls with PP had significantly more psychiatric diagnosis than controls (68.3 % vs 20 %, p < 0.001). PP group had significantly higher anxious-depressed, somatic complaints, social problems, aggresive behaviors and interestingly autistic traits. Increased symptom levels of depression and anxiety, and lower self-concept scores were also obtained from PP subjects. PP is an independent predictor of psychiatric disorders. It is also associated with poorer psychiatric status, lower self esteem characteristics, and autistic traits. A multidisciplinary approach combining endocrinologic and psychiatric evaluations seem to be beneficial for the management of girls with PP.

Teacher Nomination of School-aged Children for Mental Health Services in a Low and Middle Income Country

ABSTRACT Background: Knowledgeable in child development, primary school teachers in low- and middle-income countries (LMICs) have the potential to identify their students needing mental health care. Objective: We evaluated whether teachers in Darjeeling, India can accurately nominate school-aged children for mental health services after training and aided by a novel tool. Methods: In 2018, 19 primary school teachers from five low-cost private (LCP) schools in rural Darjeeling were trained to nominate children needing care. Teachers evaluated all of their students aided by a novel tool, ‘Behavior Type and Severity Tool’ (BTST), completed the Achenbach Teacher Report Form (TRF) as a mental health status reference standard, and nominated two students for care. Sensitivity and specificity of being nominated compared to TRF overall and subdomain scores were calculated. BTST performance was determined by comparing BTST and TRF scores and creating Receiver Operating Characteristic curves to determine optimal cutoffs. Multivariable regression models were used to identify demographic predictors of teacher accuracy using the BTST. Results: For students demonstrating a clinical or borderline score in at least one TRF subdomain, the sensitivity (72%) and specificity (62%) of teacher nomination were moderately high. BTST overall scores and TRF Total Problem scores were correlated (Spearman’s ρ = 0.34, p < 0.0001), as were all subdomains. For the TRF Total Problem score, a maximum Youden’s J of 0.39 occurred at BTST cutoff >4 for borderline struggles and 0.54 at the BTST cutoff >6 for clinical struggles. Younger teacher age, less education, less formal education training, and more years of experience were positively associated with teacher accuracy. Conclusions: With training and a simple decision support tool, primary school teachers in an LMIC nominated students for mental health services with moderate accuracy. With the BTST being weakly accurate, teachers’ judgment largely accounted for the moderate accuracy of nominations.

Taijiquan and qigong as a mindfulness cognitive-behavioural based therapy on the treatment of cothymia in school-age children – A preliminary study

IntroductionThe development and well-being of children are directly linked to several aspects. Among those aspects, physical activity, an adequate nutrition, and a healthy mind, seem to be of crucial importance. Psychopathologies, such as anxiety and depression, have a negative impact on life, especially when co-occurring (mixed-anxiety depression disorder/cothymia), and the clinical implications include a higher risk of suicide and psychiatric hospitalization, elevated disability, decreased compliance with medical treatment, and considerably increased usage of medical services. Thus, research in conventional and nonconventional modalities is necessary to address this issue. The main objective of this study was to understand if TJQ and QG could be effective as a mindfulness cognitive-behavioural based therapeutic tool with body movement, for the treatment of children suffering from cothymia. MethodsIn this small study, six selected children, four males and two females aged between 7 and 11 years old, were taught a set of exercises of TaijiQuan (TJQ) and Qi Gong (QG). To obtain the results, the Achenbach Teacher's Report Form (TRF) was applied at the beginning of the experimental period, as well as at the ending of the experimental period. The resulting scores were analysed to observe the difference between both moments of evaluation. ResultsResults showed some improvements in symptoms, with an average improvement of 46%. ConclusionTJQ and QG seem to be a promising complementary therapeutic tool in cognitive-behavioural approaches for children who suffer from cothymia, as well as prevention and control for children who may not display symptoms at a clinical level. However, further research is needed in order to understand the full potential of these therapeutic exercises.

The Effect of Smoking during Pregnancy on Severity and Directionality of Externalizing and Internalizing Symptoms: A Genetically Informed Approach.

The objective was to examine the association between maternal smoking during pregnancy (SDP) and (I) severity and (II) directionality of externalizing and internalizing symptoms in a sample of sibling pairs while rigorously controlling for familial confounds. The Missouri Mothers and Their Children Study is a family study (N = 173 families) with sibling pairs (aged 7 to 16 years) who are discordant for exposure to SDP. This sibling comparison study is designed to disentangle the effects of SDP from familial confounds. An SDP severity score was created for each child using a combination of SDP indicators (timing, duration, and amount). Principal component analysis of externalizing and internalizing behavior, assessed with the Child Behavior Checklist and Teacher Report Form, was used to create symptom severity and directionality scores. The variance in severity and directionality scores was primarily a function of differences between siblings (71% and 85%, respectively) rather than differences across families (29% and 15%, respectively). The severity score that combines externalizing and internalizing symptom severity was not associated with SDP. However, a significant within-family effect of SDP on symptom directionality (b = 0.07, p = 0.04) was observed in the sibling comparison model. The positive directionality score indicates that SDP is associated with differentiation of symptoms towards externalizing rather than internalizing symptoms after controlling for familial confounds with a sibling comparison model. This supports a potentially causal relationship between SDP and externalizing behavior.

A Model of Intervention and Implementation of Quality Building and Quality Control in Childcare Centers to Strengthen the Mental Health and Development of 1-3-Year Olds: Protocol for a Randomized Controlled Trial of Thrive by Three.

BackgroundUniversal, high-quality childcare offers a unique opportunity to prevent developmental trajectories leading to mental health problems. Yet, growing evidence has shown that the process quality of Norwegian childcare centers varies considerably, and that research-based models for quality building are significantly lacking.ObjectiveTo examine whether a model for quality building in childcare centers, Thrive by Three, increases the quality of child–caregiver interactions, and promotes child development, well-being, and mental health.MethodsThe Thrive by Three study is a clustered randomized controlled trial involving 187 toddler groups in childcare centers across 7 municipalities within southern and central Norway. Each center is randomly allocated to the intervention or wait-list control group. Data are collected at 4 points: preintervention (T1), midway (T2), postintervention (T3), and 1-year postintervention (T4). Primary outcomes are changes in childcare quality measured by the Classroom Assessment Scoring System toddler version (CLASS), Student–Teacher Relationship Scale, Short Form (STRS-SF), and Life in Early Childhood Programs (LECP), as well as child development and mental health measured by The Brief Infant Toddler Social and Emotional Assessment (BITSEA, parent and teacher report), the Caregiver–Teacher Report Form (C-TRF), and Child Behavior Checklist (parent report) from the Achenbach System of Empirically Based Assessment (ASEBA) from 1.5 to 5 years, and child well-being measured by the Leiden Inventory for Child’s Well-Being in Day Care (LICW-D). Secondary outcomes are child cortisol levels, assessed in a subsample of 372 children.ResultsAs of August 2020, a total of 1531 children and 769 staff from 187 toddler groups were recruited. Because of turnover, the recruitment of staff will be ongoing until August 2020. As of January 2020, the intervention group has been working with Thrive by Three for 1.5 years. Data at T1, T2, and T3 from both the intervention and control groups have been completed and T4 will be completed in August 2020.ConclusionsThis study makes an important contribution to the field of quality building in childcare centers. The results will provide greater insight into how high quality can be obtained and the effects of high-quality early childcare on child mental health. This in turn will be significant for policymakers and to the Norwegian society at large.Trial RegistrationClinicalTrials.gov NCT03879733; https://clinicaltrials.gov/ct2/show/NCT03879733 and Norwegian Research Council 260624/H10; https://prosjektbanken.forskningsradet.no/#/project/NFR/260624/Sprak=enInternational Registered Report Identifier (IRRID)DERR1-10.2196/17726

The Student Risk Screening Scale for Early Childhood: Additional Validation Studies

We report findings of two validation studies of the Student Risk Screening Scale for Early Childhood (SRSS-EC). Although previous exploratory inquiry suggested a two-factor solution, results of Study 1 conducted with 274 preschool-age youth suggested mixed support for a two-factor model, with only one fit index suggesting an adequate fit (incremental index, comparative fit index [CFI] = 0.963). However, results did provide additional evidence of convergent validity between SRSS-EC and Strengths and Difficulties Questionnaire scores. In Study 2, results of convergent validity studies with 90 preschool-age children offered evidence between SRSS-EC and (a) Social Skills Improvement System–Performance Screening Guide and (b) Caregiver–Teacher Report Form (C-TRF) scores. Results suggested the following cutting scores: SRSS-EC E7 (0–5 low, 6–7 moderate, 8–21 high risk) and SRSS-EC I4 (0–2 low, 3–4 moderate, and 5–12 high risk), with C-TRF scores as the criterion. We discuss limitations and directions for future inquiry.

Strengths and Difficulties Questionnaire: Psychometric Properties and Normative Data for Spanish 5- to 17-Year-Olds.

The Strengths and Difficulties Questionnaire (SDQ) has been extensively used to measure common forms of psychopathology among children and adolescents. However, its psychometric properties vary across countries and several controversial issues warrant further investigation. This study aimed to evaluate whether the Spanish version of the SDQ is a reliable and valid tool for assessing emotional and behavioral problems in a sample of 6,775 students aged 5 to 17 years, as rated by parents, teachers, and youth. We examined the internal consistency of the questionnaire, its factor structure, and measurement invariance across child's gender and age. Criterion validity was tested against the Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and Youth Self-Report (YSR), and we measured the ability of the SDQ to identify children with specific psychiatric disorders. Finally, we provide, for the first time, Spanish normative data for children aged 5 to 10 and 11 to 17 years, according to gender and each informant. Our results revealed acceptable reliability estimates for all SDQ subscales. Confirmatory factor analysis supported the original five-factor model and full measurement invariance was found. Furthermore, SDQ scores showed a moderate to strong correlation with those on the equivalent CBCL/TRF/YSR scales, and were effective in discriminating individuals with and without clinical diagnoses.

A Pilot Randomized Control Trial With the Probiotic Strain Lactobacillus rhamnosus GG (LGG) in ADHD: Children and Adolescents Report Better Health-Related Quality of Life.

Objectives: This double-blind pilot randomized placebo-controlled trial examined the possible effect of the probiotic strain Lactobacillus rhamnosus GG ATCC53103 (LGG) on symptoms of attention-deficit/hyperactivity disorder (ADHD), health-related quality of life (QoL), and serum levels of cytokines in children and adolescents with ADHD.Methods: This trial evaluated 32 drug-naive children and adolescents aged between four and 17 years with a diagnosis of ADHD. The study subjects were randomly assigned to either the group that received LGG or the group that received the placebo. Assessments, comprising the ADHD Parent-Report Rating Scale-IV: Home Version; the Child Self-Report and Parent Proxy-Report of the Pediatric Quality of Life InventoryTM (PedsQLTM) 4.0 Generic Core Scale; the Parent Form (CBCL/6-18) and the Teacher Report Form (TRF) of the Child Behavior Checklist (CBCL) for ages 6–18 of the Achenbach System of Empirically Based Assessment (ASEBA); and the serum cytokines; were compared between the groups at the baseline and after 3 months.Results: Thirty-five participants were randomized, with 32 completing the study (91.4% retention). There was a significant improvement in the PedsQL Child Self-Report Total Score after 3 months of treatment in the probiotic (p = 0.021, d = 0.53), whereas there was no significant improvement in the placebo group (p = 0.563, d = 0.04). The results of psychometric parameters assessed by parents and teachers were not so straightforward. There were statistically significant differences in the levels of serum cytokines between the groups after the 3-month treatment period: IL-6 in both the probiotic (p = 0.004, d = 0.73) and the placebo groups (p = 0.035, d = 0.94); IL-10 (p = 0.035, d = 0.6); IL-12 p70 (p = 0.025, d = 0.89); and TNF-α (p = 0.046, d = 0.64) in the probiotic group only.Conclusions: Children and adolescents with ADHD who received LGG supplementation reported better health-related QoL compared to their peers who received the placebo. This suggests that LGG supplementation could be beneficial. But results with psychometric tests conducted by parents and teachers as well as differences in the levels of inflammatory cytokines were ambiguous. Based on these results, we propose some study modifications: a longer observation period (6–12 months); inclusion of more children's self-report assessments; recruitment of non-drug naive patients and the possible omission of serum cytokines measurements.Clinical Trial Registration: Medical Ethics Committee (UKC-MB-KME-19-06/16).

Evidence of validity for Socially Skillful Responses Questionnaires - SSRQ-Teachers and SSRQ-Parents

Abstract There is a lack of free-of-charge validated instruments whereby parents and teachers may be respondents to assess child social skills. Social skills are known to prevent behavioral problems among preschool and school-aged children. This study fills in this gap, the objective of which is to assess the internal consistency and construct and discriminant validity of the Questionários de Respostas Socialmente Habilidosas [Socially Skillful Responses Questionnaire] - teachers’ version - SSRQ-Teachers and parents’ version - SSRQ-Parents. A total of 134 primary school and preschool teachers and 183 mothers/fathers/caregivers of 88 school-aged children and 95 preschoolers of both sexes participated in the study. In addition to the SSRQ teachers’ and parents’ versions, the participants completed an additional instrument: the teachers completed the Teacher Report Form - TRF and the parents completed the Child Behavior Checklist (CBCL). The results obtained in the exploratory factor analysis and ROC curve analysis, along with alpha values, indicate good psychometric properties. Thus, the SSRQ-Teachers and SSRQ-Parents presented in this paper are appropriate for assessing both preschool and school-aged children.

Mothers' distress exposure and children's withdrawn behavior - A moderating role for the Interferon Gamma gene (IFNG).

The dysregulation of the inflammatory response, including pro-inflammatory molecules, produces neuropsychiatric symptoms and depression-like behavior, including withdrawal from the physical and social environment. Genetic variants that enhance immune reactivity may thus increase inflammatory and withdrawn reactions to stress. Here we investigated a functional polymorphism of Interferon Gamma gene (IFNG+874 T>A, rs2430561) as moderator of the relationship between mothers' distress exposure and children's withdrawn behavior at preschool age. Participants were 198 Portuguese preschool children (mean age=57.98months). Exposure to mother's distress was assessed using the Brief Symptom Inventory, and withdrawn behavior with the Caregiver Teacher Report Form. All children provided saliva samples for genotyping. Contrary to expecations based on prior work, the rs2430561 AA genotype-not the T variant-interacted with (high levels of) mothers' distress exposure, to increase children's withdrawn behavior. No significant main effects were detected. The polymorphism in Interferon Gamma gene showed specific environmental stressor-dependent effects on withdrawn behavior during childhood, ones which are interpreted in light of the "behavioral immune system" hypothesis, and which proved inconsistent with diathesis-stress thinking.

Parent-teacher agreement on children’s externalizing behaviors: Results from a community sample of Portuguese elementary-school children

Behavior checklists using multiple informants are common and considered best practice in the assessment of childhood externalizing problems. Nevertheless, discrepancies between observers’ assessments are usual in studies that rely on behavior ratings. Therefore, this study sought to investigate the agreement between parent and teacher ratings of children behavioral problems. A sample of Portuguese elementary-school children (n = 146), aged between 6 and 9 years, was assessed between 2014 and 2017 using the Child Behavior Checklist and its counterpart, the Teacher Report Form, scales of: social problems, attention problems, rule breaking behavior and aggressive behavior. Agreement between parents and teachers was measured through three indices: mean scores, Pearson correlations and T-scores. It was found that parent and teacher reports on each scale were positively correlated and low to moderate cross-informant agreement was observed for the total sample. Lower levels of agreement were found when controlling for the child’s gender. Results also revealed the existence of significant differences between parent and teacher ratings on almost all scales, both for the total sample, and for each gender group, with parents rating their children’s behavioral problems with higher scores, compared to teachers. It was also found that parent-teacher agreement was higher for children scoring lower on behavioral problems. These results are discussed in the light of previous studies on cross-informant agreement. It is suggested that, despite discrepancies, both parents and teachers constitute mandatory sources for the assessment of children’s behavioral problems.

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children.

Attention deficit hyperactivity disorder (ADHD), one of the most prevalent childhood disorders today, is generally more likely to be diagnosed and treated in boys than in girls. However, gender differences in ADHD are currently poorly understood, partly because previous research included only a limited proportion of girls and relied mainly on subjective measures of ADHD, which are highly vulnerable to reporter’s bias. To further examine gender differences in ADHD and to address some of the shortcomings of previous studies, this study examined gender differences in subjective and objective measures of ADHD among clinic-referred children with ADHD. Participants were 204 children aged 6–17 years-old with ADHD (129 boys, 75 girls). A retrospective analysis was conducted using records of a clinical database. Obtained data included parent and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher’s Report Form (TRF), and child’s continuous performance test (CPT) scores. Results showed that according to parents’ and teachers’ reports of ADHD-related symptoms (Conners ADHD rating scales), girls had more inattention problems than boys, but no differences were identified in the level of hyperactivity and impulsivity symptoms. CPT data, however, revealed higher impulsivity among boys. We did not find gender differences in the level of distractibility during CPT performance. Specifically, the effects of distractors type (visual environmental stimuli, auditory stimuli, or a combination of them) and distractors load (one or two distracting stimuli at a time) on CPT performance did not differ between boys and girls with ADHD. These findings suggest that gender effects on ADHD symptoms may differ between subjective and objective measures. Understanding gender differences in ADHD may lead to improved identification of girls with the disorder, helping to reduce the gender gap in diagnosis and treatment.

ADHD symptoms in relation to internalizing and externalizing symptoms in children: the mediating role of sluggish cognitive tempo

Objective: Although internalizing and externalizing disorders have received considerable attention among young population, the mechanisms that explain the relationships of internalization and externalization symptoms with attention deficit/hyperactivity disorder (ADHD) in children and adolescents are not well understood. Since sluggish cognitive tempo (SCT) symptoms had significant associations with ADHD, and internalization/externalization disorders, we examined whether SCT may mediate between ADHD symptoms and internalizing/externalizing problems during childhood.Methods: We performed a retrospective chart-review of 95 children and adolescents (76 boys and 19 girls, aged 6–16) with ADHD. The severity of ADHD was evaluated by Turgay DSM-IV-Based Disruptive Behavioral Disorders Screening and Rating Scale (T-DSMIV-S) completed by teachers. Measures of SCT, internalisation and externalisation symptoms, social, thought, and attentional problems were based on the Teacher Report Form (TRF) that was completed by subjects’ primary teachers.Results: The withdrawn scores were significantly correlated with SCT scores, social problems, and ADHD-inattention. There was an inverse correlation between withdrawn and ADHD-hyperactivity/impulsivity scores. The mediation test using bootstrapping method showed that the indirect coefficient for SCT was significant, after controlling of ADHD-inattention and social problems covariates, consistent with partial mediation.Conclusion: Our results may demonstrate that while externalization symptoms were associated with hyperactivity/impulsivity symptoms of ADHD, the internalization symptoms were significantly related to SCT in youngs with ADHD. Specifically, although social withdrawal was significantly related to ADHD-inattention, this relationship was mediated by the severity of SCT.

Disruptive Behavior in Siblings Discordant for Exposure to Maternal Smoking During Pregnancy: A Multi-rater Approach.

Maternal smoking during pregnancy (SDP) is associated with disruptive behavior. However, there is debate whether the SDP-disruptive behavior association is a potentially causal pathway or rather a spurious effect confounded by shared genetic and environmental factors. The Missouri Mothers and Their Children Study is a sibling comparison study that includes families (n = 173) selected for sibling pairs (aged 7-16 years) discordant for SDP. Critically, the sibling comparison design is used to disentangle the effects of SDP from familial confounds on disruptive behavior. An SDP severity score was created for each child using a combination of SDP indicators (timing, duration, and amount of SDP). Multiple informants (parents and teachers) reported on disruptive behavior (i.e., DSM-IV semi-structured interview, the Child Behavior Checklist, and Teacher Report Form). The variability in disruptive behavior was primarily a function of within-family differences (66%-100%). Consistent with prior genetically informed approaches, the SDP-disruptive behavior association was primarily explained by familial confounds (genetic and environmental). However, when using a multi-rater approach (parents and teachers), results suggest a potentially causal effect of SDP on disruptive behavior (b = 0.09, SE = 0.04, p = 0.03). The potentially causal effect of SDP remained significant in sensitivity analyses. These findings suggest that familial confounding likely plays a complex role in the SDP-disruptive behavior association when examining both parent and teacher reports of behavior. Importantly, the current study highlights the importance of multiple raters, reflecting a more comprehensive measure of complex behaviors (e.g., disruptive behavior) to examine the teratogenic effects of SDP. Our study provides additional evidence that controlling for genetic and family factors is essential when examining the effect of SDP on later behavioral problems, as it explains a portion of the association between SDP and later behavioral problems. However, we found a significant association between SDP and disruptive behavior when using a multi-rater approach that capitalizes on both parent and teacher report, suggesting that parent and teacher ratings capture a unique perspective that is important to consider when examining SDP-behavior associations.

Maternal acetaminophen use during pregnancy and childhood behavioural problems: Discrepancies between mother- and teacher-reported outcomes.

Maternal acetaminophen use during pregnancy is common and has been associated with childhood behavioural problems among offspring, specifically hyperactivity and conduct problems. Assessments of child behaviour in many previous studies have relied on maternal or parent report. Acknowledging that results of behavioural assessments vary between informants, we examined the association between maternal acetaminophen use during pregnancy and behaviour problems in childhood based on mother- and teacher-report. A longitudinal study of 560 mother-child pairs with data on illnesses and medication use during pregnancy and neurodevelopmental assessments during childhood was conducted. Acetaminophen use during pregnancy was captured using a standardised maternal interview, completed 1year after delivery on average. Measures of childhood (6-12years of age) behaviour were obtained via mother- and teacher-report, using the Child Behaviour Checklist and Teacher Report Form. Linear and log-binomial models were used to calculate adjusted mean differences (MD) and risk ratios (RR), respectively and 95% confidence intervals (CI) for internalising, externalising, and total behaviour problems comparing acetaminophen users to non-users. Stabilized inverse probability weights were used to account for loss to follow-up, and adjustments for indication were made. Approximately 60% (n=354) of women reported use of acetaminophen during pregnancy. Acetaminophen use during pregnancy was associated with an increase in total behaviour problem score and risk of clinical behaviour problems according to mother report (MD 2.2, 95% CI 0.3, 4.1 and RR 1.93, 95% CI 0.99, 3.76) but not according to teacher report. Weighting to account for participation did not alter results, while adjustment for indications of acetaminophen use greatly attenuated the associations with mother-reported total behaviour problem score and risk of clinical behaviour problems (MD 0.1, 95% CI -2.1, 2.3 and RR 1.31, 95% CI 0.67, 2.58). Acetaminophen use during pregnancy was weakly associated with mother-reported behaviour problems and not associated with teacher-reported problems.

Identifying comorbid ADHD in autism: Attending to the inattentive presentation

BackgroundThere are high rates of comorbidity between ADHD and ASD; however, there has been limited work parsing rates by ADHD presentation. In addition, commonly used questionnaires have demonstrated reduced utility in capturing ADHD symptoms in individuals with ASD. We examined the prevalence of comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) parsed by DSM-5 presentation in clinic-referred youth with Autism Spectrum Disorder (ASD) without intellectual disability (ID). We compared common rating scales to determine which most effectively identified comorbid ADHD. MethodWe examined comorbid ADHD diagnoses from archival assessment data for 419 youth with ASD without ID. We examined diagnostic discriminability of the parent and teacher ADHD Rating Scale (ADHD R-S), and Attention and ADH Problems Scales of the Child Behavior Checklist and Teacher Report Form using receiver operating characteristic (ROC) curves. Hierarchical logistic regression was used to examine measures’ unique contribution to ADHD diagnosis. ResultsSixty-one percent of the study sample met DSM-5 criteria for an attention disorder. ADHD, Combined (ADHD-C) represented the largest proportion of ADHD diagnoses (76.8%), followed by Inattentive (ADHD-I;19.7%), Hyperactive/Impulsive (.02%), and Un-/Other Specified (.02%). Measures provided greater diagnostic discriminability in identifying ADHD-C relative to ADHD-I. The ADHD R-S inattentive symptom count provided the greatest discriminability for both subtypes and was the only scale that provided clinically meaningful differentiation between those with ASD only and ASD + ADHD-I. ConclusionsThese results support using the ADHD R-S to capture comorbid ADHD symptoms in ASD. The findings underscore the need for more thorough examination of inattentive symptoms to rule out ADHD-I.

Cognitive and behavioural outcome of children born after IVF at age 9 years.

STUDY QUESTIONDo ovarian stimulation (OS) and the in vitro laboratory procedures affect offsprings’ cognitive and behavioural outcome at 9 years?SUMMARY ANSWEROS and the in vitro laboratory procedures or the combination of both were not associated with cognitive and behavioural outcome at age 9 years.WHAT IS KNOWN ALREADYART is not associated with an adverse short-term developmental outcome of the offspring, but limited knowledge is available on the offspring’s long-term neurodevelopmental condition.STUDY DESIGN, SIZE, DURATIONA 9-year longitudinal, assessor-blinded, prospective follow-up study of 169 out of 215 singletons (79%) born between March 2005 and December 2006 was performed.PARTICIPANTS/MATERIALS, SETTING, METHODSSingletons born following IVF or ICSI with OS (n = 57), born after modified natural cycle IVF/ICSI (MNC-IVF/ICSI; n = 46) and born after natural conception to subfertile couples (Sub-NC; n = 66), were assessed at 9 years. This study design, with two ART groups and a subfertile reference group, allows for disentangling the effects of OS and ART procedures on developmental outcome. Cognitive outcome was evaluated with the Wechsler abbreviated scale of intelligence and the NEPSY-II. Behaviour was assessed with the child behaviour checklist (CBCL) and teacher report form (TRF). Univariable analyses and multiple linear regression models were used.MAIN RESULTS AND THE ROLE OF CHANCEThere was no significant difference in intelligence quotient (IQ) scores between ART groups (mean IQ (95% CI): OS 114.8 (83.2–142.6); MNC 114.0 (90.2–140.8); Sub-NC 115.4 (87.9–141.2), P = 0.746). Multivariable analyses did not reveal a statistically significant association between ART group and total, verbal and performance IQ. CBCL and TRF scores did not differ significantly between ART groups (P = 0.090 and 0.507, respectively). Multivariable analyses did not demonstrate a statistically significant association between ART group and CBCL and TRF total, or internalising and externalising T-scores. No significant correlations between time to pregnancy (TTP)—a proxy for the severity of parental subfertility—and outcome measures were found (Spearman rho between −0.050 and 0.049, NS), which was confirmed with multivariable analyses.LIMITATIONS, REASONS FOR CAUTIONThe attrition rate of 21% may be considered as a limitation of the study; however, after a follow-up period of 9 years, this rate is generally considered acceptable, and there were no significant differences in background characteristics between children with and without follow-up, making an attrition-related selection bias less likely. Another limitation of the study is the relatively small sample size, which could contribute to selection bias, hamper generalizability to the ART population and lead to false negative findings as a result of underpowering. An a priori power analysis on total IQ indicated that the OS-IVF/ICSI and Sub-NC groups should contain 64 children, confirming that our study including 57 and 66 children, respectively, was slightly underpowered.WIDER IMPLICATIONS OF THE FINDINGSOur study indicated that OS and the in vitro laboratory procedures or the combination of both and TTP were not associated with cognitive and behavioural outcome at 9 years. These are reassuring results for both parents and clinicians involved in ART.STUDY FUNDING/COMPETING INTEREST(S)The study was financially supported by the University Medical Center Groningen (UMCG), two graduate schools of the UMCG (BCN and SHARE) and the Cornelia Stichting. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The authors have no conflicts of interest to declare.

Executive functioning and neurodevelopmental disorders in early childhood: a prospective population-based study

BackgroundExecutive functioning deficits are common in children with neurodevelopmental disorders. However, prior research mainly focused on clinical populations employing cross-sectional designs, impeding conclusions on temporal neurodevelopmental pathways. Here, we examined the prospective association of executive functioning with subsequent autism spectrum disorder (ASD) traits and attention-deficit/hyperactivity disorder (ADHD) traits.MethodsThis study included young children from the Generation R Study, a general population birth cohort. The Brief Rating Inventory of Executive Function-Preschool Version was used to assess parent-reported behavioral executive functioning when the children were 4 years old. ASD traits were assessed at age 6 (n = 3938) using the parent-reported Social Responsiveness Scale. The Teacher Report Form was used to assess ADHD traits at age 7 (n = 2749). Children with high scores were screened to determine possible clinical ASD or ADHD diagnoses. We were able to confirm an ASD diagnosis for n = 56 children by retrieving their medical records and established an ADHD diagnosis for n = 194 children using the Diagnostic Interview Schedule for Children-Young Child version (DISC-YC). Data were analyzed using hierarchical linear and logistic regressions.ResultsImpaired executive functioning was associated with more ASD and ADHD traits across informants (for ASD traits and diagnoses: β = 0.33, 95% CI [0.30–0.37]; OR = 2.69, 95% CI [1.92–3.77], respectively; for ADHD traits and diagnoses: β = 0.12, 95% CI [0.07–0.16]; OR = 2.32, 95% CI [1.89–2.85], respectively). Deficits in all subdomains were associated with higher levels of ASD traits, whereas only impaired inhibition, working memory, and planning/organization were associated with more ADHD traits.ConclusionsThe findings of the current study suggest a graded association of executive functioning difficulties along the continuum of ASD and ADHD and that problems in executive functioning may be a precursor of ASD and ADHD traits from an early age onwards.

ROC Analyses of Relevant Conners 3-Short Forms, CBCL, and TRF Scales for Screening ADHD and ODD.

Receiver operating characteristic curve analysis was used to examine and compare the diagnostic accuracy of the Conners 3-Parent Short Form (C 3-P(S)), and the Conners 3-Teacher Short Form (C 3-T(S)) inattention and hyperactivity/impulsivity scales, and the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) attention problems scales, to distinguish those with and without attention deficit/hyperactivity disorder (ADHD). It also examined and compared the diagnostic accuracy of the C 3-P(S) and C 3-T(S) Aggression (AG) scales, and the CBCL and TRF Aggressive Behavior (AB) scales, to distinguish those with and without oppositional defiant disorder (ODD). The study used archival data (N = 150-261) involving a large group of clinic-referred children aged between 6 and 11 years who had been interviewed for clinical diagnosis of ADHD and ODD using the Anxiety Disorders Interview Schedule for Children (ADISC-IV) as the reference standard, and then administered one or more of the screening measures. The findings provided empirical support for the use of the C 3-P(S) and CBCL for identifying ADHD and ODD, with the CBCL aggressive behavior scale having better ability to detect ODD. The implications of the findings for using the screening scales for diagnoses of ADHD and ODD are discussed.

Understanding the Externalizing Behavior of School-Age Boys: The Role of a Mother\u2019s Mentalization and Attachment

ObjectivesExternalizing behavior problems are considered to be a serious impediment to a child’s development, and therefore it is important to identify their predictors. In this study, we investigated the connections between school-aged boys’ externalizing problems, the mother’s reflective functioning (RF) and the mother’s perception of her childhood relationship with her own caregivers.MethodsThe study sample comprised 39 school-age boys diagnosed with externalizing behavior problems together with their mothers. A child’s psychopathology was assessed using the Child Behavior Checklist and Teacher Report Form. Our assessment of the mothers’ mentalizing capacities was based on the Adult Attachment Interview and Reflective Functioning Scale. The perception of a mother’s childhood relationship with her parents was assessed using the Parental Bonding Instrument.ResultsThe analysis revealed that more severe cases of aggressive and rule-breaking behavior in boys were associated with lower RF in mothers, as well as with a mother’s perception of her childhood relationship with her own parents as less autonomous. More aggressive behavior in boys was also associated with a mother’s perception of herself as experiencing a higher degree of care from her father during her own childhood.ConclusionsThese are only preliminary findings and we have discussed them with a view to understanding the possible ways in which a mother’s RF and the intergenerational context of relationship quality are associated with externalizing behavior problems in middle childhood.