Effects of methylphenidate and behavior modification on the social and academic behavior of children with disruptive behavior disorders: the moderating role of callous/unemotional traits.

This study examined whether response to behavior modification with and without methylphenidate differed for children with attention-deficit/hyperactivity disorder (ADHD) and conduct problems (CP) depending on the presence of callous/unemotional (CU) traits. Participants were 37 children ages 7 to 12, including 19 with ADHD/CP-only and 18 with ADHD/CP-CU, referred to a university-based summer treatment program. Results showed that ADHD/CP-CU children had worse behavior in the behavior-therapy-only (BT-only) condition, especially on measures of CP, noncompliance, and rule violations, but these differences largely disappeared when medication was added to BT. Children with ADHD/CP-CU were also less likely to be normalized by treatment than were children with ADHD/CP-only. These findings, though tentative, suggest that children with ADHD/CP-CU may not show a sufficient positive response to BT alone and that the combination of medication and BT may be especially important for them.     

Metabolite changes resulting from treatment in children with ADHD: a 1H-MRS study

Previously the authors noted an increase in glutamatergic tone in children with attention deficit hyperactivity disorder compared with age- and gender-matched control subjects. In this study they examine the effect of treatment on metabolite concentrations. Fourteen children with attention deficit hyperactivity disorder were investigated medication free and after treatment, using proton magnetic resonance spectroscopy. In the prefrontal cortex and striatum, metabolite peaks of N-acetyl-aspartate, glutamate/glutamine/gamma-aminobutyric acid, creatine/phosphocreatine, and choline compounds were measured, and ratios of the peaks were calculated and compared before and after treatment. The glutamate/glutamine/gamma-aminobutyric acid-to-creatine/phosphocreatine ratio decreased significantly in the striatum. No other metabolites demonstrated any change in response to medication. These findings suggest that glutamate may be involved in treatment response in attention deficit hyperactivity disorder, especially in the striatum.     

Effects of methylphenidate and expectancy on performance, self-evaluations, persistence, and attributions on a social task in boys with ADHD.

This study examined the effects of 0.3 mg/kg methylphenidate (MPH) and expectancy regarding medication on the performance and persistence of 137 boys with attention-deficit/hyperactivity disorder (ADHD) in a get-acquainted dyadic interaction with a peer, using a balanced-placebo design. Boys in 4 groups-administered placebo or MPH crossed with being told they received placebo or MPH-interacted with child confederates in experimental situations in which social success and failure were manipulated. In contrast with studies of academic persistence, MPH did not affect boys' task persistence or performance. Boys gave more positive self-evaluations and talked more in the success condition as compared with the failure condition. Boys attributed success to effort and ability and failure to task difficulty, and neither MPH nor expectancy affected this pattern. These findings are consistent with other studies in failing to find debilitating effects of MPH or medication expectancies on ADHD boys' attributions or self-evaluations.     

Noradrenergic and serotonergic neuroendocrine responses in prepubertal,peripubertal, and postpubertal rats pretreated with desipramine and sertraline

OBJECTIVE: To explore whether developmental status of neurotransmitter systems may affect response to antidepressant treatment. This study investigated whether younger animals, compared with mature animals, showed the same neuroendocrine response to challenge drug probes when pretreated with a serotonergic or noradrenergic antidepressant. METHOD: Prepubertal, pubertal, and adult rats were pretreated with low- or high-dose sertraline or desipramine for 14 days. Animals were then challenged with a noradrenergic probe (clonidine for desipramine-treated animals) or a serotonergic probe (fenfluramine for sertraline-treated animals). The neurohormonal response of growth hormone to the clonidine challenge and prolactin to the fenfluramine challenge was then measured. RESULTS: In animals challenged with fenfluramine, the postpubertal control group showed a significantly higher prolactin response to fenfluramine than postpubertal animals pretreated with low- or high-dose sertraline. No differences were found in the pubertal or prepubertal group. In animals challenged with clonidine, there was a significant age by treatment interaction effect for the prepubertal group pretreated with high doses of desipramine (less growth hormone secretion) but not for the peri- or postpubertal groups. CONCLUSIONS: These data indicate neurodevelopmental factors may play a role in the functional physiology of neurotransmitter systems, which in turn may affect response to psychotropics.     

The relationship between childhood behaviour disorders and unintentional injury events

OBJECTIVE

To examine the controversy regarding the existence of a relationship between behavioural disorders and unintentional injuries in children.

DESIGN

A retrospective cohort analysis of children between six and 19 years of age, who were diagnosed with attention deficit hyperactivity disorder (ADHD) only (n=955), ADHD plus conduct problems (CP) (n=160), or CP only (n=234), were compared with a nondisorder group of children (n=21,308) for unintentional injury events resulting in a physician office or emergency room visit, or hospitalization.

RESULTS

The risk of an injury event was greater among children with a behaviour disorder diagnosis and severity of injury varied among the behaviour disorder groups. Children with ADHD were the only disorder group at increased risk for all three injury outcomes. Children with a comorbid diagnosis were at a greater risk for both minor and more serious emergency injury visits, and children with CP only were at greatest risk for the most serious injuries (hospital admission).

CONCLUSIONS

These findings provide further support that children with ADHD are at an increased risk for not only hospitalized injury events but also minor injury events. In addition, these findings provide evidence that serious injuries are more likely to be experienced by children with CP.     

Relative Frequency of Psychiatric,Neurodevelopmental, and Somatic Symptoms as Reported by Mothers of Children with Autism Compared with ADHD and Typical Samples

Journal of Autism and Developmental Disorders - No study has analyzed the relative occurrence of a broad range of symptoms reported by mothers of children with autism, ADHD-Combined, and...     

Modifying an Evidence-Based Summer Treatment Program for Use in a Summer School Setting: A Pilot Effectiveness Evaluation

This report evaluates a pilot implementation of a modified version of the Summer Treatment Program (STP; Pelham et al. in Evidence-based psychotherapies for children and adolescents. The Guilford Press, New York, 2010) as an afternoon adjunct to a mandatory summer school curriculum in three inner city elementary schools (Summer School STP; SSSTP). Using preliminary post-test measures, the SSSTP was compared with afternoon adjunct programs implemented in two comparison schools. Students in pre-kindergarten through sixth grade who failed to meet grade-level requirements for grade promotion were required to attend the program and served as participants (SSSTP n?=?585; Comparison n?=?686). Measures collected include the following: student self-reports, teachers?? program evaluations, staff evaluations (of students, program, benefit to self), staff ratings of benefit to junior counselors (i.e., adolescent employees), and independent observations. Results suggest that the SSSTP is an acceptable and feasible adjunctive intervention for the summer school setting in inner city schools. Further research is needed to examine academic and therapeutic benefits.     

Should sex-specific norms be used to assess attention-deficit/hyperactivity disorder or oppositional defiant disorder?

The authors investigated whether sex-specific norms should be used to assess symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in girls. It was hypothesized that (a) there would be a group of girls who exhibit ADHD or ODD symptoms using sex-specific norms but not using Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) criteria; (b) these girls would be significantly impaired relative to typically developing girls. These hypotheses were examined using behavior ratings completed by mothers and teachers of 1,491 elementary school students. Results showed that there was a small group of girls who did not meet DSM-IV criteria for ADHD or ODD but who had elevated ADHD and ODD scores when sex-specific norms were used. The same was not true for boys. The girls identified with sex-specific norms were more impaired than other girls. These results suggest that there may be a small number of girls who have behaviors and impairment that are consistent with ADHD and ODD, but they are not currently being identified by DSM-IV criteria.     

Callous-Unemotional Traits Among Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): Associations with Parenting

This study examined the extent to which positive and negative parenting relates to conduct problems (CP) and callous-unemotional (CU) traits among 172 adolescents (72 % males; M^age = 16.91 years, SD = .67) with attention-deficit/hyperactivity disorder and whether CU traits moderate the link between parenting and CP. Mothers reported on their adolescents’ CP, CU traits, and their own parenting practices. Maternal behaviors were observed during a problem-solving communication task. Parents who engaged in more positive parenting (self-reported and observed) reported their adolescents as having lower levels of CU traits. No effect was found for negative parenting. Moderation analyses indicated that lower levels of positive maternal behavior was only associated with higher CP in the presence of higher levels of CU traits. Negative parenting was positively related to CP regardless of CU traits. Positive parenting, irrespective of measurement approach, uniquely relates to adolescents’ CU traits while both positive and negative parenting relate to CP.