Child Psychiatry Journals

Purpose: Every year increasing numbers of candidates request special accommodations for high-stakes medical licensing examinations, due to ADHD, on the basis of the Americans with Disabilities Act (ADA). This poses significant challenges for both the applicant and the medical boards and has significant financial, legal, and ethical implications. The purpose of this survey is to review all applications requesting ADA accommodations, on the basis of ADHD, submitted to the National Board of Osteopathic Medical Examiners (NBOME) COMLEX exam. Method: The authors review all 50 requests for special accommodations, on the basis of ADHD, submitted to the NBOME between 2005 and 2007. All requests are reviewed by the investigators independently and then cross-checked to determine interrater reliability. Results: Of all applicants, only 14% (7/50) provide sufficient documentation to support a diagnosis of ADHD. Interrater reliability is high. Conclusions: The majority of applicants who request special testing accommodations on the basis of ADHD do not provide adequate documentation to the medical boards to support the diagnosis.

Introduction: ADHD has a high comorbidity with substance use disorders (SUD). Both diseases have profound social, psychological, and economic consequences and are therefore highly relevant for health systems. The high comorbidity indicates some shared underlying neurobiological substrates. Knowing these substrates may increase the understanding of the disease and help identify therapeutic processes. Method: Neuroimaging studies of ADHD were reviewed and similarities with SUD identified. For this a PubMed research was conducted with the search terms ADHD, SUD, MRI or positron emission tomography (PET) or spectroscopy or imaging. Results: Similarities were found, in both PET and fMRI studies, between patients with ADHD and those with addiction-related craving. Results from structural MRI and MR spectroscopy do not support a common pathophysiological background, probably because of the lack of studies on craving. Discussion: ADHD and SUD-related craving share some neurobiological similarities. One reason may be that patients with addiction show more craving when they also suffer from ADHD. The present review thus supports the conclusion from an earlier meta-analysis of clinical studies which found that adequate treatment of ADHD reduces craving and relapse into substance use.

Objective: We compared ratings of behavior and attention problems between youth-onset psychosis and ADHD, two disorders in which attentional impairments play a key role, and examined the effect of psychostimulant use on age of onset in psychosis. Method: Parent and teacher ratings of behavioral problems and ADHD symptoms were collected using the Achenbach CBCL, TRF, and SNAP-IV Teacher Rating Scales on 42 participants with psychosis, 36 with ADHD and 57 controls (ages 8-19). Results and Conclusions: Results suggested that academic, externalizing, and attention problems reflect symptoms shared between the disorders, whereas internalizing, social and thought problems reflect factors that differ between disorders. Furthermore, participants with psychosis who had been prescribed psychostimulants had a younger age of onset of psychotic symptoms than those who had not. This difference could reflect dissimilarities in symptom severity symptom between subgroups or potentially harmful effects of psychostimulants in individuals predisposed to develop psychosis.

Objective: Individuals with ADHD often report sleep problems. Though most studies on ADHD and sleep examined children or nonclinically diagnosed adults, the present study specifically examines nonmedicated adults with ADHD to determine whether inattentive and hyperactive-impulsive symptoms are associated with sleep problems. Method: A total of 22 nonmedicated adults diagnosed with ADHD are assessed with a DSM-IV-based interview and the Pittsburg Sleep Quality Index (PSQI). Results: The number of hyperactive-impulsive symptoms indicate a positive correlation with sleep duration, habitual sleep efficiency, and global PSQI score. No significant associations are found between inattentive symptoms and sleep quality. Conclusion: The results show that sleep problems are associated with hyperactive and impulsive symptoms in nonmedicated adults with ADHD. These findings provide information on the nature of sleep problems without the confounding effects of medication associated with ADHD. Treatment of sleep problems, especially in those with hyperactive-impulsive symptoms, may help ameliorate ADHD symptomatology.

Objective: The current study evaluated the effects of differing intensities of behavior modification and medication on parents’ self-reported success in managing their child’s misbehavior and the attributions parents gave for success or failure.

Method: Children were randomized to receive in counterbalanced orders different levels of behavior modification, each for 3-week cycles. In addition, medication was manipulated using a medication assessment procedure. Parents reported daily how successful they were in managing their child’s misbehavior and the attributions for either their success or failure.

Results: Parents of children with ADHD generally felt successful in managing their child’s behavior, regardless of treatment condition. In the high behavior modification condition, they were more likely to endorse items that attributed their success to their own effort. Conclusion: In conditions in which parents were given more intensive tools to manage misbehavior they were more likely to attribute their success to their own effort.

Objective: The article discusses the ADHD Observational Research in Europe (ADORE) study that examined the impact of early treatment choices on outcome within the first few months, in previously untreated children with impairing inattention, impulsivity, and hyperactivity. Methods: Data are collected from a longitudinal, observational study conducted in 10 European countries that involve 1,478 children (aged 6 to 18 years) with symptoms of hyperactivity, impulsivity, or inattentiveness. Linear model with a propensity score adjustment compares the decrease in ADHD-RS scores between baseline and last recorded visit across treatment groups (2 to 5 months). Results: At baseline, 49.9% of participants are prescribed pharmacotherapy and 44.3% a psychosocial intervention. Analysis of the effect of treatment on the evolution of ADHD-RS scores shows a positive effect of medications and either an insignificant or negative effect of psychosocial intervention. Conclusions: Early use of medication effectively reduces ADHD symptoms in routine clinical practice in Europe. The effect of psychosocial intervention has to be interpreted cautiously because the number, length, and level of standard of the sessions are not taken into account in the analyses.

Objective: The present study investigated how teachers rated children’s Behavior, IQ, and Personality contingent on the presence or absence of an Attention Deficit Hyperactivity Disorder (ADHD) label. Method: Teachers from K-12 read a hypothetical description of either a male or female child with no label, an ADHD label, or an ADHD with stimulant treatment label. Teachers responded to 30, 7-point Likert rating scales anchored with descriptors related to Behavior, IQ, and Personality. Results: Teachers rated the child with an ADHD label and ADHD with stimulant treatment label significantly less favorably than the child with no label. Results partially supported that teachers rated the child with an ADHD label significantly less favorably than the child with an ADHD with stimulant treatment label. Conclusion: Teachers rated the children with ADHD and ADHD with stimulant treatment label less favorably than the child with no label. Implications for educators and future research are discussed.

Objective: Examine clinical correlates and distinguishing features of autism spectrum disorders (ASD), ADHD, and tic disorders in girls referred for social impairment, attention/academic deficits, and/or tics. Method: One hundred 3- to 18-year-old girls referred for social impairment and attention symptoms were assessed in detail. Sixty of these girls, 7 to 16 years of age (IQ ≥ 80) were compared with age-matched girls (IQ ≥ 80) from the community. Results: Main diagnoses of ASD, ADHD, tic disorders, and "other psychiatric disorder" were made in 46, 46, 3, and 5, respectively, of the referred girls. The ASD and ADHD groups (mean age at diagnosis 8.8 and 13.0 years, respectively) had the same types and high rates of psychiatric comorbidity. Girls with ASD had more problems with global functioning and adaptive levels of daily living skills than girls with ADHD. Differences between these girls referred for investigation and the community sample of girls were very considerable across a range of factors. Conclusions: Girls referred for social and/or attention deficits usually meet diagnostic criteria for either ASD or ADHD. They have severe psychiatric comorbidities and low global levels of functioning.

Objective: The present study was designed to test some assumptions about screening procedures for ADHD in adults. Method: Twenty-eight incarcerated male adults completed a self report scale of attention deficits as a part of an examination of attention and reading skills. Further assessment of attention included a battery of tests that assessed vigilance, attention shifts, and other aspects of cognitive control. Results: Fifty seven percent of the sample showed test performance indicating a high probability of ADHD. Correlation analyses yielded significant effects for self report scales and objective tests of attention. Conclusion: The results support the assumption that the self report measures share a significant part of the variance with tests of attention commonly used in clinical assessment. However, the risk of making both false positive and false negative inferences about ADHD is present, as the specificity and the sensitivity of the rating scale needs to be further explored.

Research Articles
Nicola Botting, Brian Faragher, Zoë Simkin, Emma Knox, Gina Conti-Ramsden,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1013-1020

Abstract
A group of 117 children who met criteria for Specific Language Impairment (SLI) at 7 years of age were reassessed at 11 years of age. The data gathered from both stages were used to identify predictors of good and poor outcome from earlier test assessments. Results of logistic regressions indicated that measures of narrative retelling skills and expressive syntax were the strongest predictors of overall prognosis. This finding persisted when a nonverbal measure was included as a predictor alongside language measures in the regression model. There was found to be a lack of independent predictive contribution of early measures of articulation to later overall prognosis. Demographic factors (maternal education and family income) were not differently distributed across outcome groups. The theoretical and practical implications of the findings are discussed.

Research Articles
Barbara Maughan, Colin Taylor,, Alan Taylor, Neville Butler, John Bynner,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1021-1028

Abstract
Recent investigations have highlighted associations between maternal smoking in pregnancy and antisocial behaviour in offspring, and suggested the possibility of a causal effect. We used data from the 1970 British birth cohort study (BCS70) to examine these links in a large, population-based sample studied prospectively from birth to age 16. We found a strong dose-response relationship between the extent of pregnancy smoking and childhood-onset conduct problems, but no links with adolescent-onset antisocial behaviours. Effects on childhood-onset conduct problems were as marked for girls as for boys, and were robust to controls for a variety of social background factors and maternal characteristics. Controls for mothers subsequent smoking history modified this picture, however, suggesting that the prime risks for early-onset conduct problems may be associated with persistent maternal smoking or correlates of persistent smoking rather than with pregnancy smoking per se.

Research Articles
Thomas H. Ollendick, Audra K. Langley, Russell T. Jones,, Christina Kephart,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1029-1034

Abstract
In this study, we explored relations among negative life events, negative attributional style, avoidant coping, and level of fear in 99 children who had survived residential fires. Overall, negative life events, negative attributional style, and avoidant coping were found to be predictive of levels of fear. However, the relation between negative life events and fear was moderated by mother s level of education such that this prediction was obtained only for those children whose mothers were low in education level. Age, ethnicity, and sex did not moderate these relations. In addition, negative attributional style and avoidant coping were related to levels of fear in those children whose mothers were high in education levels but not those whose mothers were low in education level. Results are discussed within a stress and coping framework.

Research Articles
Harry Zeitlin, Mary Robertson, Heatha Hornsey, Sube Banerjee,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1035-1039

Abstract
This study s aim was to estimate the prevalence and describe the clinical characteristics of Tourette syndrome (TS) in 13 14-year-old schoolchildren attending mainstream secondary schools. A three-stage ascertainment procedure was used to identify those who had TS. First, all 1012 Year 9 pupils were screened for tics using validated self-report questionnaires, which were completed by parents, teachers, and pupils. Data were available from at least one informant for 918 (90 7%) subjects. Tics were identified in 189 (18 7%) pupils. Second, families were contacted and a semistructured interview was carried out to determine whether they had TS. Finally, to ensure that the diagnosis of TS was correct, all those assessed as having TS were systematically assessed by an expert clinician in the field of TS.Seven young people were identified as fulfilling the criteria for TS, giving a minimum prevalence rate amongst 13 14-year-olds of 0 76% (95% CI 0 31 to 1 57) and a more realistic estimate of 1 85% (95% CI 1 00 to 2 95). Behavioural problems, in particular hyperkinetic disorder, were frequently associated with the TS group. These findings lend further support to the contention that the prevalence of TS in the community has hitherto been underestimated, though the symptoms may be generally milder than cases of TS presenting to clinics. This study supports the need for vigilance for TS in school-age children in primary care and in educational settings, so that children with this potentially serious disorder can be identified and assessed and effective management packages can be formulated to address their needs, when necessary.

Research Articles
Enrico Mezzacappa, Dan Kindlon, Felton Earls,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1041-1048

Abstract
We examined executive functions using performance tasks in 126 boys aged 6 to 16 years, who attended public schools and therapeutic schools for children with emotional and behavioral problems. Children were further grouped based on the presence or absence of substantiated abuse histories. Based on their abuse histories and schools of origin, children were classified as Therapeutic, Abused (TA, N = 25), Therapeutic, Nonabused (TN, N = 52), and Public School (PS, N = 48). Controlling IQ and medication status, we compared children in the three groups on teacher ratings of behavior, on experimenter observations of behavior during testing, and on performance tasks challenging the capacities to inhibit an act in progress, and to passively avoid responses associated with adverse consequences. We examined mean group differences in symptoms, behaviors, and task performance, as well as differential age-dependent changes in these dimensions. Independent of abuse history, therapeutic school children demonstrated comparable levels of internalizing and externalizing symptoms, and comparable levels of redirections to task during testing sessions, that were significantly higher than those of the public school children. Both groups of therapeutic school children also showed comparable overall performance on the capacities to inhibit an act in progress, and to passively avoid responses associated with adverse consequences that were poorer than the performance of children from the public school. Children with histories of substantiated abuse showed diminished improvement with increasing age in the capacity to passively avoid responses associated with adverse consequences when compared not only to the public school children, but also to the children from the therapeutic schools without histories of abuse. Our findings complement reports of behavioral observations of abused children, and reports associating child abuse with altered cognitive development in other areas of competence. They suggest that child abuse may negatively influence the expected developmental progression of competence in certain executive functions. This in turn could have implications for the nature and the persistence of certain forms of psychopathology associated with abuse and poor self-control. Given the cross-sectional nature of our data, however, longitudinal developmental studies of the relations between child abuse and executive functions are needed to elucidate the influence of abuse on the growth and development of such organizing principles of behavioral self-regulation.

Research Articles
Joanne F. Rovet, Sandra L. Hepworth,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1049-1056

Abstract
Recent studies suggest that children with different etiologies of attention disorder also differ as to the types of errors they make on attention tasks. Because these errors are reflective of the core deficits underlying their attention problems, we sought to compare error patterns in children with different attention disorders. Studied were 144 children aged 7 12 years, 43 with attention deficit hyperactivity disorder (ADHD), 35 with congenital hypothyroidism (CH), and 68 controls. Two variations of the continuous performance task (CPT) that differed in demands on inhibitory control and memory were used. One variation, the CPT:A-not-X task, required subjects to observe a continuous stream of letters shown at different rates on the computer screen and respond to all stimuli except X . The other variation, the CPT:AX task, required them to respond whenever a specified combination of letter such as A followed by X appeared on the screen. On the CPT:A-not-X task, children with ADHD differed from controls in commission errors, signifying difficulty with inhibitory control, whereas children with CH differed in perceptual sensitivity or signal detection. Although the CH and ADHD groups both performed more poorly than controls on the CPT:AX task, children with CH made more errors to the first stimulus item, suggesting a problem holding information in memory, whereas children with ADHD made more errors to the second item, suggesting impulsivity. These results therefore signify the utility of these tasks in identifying the different mechanisms underlying the specific attention deficits of different groups of children.

Research Articles
Elise C. Guymer, David Mellor, Ernest S. L. Luk, Vicky Pearse,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1057-1063

Abstract
Childhood cruelty to animals may be a marker of poor prognosis amongst conduct disordered children. However, other than semistructured interviews with parents or children, there are no screening instruments for this behavior. The aim of this study was to develop such an instrument. In the first phase of the study, a parent-report questionnaire, Children s Attitudes and Behaviors Towards Animals (CABTA) was designed and piloted on 360 elementary school children, enabling community norms and a factor structure for the instrument to be derived. In the second phase, the questionnaire was completed by the parents of a small sample of children (N = 17) to establish its test retest reliability. In the third phase of the study, the CABTA was completed by the parents of 19 children who had been diagnosed with either a Disruptive Behavioral Disorder or Attention Deficit Hyperactivity Disorder, and the results were compared with the outcome of a semistructured interview with parents regarding their child s behavior toward animals. The results of the various phases of the study indicated that the CABTA consists of two factors, Typical and Malicious Cruelty to animals, and is a reliable and valid tool for detecting childhood cruelty to animals. Possible use and adaptations of the CABTA as a screening instrument in clinical and community samples are discussed.

Research Articles
Tom Manly, Vicki Anderson, Ian Nimmo-Smith, Anna Turner, Peter Watson, Ian H. Robertson,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1065-1081

Abstract
Attention is not a unitary brain process. Evidence from adult studies indicates that distinct neuroanatomical networks perform specific attentional operations and that these are vulnerable to selective damage. Accordingly, characterising attentional disorders requires the use of a variety of tasks that differentially challenge these systems. Here we describe a novel battery, the Test of Everyday Attention for Children (TEA-Ch), comprising nine subtests adapted from the adult literature. The performance of 293 healthy children between the ages of 6 and 16 is described together with the relationships to IQ, existing measures of attention, and scholastic attainment. This large normative sample also allows us to test the fit of the adult model of functionally separable attention systems to the observed patterns of variance in children s performance. A Structural Equation Modelling approach supports this view. A three-factor model of sustained and selective attention and higher-level executive control formed a good fit to the data, even in the youngest children. A single factor model was rejected.There are behavioural and anatomical grounds to believe that Attention Deficit Disorder (ADD) is particularly associated with poor self-sustained attention and behavioural control. The TEA-Ch performance of 24 boys diagnosed with ADD presented here is consistent with this view. When performance levels on WISC-III subtests were taken into account, specific deficits in sustained attention were apparent while selective attention performance was within the normal range.

Research Articles
Ted Ruffman, Wendy Garnham,, Paul Rideout,
The Journal of Child Psychology and Psychiatry and Allied Disciplines, Volume 42 Issue 08 , pp 1083-1094

Abstract
Twenty-eight children with autism and 33 MLD children were given two tasks tapping social understanding and a control task tapping probability understanding. For each task there was a measure of eye gaze (where children looked when anticipating the return of a story character or an object) and a verbal measure (a direct question). We found that eye gaze was better than verbal performance at differentiating children with autism from children with MLD. Children with autism did not look to the correct location in anticipation of the story character s return in the social tasks, but they did look to the correct location in the nonsocial probability task. We also found that within the autistic group, children who looked least to the correct location were rated as having the most severe autistic characteristics. Further, we found that whereas verbal performance correlated with general language ability in the autistic group, eye gaze did not. We argue that: (a) eye gaze probably taps unconscious but core insights into social behavior and as such is better than verbal measures at differentiating children with autism from mentally handicapped controls, (b) eye gaze taps either spontaneous processes of simulation or rudimentary pattern recognition, both of which are less based in language, and (c) the social understanding of children with autism is probably based mostly on verbally mediated theories whereas control children also possess more spontaneous insights indexed by eye gaze.