Yale Children's Inventory Research Articles

Minor neurodevelopmental impairments are associated with increased occurrence of ADHD symptoms in children born extremely preterm

ADHD is more common in children born preterm than at term. The purpose of the study was to examine if, and to what extent, ADHD symptoms are associated with minor neurodevelopmental impairments (NDI) in extremely preterm children. In a national population-based cohort with gestational age 22-27 weeks or birth weight <1,000 g assessed at 5 years of age, scores on Yale Children's Inventory (YCI) scales (seven scales) were related to normal functions vs. NDI defined as mild impairments in cognitive function (IQ 70-84), motor function (Movement Assessment Battery for children score > the 95th percentile or freely ambulatory cerebral palsy), vision (correctable), and hearing (no hearing aid). YCI was completed for 213 of 258 eligible children (83%). Children with minor NDIs (n = 98) had significantly higher scores (more ADHD symptoms) than those without NDI (n = 115) on the YCI scales of Attention, Tractability, Adaptability and Total score. Increasing numbers of minor NDIs were associated with higher mean YCI scores. In multivariate analysis only decreased hearing, IQ, and male gender were significantly associated with scores on the Attention scale. Thirty-three children (16%) had scores >3 on the Attention scale (probably ADHD), and the proportion was significantly higher for those with mild NDIs compared to those without (Odds ratio = 2.7, 95% CI 1.3-6.0). Children born extremely preterm with minor NDIs were more likely to have ADHD symptoms than those with no NDI, and increasing number of minor NDIs were associated with more ADHD symptoms.

Population Based, Controlled Study of Behavioural Problems and Psychiatric Disorders in Low Birthweight Children at 11 Years of Age

The long-term risk of behavioral and psychiatric disorders associated with low birth weight was assessed in 130 low-birth-weight (LBW) children who weighed less than 2000 g at birth but who had no major handicaps at age 11 years. The control group included 131 normal-birth-weight (NBW) children whose birth weight exceeded 3000 g. Mothers and teachers completed validated questionnaires dealing with behavior. The Yale Children's Inventory served to assess attention deficit hyperactivity disorder (ADHD). Social skills were evaluated using the psychometric scale of the Asperger Syndrome Diagnostic Interview. In addition, children were evaluated by a child psychiatrist in a semistructured interview based on the Children Assessment Schedule (CAS). This instrument covers such areas as friends, school, activities, family, anxiety, self-esteem, somatic complaints, aggressive behavior, and problems in thinking. Psychometric intelligence was significantly lower in LBW than in NBW children. Parental educational levels were lower in LBW families, and parental stress was rated as somewhat higher. Child rearing was more often assessed as being less nurturing. Mothers of LBW children more often smoked during pregnancy. More LBW than NBW children scored abnormally in attention, social problems, and anxiety/depression. Asperger syndrome was diagnosed in a single LBW child. Teachers reported that more LBW children had abnormal scores for social and attentional problems and delinquent behavior. CAS findings pointed to more problems in school as well as leisure-time activities for the LBW children, as well as more aggressive behavior and lower self-esteem. Total problem scores were abnormal in 40% of LBW children and 7% of the NBW group and changed little after adjusting for child intelligence and possible confounding parental factors. Psychiatric disorder was diagnosed in 27% of LBW children and 9% of NBW children. Of the 33 LBW children affected, 13 had ADHD. Apart from ADHD, which was more prevalent in boys, there were no significant gender differences within the LBW group. Multiple logistic regression analysis failed to identify any prenatal or neonatal factors that predicted behavioral or psychiatric problems at age 11. This study revealed an increased risk of both behavioral and psychiatric disorders persisting at least to early adolescence when birth weight is less than 2000 g. The study demonstrated no interaction between birth weight and parental risk factors.

Cord Serum Ferritin Concentrations and Mental and Psychomotor Development of Children at Five Years of Age

There is clear evidence that iron deficiency in early life can lead to enduring delay in mental and psychomotor development. Trials of iron supplementation have, however, failed to consistently demonstrate benefit. The authors assessed fetal iron status by determining the umbilical-cord serum ferritin concentration by radioimmunoassay in 278 children and related the findings to full-scale intelligence quotient (FSIQ), language ability, fine and gross motor skills, attention, and tractability at age 5 years. Participants took part in a study designed to identify risk factors for small-for-gestational-age (SGA) infants. Mothers completed the Home Screening Questionnaire, a measure of the home environment for children, as well as the Peabody Picture Vocabulary Test, a measure of cognitive function. In addition to the FSIQ, children completed the Test for Auditory Comprehension of Language (TACL), the Peabody Developmental Motor Scales, and the Yale Children's Inventory for attention and tractability (the ability to obey rules of decorum). The mothers were predominantly African-American and had scores typical of a resource-poor inner city population. The prevalence of preterm birth before 37 weeks' gestation was 13%, and that of SGA infants was 22%. Birth weights were lower for those in the lowest quartile of serum ferritin. After adjusting for gender, birth weight, and smoking, cord ferritin levels correlated significantly but weakly with maternal serum ferritin levels at 36 weeks' gestation. Children in the lowest quartile of cord blood ferritin scored the lowest in all tests, and had significantly lower scores on the TACL and the test of fine motor function than did those in the two median quartiles. There were no such differences in FSIQ or gross motor function scores. In no respect did the children in the highest ferritin quartile differ from those in the median quartiles. Analyzing test scores below the 15th percentile, the chance of a low score on any of the tests was increased by at least 60% for children in the lowest ferritin quartile. Children in the highest ferritin quartile were more than 3 times as likely as those in the two median quartiles to have a FSIQ score lower than 70 (the 15th percentile cutoff score). These findings suggest that poor iron status at birth is associated with impaired performance on mental and psychomotor evaluation at age 5 years. The finding that high ferritin levels correlate with low FSIQ scores remains unexplained.

The relationship between cognitive abilities and maternal ratings of externalizing behaviors in preschool children.

The association between child cognitive abilities and maternal ratings of child externalizing behaviors was investigated in a randomly selected sample of 290 preschool children. Child cognitive abilities were assessed by the WPPSI-R, whereas mothers completed the Yale Children's Inventory for the assessment of child externalizing behaviors. Maternal education, and maternal child-rearing style, as defined by scores on the Child Rearing Practices Report, was significantly related to perceived externalizing child behavior. Hierarchical regression analyses revealed that for girls, low child IQ remained a significant predictor of perceived externalizing behavior when effects of maternal education and child-rearing style were controlled for (p < 0.01). Maternal child-rearing style made independent contributions to explaining variance in girls' and boys' behavior score. The results are discussed in terms of differential gender socialization practices and gender stereotypes.

Behavior in term, small for gestational age preschoolers.

To evaluate whether being born small for gestational age (SGA) was associated with an increased frequency of preschool behavioral problems. Follow-up study at 5 years of age. A population based cohort of 318 term infants who were SGA, defined as having a birthweight less than the 15th percentile for gestational age, and without major handicap such as cerebral palsy or mental retardation, and a random control sample of 307 appropriate for gestational age (AGA) infants. The Personality Inventory for Children and the Yale Children's Inventory (completed by the mothers), and child behavior during psychometric testing. Behavior problems was not more common among the SGA children. The results were not confounded by a wide range of parental demographic and child rearing factors, including maternal non-verbal problem solving abilities, child rearing style, and maternal psychological distress. However, the parental factors explained 13% of the variance in a summary score of child behavior compared to 1% explained by SGA vs. AGA status. The SGA children were not more sensitive to the negative impacts of parental risk factors than AGA controls. The study does not address the outcome of severely growth-retarded SGA infants. Being born moderately SGA is not a significant risk factor for preschool behavior problems.

Transient dystonia in non-handicapped low-birthweight infants and later neurodevelopment.

The aim of the present study was to evaluate the long-term prognostic significance of transient increase in muscle tone during infancy (dystonia) in very low-birthweight (VLBW) infants without cerebral palsy. Motor (Peabody Developmental Motor Scales), cognitive (Wechsler Preschool and Primary scale of Intelligence) and behavioural (Personality Inventory for Children, Yale Children's Inventory) development was assessed at 5 years of age. In a population-based sample of 50 VLBW children, transient dystonia was present in 14. In explorative analyses, transient dystonia was associated with low 1 min Apgar scores, neonatal bacterial infection, and lack of breast-milk in the neonatal period. Cognitive, neuromotor and behavioural development at 5 years of age was comparable in those with and without transient dystonia, although there was a statistically non-significant tendency towards more neuromotor problems in the dystonic children.

Behavioral problems in low-birthweight preschoolers.

Preschool behavior of a population-based sample of 144 5-year-old children with birthweights less than 2000g (LBW) was compared with a random sample of 163 normal-birthweight term controls. The Personality Inventory for Children and the Yale Children's Inventory were completed by the mothers, and child behavior during psychometric testing was assessed. Nineteen per cent of the LBW children compared to 4% of controls had behavioral problems as defined by abnormal scores on more than three behavioral measures. The LBW children were more often socially insecure, anxious and difficult to manage, but inattention and hyperactivity were not prominent. The LBW children were not more sensitive to the negative impact of parental risk factors than normal-birthweight children.

Demographic and Clinical Features of Obsessive-Compulsive Disorder in Children and Adolescents

To describe the demography, symptomatology, and comorbidity of 31 clinically referred children and adolescents with obsessive-compulsive disorder. The patients were assessed in an outpatient clinic for lifetime psychopathology with the Diagnostic Interview for Children and Adolescents. The child and adolescent version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used to group obsessive-compulsive symptoms and rate symptom severity. Demographic, medical, developmental, academic, and behavioral information was recorded by the parents in the Yale Children's Inventory and the Child Behavior Checklist. The male-female ratio was approximately 3:2. Most patients had had multiple obsessions and compulsions that had changed over time. The CY-BOCS correlated highly with another measure of obsessive-compulsive behavior, but not with any of the Child Behavior Checklist scales. Symptom severity was influenced by an interaction between gender and age at onset of the illness. More than 80% of the subjects had other lifetime psychiatric diagnoses. The results provide further evidence that obsessive-compulsive disorder is a chronic, severe illness in children and adolescents that is often associated with other forms of psychopathology. The data support the concurrent and discriminant validity of the CY-BOCS.

Growth hormone and prolactin response to methylphenidate in children with attention deficit disorder

Utilizing a double-blind, drug-placebo design, we examined growth hormone (GH) and prolactin (Pro) response to oral administration of methylphenidate (MPH) in 14 boys (ages 7.0–12.4 years) with Attention Deficit Disorder (ADD). Four conditions representing three different MPH doses (0.3 mg/kg O.D., 0.3 mg/kg B.I.D., 0.6 mg/kg O.D.) and Placebo were compared in each subject, each condition lasting for a period of 3 weeks. GH and Pro response were measured both as maximum peak GH (DGH) or nadir of Pro (DPro) as well as area under the curve for the first four hours after MPH administration (AUCGH, AUCPro). Behavioral measures included parent ratings on the Yale Children's Inventory and teacher ratings on the yale and Conners Behavior Rating Scales and Kagan's Matching Familiar Figures Test (MEFT). Prolactin response as measured by AUCPro was significantly increased after MPH compared to placebo (t=2.04, p<0.05, placebo vs all doses MPH). This difference observed for AUCPro between placebo and MPH was evident as well when we considered the number of times AUCPro declined after MPH as compared to placebo (p=.018, Fisher's exact test). Within-subjects analysis of covariance demonstrated significant correlations between the improvement in reaction time on the MFET and 1) GH response (AUCGH, r=.58, p<.001) and 2) prolactin response (AUCPro, r=.40, p<.05) and between improvement in attention as measured on the Yale BRS and GH response (AUCGH, r=.57, p<.05). Our findings suggest that measures other than GH and prolactin may be more desirable measures of brain catecholaminergic functioning.

Concurrent and Predictive Validity of the Yale Children's Inventory: An Instrument to Assess Children With Attentional Deficits and Learning Disabilities

The Yale Children's Inventory rating scales for completion by parents were developed to improve the ability of clinicians and researchers to evaluate the school-related problems of children. The inventory consists of 11 narrow-band and two broad-band scales, the Behavioral and the Cognitive. The concurrent and predictive validity of the Yale Children's Inventory scales are reported in a school-based sample of 103 boys. External criterion variables were obtained from parents, teachers, and standardized tests administered to the children. We found that the Attention scale overlaps both broad-band domains, indicating the importance and the intrinsic relationship of attention to both behavioral and cognitive functions, which supports the Diagnostic and Statistical Manual of Mental Disorders, ed 3 nosology for disorders of attention and activity regulation. It also increases the number of children whose assessment may be enhanced by the availability of systematic parent report forms.

Yale Children's Inventory (YCI): an instrument to assess children with attentional deficits and learning disabilities. I. Scale development and psychometric properties.

The Yale Children's Inventory (YCI), a parent-based rating scale, and the scales derived from it have been developed to identify and measure multiple dimensions of learning disabilities with particular emphasis on attentional deficits. Scale construction was based on factor-analytic procedures. Measures of internal consistency, test-retest reliability, and coefficients of congruence support the reliability and stability of the 11 scales. A discriminant function classified normal and learning-disabled children with a relatively high rate of accuracy. The relationship and content of the three relevant YCI scales were compared to the DSM-III diagnostic categories for ADD. As operationalized, DSM-III criteria for hyperactivity formed a cohesive factor, while criteria for attention and impulsivity were not distinguishable from each other since they loaded together on a single factor. In contrast, the equivalent YCI scales for attention, impulsivity, and hyperactivity were found to be distinct.

1703 PLASMA MONOAMINE METABOLITES FOLLOWING DEBRISOQUIN IN ADD

We report an important new strategy in the investigation of the biology of ADD, the debrisoquin loading test. Debrisoquin, a unique monoamine oxidase inhibitor reduces the peripheral contribution to plasma catecholamine metabolites (HVA and MHPG, the principal metabolites of dopamine and norepinephrine, respectively), effectively minimizing the “noise” in the system, allowing central monoaminergic mechanisms to be more accurately examined. We studied the relationship between behaviors representing the cardinal symptoms of ADD and plasma monoamine metabolites in 5 boys with ADD (ages 7-14 years) before and after debrisoquin. Behavior was assessed by the Yale Children's Inventory (YCI) and a variety of cognitive and attentional tasks. Significant correlations were observed between plasma HVA and measures of impulsivity (YCI Impulsivity scale and Matching Familiar Figures Test), and plasma MHPG and measures of activity (YCI Activity scale) and attention (YCI Attention scale, Paired Associate Learning Test. Our findings suggest that dopaminergic systems influence those mechanisms responsible for impulsivity while noradrenergic systems relate to attention regulation and activity modulation.