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Annual Research Review: Categories versus dimensions in the classification and conceptualisation of child and adolescent mental disorders: implications of recent empirical study.

J Child Psychol Psychiatry. 2012 Jan 31;

Authors: Coghill D, Sonuga-Barke EJ

Abstract

The question of whether child and adolescent mental disorders are best classified using dimensional or categorical approaches is a contentious one that has equally profound implications for clinical practice and scientific enquiry. Here, we explore this issue in the context of the forth coming publication of the DSM-5 and ICD-11 approaches to classification and diagnosis and in the light of recent empirical studies. First, we provide an overview of current category-based systems and dimensional alternatives. Second, we distinguish the various strands of meaning and levels of analysis implied when we talk about categories and dimensions of mental disorder – distinguishing practical clinical necessity, formal diagnostic systems, meta-theoretical beliefs and empirical reality. Third, we introduce the different statistical techniques developed to identify disorder dimensions and categories in childhood populations and to test between categorical and dimensional models. Fourth, we summarise the empirical evidence from recent taxometric studies in favour of the ‘taxonomic hypothesis’ that mental disorder categories reflect discrete entities with putative specific causes. Finally, we explore the implications of these findings for clinical practice and science.

PMID: 22288576 [PubMed - as supplied by publisher]

Affective-motivational brain responses to direct gaze in children with autism spectrum disorder.

J Child Psychol Psychiatry. 2012 Jan 25;

Authors: Kylliäinen A, Wallace S, Coutanche MN, Leppänen JM, Cusack J, Bailey AJ, Hietanen JK

Abstract

Background:  It is unclear why children with autism spectrum disorders (ASD) tend to be inattentive to, or even avoid eye contact. The goal of this study was to investigate affective-motivational brain responses to direct gaze in children with ASD. To this end, we combined two measurements: skin conductance responses (SCR), a robust arousal measure, and asymmetry in frontal electroencephalography (EEG) activity which is associated with motivational approach and avoidance tendencies. We also explored whether degree of eye openness and face familiarity modulated these responses. Methods:  Skin conductance responses and frontal EEG activity were recorded from 14 children with ASD and 15 typically developing children whilst they looked at familiar and unfamiliar faces with eyes shut, normally open or wide-open. Stimuli were presented in such a way that they appeared to be looming towards the children. Results:  In typically developing children, there were no significant differences in SCRs between the different eye conditions, whereas in the ASD group the SCRs were attenuated to faces with closed eyes and increased as a function of the degree of eye openness. In both groups, familiar faces elicited marginally greater SCRs than unfamiliar faces. In typically developing children, normally open eyes elicited greater relative left-sided frontal EEG activity (associated with motivational approach) than shut eyes and wide-open eyes. In the ASD group, there were no significant differences between the gaze conditions in frontal EEG activity. Conclusions:  Collectively, the results replicate previous finding in showing atypical modulation of arousal in response to direct gaze in children with ASD but do not support the assumption that this response is associated with an avoidant motivational tendency. Instead, children with ASD may lack normative approach-related motivational response to eye contact.

PMID: 22276654 [PubMed - as supplied by publisher]

Sex-specific associations between umbilical cord blood testosterone levels and language delay in early childhood.

J Child Psychol Psychiatry. 2012 Jan 26;

Authors: Whitehouse AJ, Mattes E, Maybery MT, Sawyer MG, Jacoby P, Keelan JA, Hickey M

Abstract

Background:  Preliminary evidence suggests that prenatal testosterone exposure may be associated with language delay. However, no study has examined a large sample of children at multiple time-points. Methods:  Umbilical cord blood samples were obtained at 861 births and analysed for bioavailable testosterone (BioT) concentrations. When participating offspring were 1, 2 and 3 years of age, parents of 767 children (males = 395; females = 372) completed the Infant Monitoring Questionnaire (IMQ), which measures Communication, Gross Motor, Fine Motor, Adaptive and Personal-Social development. Cut-off scores are available for each scale at each age to identify children with ‘clinically significant’ developmental delays. Chi-square analyses and generalized estimating equations examined longitudinal associations between sex-specific quartiles of BioT concentrations and the rate of developmental delay. Results:  Significantly more males than females had language delay (Communication scale) at age 1, 2 and 3 years (p-values ≤. 01). Males were also more likely to be classified as delayed on the Fine-Motor (p = .04) and Personal-Social (p < .01) scales at age 3 years. Chi-square analyses found a significant difference between BioT quartiles in the rate of language delay (but not Fine-Motor and Personal-Social delay) for males (age 3) and females (age 1 and 3). Generalized estimating equations, incorporating a range of sociodemographic and obstetric variables, found that males in the highest BioT quartile were at increased risk for a clinically significant language delay during the first 3 years of life, with an odds ratio (OR) of 2.47 (95% CI: 1.12, 5.47). By contrast, increasing levels of BioT reduced the risk of language delay among females (Quartile 2: OR = 0.23, 95% CI: 0.09, 0.59; Quartile 4: 0.46, 95% CI: 0.21, 0.99). Conclusion:  These data suggest that high prenatal testosterone levels are a risk factor for language delay in males, but may be a protective factor for females.

PMID: 22276678 [PubMed - as supplied by publisher]

Commentary: Translating quantitative genetics into molecular genetics: decoupling reading disorder and ADHD – reflections on Greven et al. and Rosenberg et al. (2012).

J Child Psychol Psychiatry. 2012 Jan 20;

Authors: Grigorenko EL

PMID: 22260725 [PubMed - as supplied by publisher]

Prevalence and mental health outcomes of homicide survivors in a representative US sample of adolescents: data from the 2005 National Survey of Adolescents.

J Child Psychol Psychiatry. 2011 Dec 23;

Authors: Rheingold AA, Zinzow H, Hawkins A, Saunders BE, Kilpatrick DG

Abstract

Background:  Each homicide leaves behind several friends and family members, or homicide survivors. However, limited information is available on the impact of homicide on adolescent survivors. The purpose of the current study was to identify the prevalence of homicide survivorship and to determine mental health outcomes within a sample of US adolescent survivors. Methods:  A nationally representative sample of American adolescents (N = 3,614) between the ages of 12 and 17 completed structured telephone interviews assessing homicide survivorship and mental health consequences including posttraumatic stress disorder (PTSD), depression, drug use, and alcohol abuse. Results:  Reported prevalence within this sample of losing a loved one to criminal homicide was 9%, losing a loved one to vehicular homicide was 7%, and losing a loved one to both types of homicide was 2%. Logistic regression analyses found that adolescents who reported being homicide survivors were significantly more likely to report depression, drug use, and alcohol abuse after controlling for demographic factors and other violence exposure. Conclusions:  If the results from this study are generalizable to the US population, roughly 1 in 5 American adolescents may be impacted by homicide. Further, adolescents exposed to such a loss are at increased risk for mental health sequelae. Results suggest that greater attention needs to be paid to address the needs of these often underserved victims.

PMID: 22211367 [PubMed - as supplied by publisher]

Annual Research Review: Phenotypic and causal structure of conduct disorder in the broader context of prevalent forms of psychopathology.

J Child Psychol Psychiatry. 2011 Dec 23;

Authors: Lahey BB, Waldman ID

Abstract

Background:  A better understanding of the nature and etiology of conduct disorder (CD) can inform nosology and vice versa. We posit that any prevalent form of psychopathology, including CD, can be best understood if it is studied in the context of other correlated forms of child and adolescent psychopathology using formal models to guide inquiry. Methods:  Review of both cross-sectional and longitudinal studies of the place of CD in the phenotypic and causal structure of prevalent psychopathology, with an emphasis on similarities and differences between CD and oppositional defiant disorder (ODD). Papers were located using Web of Science by topic searches with no restriction on year of publication. Results:  Although some important nosologic questions remain unanswered, the dimensional phenotype of CD is well defined. CD differs from other disorders in its correlates, associated impairment, and course. Nonetheless, it is robustly correlated with many other prevalent dimensions of psychopathology both concurrently and predictively, including both other ‘externalizing’ disorders and some ‘internalizing’ disorders. Based on emerging evidence, we hypothesize that these concurrent and predictive correlations result primarily from widespread genetic pleiotropy, with some genetic factors nonspecifically influencing risk for multiple correlated dimensions of psychopathology. In contrast, environmental influences mostly act to differentiate dimensions of psychopathology from one another both concurrently and over time. CD and ODD share half of their genetic influences, but their genetic etiologies are distinct in other ways. Unlike most other dimensions of psychopathology, half of the genetic influences on CD appear to be unique to CD. In contrast, ODD broadly shares nearly all of its genetic influences with other disorders and has little unique genetic variance. Conclusions:  Conduct disorder is a relatively distinct syndrome at both phenotypic and etiologic levels, but much is revealed by studying CD in the context of its causal and phenotypic associations with other disorders over time. Advancing and refining formal causal models that specify the common and unique causes and biological mechanisms underlying each correlated dimension of psychopathology should facilitate research on the fundamental nature and nosology of CD.

PMID: 22211395 [PubMed - as supplied by publisher]

Childhood personality types: vulnerability and adaptation over time.

J Child Psychol Psychiatry. 2011 Dec 29;

Authors: De Clercq B, Rettew D, Althoff RR, De Bolle M

Abstract

Background:  Substantial evidence suggests that a Five-Factor Model personality assessment generates a valid description of childhood individual differences and relates to a range of psychological outcomes. Less is known, however, about naturally occurring profiles of personality and their links to psychopathology. The current study explores whether childhood personality characteristics tend to cluster in particular personality profiles that show unique associations with psychopathology and quality of life across time. Methods:  Latent class analysis was conducted on maternal rated general personality of a Flemish childhood community sample (N = 477; mean age 10.6 years). The associations of latent class membership probability with psychopathology and quality of life 2 years later were examined, using a multi-informant perspective. Results:  Four distinguishable latent classes were found, representing a Moderate, a Protected, an Undercontrolled and a Vulnerable childhood personality type. Each of these types showed unique associations with childhood outcomes across raters. Conclusions:  Four different personality types can be delineated at young age and have a significant value in understanding vulnerability and adaptation over time.

PMID: 22211435 [PubMed - as supplied by publisher]

The timing of maternal depressive symptoms and child cognitive development: a longitudinal study.

J Child Psychol Psychiatry. 2011 Dec 23;

Authors: Evans J, Melotti R, Heron J, Ramchandani P, Wiles N, Murray L, Stein A

Abstract

Background:  Maternal depression is known to be associated with impairments in child cognitive development, although the effect of timing of exposure to maternal depression is unclear. Methods:  Data collected for the Avon Longitudinal Study of Parents and Children, a longitudinal study beginning in pregnancy, included self-report measures of maternal depression the Edinburgh Postnatal Depression Scale, completed on 6 occasions up to 3 years of age, and IQ of the index child (WISC) measured at aged 8 years. We used these data to assign women to 8 groups according to whether depression occurred in the antenatal, postnatal, preschool period, any combination of these times, or not at all. We compared a model comprising all patterns of depression (saturated model) with models nested within this to test whether there is a relationship between depression and child cognitive development and, if so, whether there is a sensitive period. We then investigated the relationship with child IQ for each model, following adjustment for confounders. Results:  Six thousand seven hundred and thirty-five of 13,615 children from singleton births (49.5%, of eligible core sample) attended a research clinic at 8 years and completed a WISC with a score ≥ 70. A total of 5,029 mothers of these children had completed mood assessments over the 3 time periods. In unadjusted analyses, all three sensitive period models were as good as the saturated model, as was an accumulation model. Of the sensitive period models, only that for antenatal exposure was a consistently better fit than the accumulation model. After multiple imputation for missing data (to n = 6,735), there was no effect of postnatal depression on child IQ independent of depression at other times [-0.19 IQ points, 95% confidence interval (CI) -1.5 to 1.1 points]. There was an effect of antenatal depression (-3.19 IQ points, 95% CI: -4.33 to -2.06) which attenuated following adjustment (-0.64 IQ points, 95% CI: -1.68 to 0.40). Conclusions:  The postnatal period is not a sensitive one for the effect of maternal depression on child cognitive development.

PMID: 22211468 [PubMed - as supplied by publisher]

Prevalence of psychiatric disorders in preschoolers.

J Child Psychol Psychiatry. 2011 Dec 29;

Authors: Wichstrøm L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH

Abstract

Background:  Many disorders in childhood and adolescence were already present in the preschool years. However, there is little empirical research on the prevalence of psychiatric disorders in young children. A true community study using structured diagnostic tools has yet to be published. Methods:  All children born in 2003 or 2004 in the city of Trondheim, Norway, who attended the regular community health check-up for 4-year-olds (97.2% of eligible children) whose parents consented to take part in the study (N = 2,475, 82.0%) were screened for behavioral and emotional problems with the Strengths and Difficulties Questionnaire (SDQ). A screen-stratified subsample of 1,250 children took part in a furthermore comprehensive study including a structured diagnostic interview (the Preschool Age Psychiatric Assessment, PAPA), which 995 parents (79.6%) completed. Results:  The estimated population rate for any psychiatric disorder (excluding encopresis – 6.4%) was 7.1%. The most common disorders were attention deficit hyperactivity disorder (1.9%), oppositional defiant disorder (1.8%), conduct disorder (0.7%), anxiety disorders (1.5%), and depressive disorders (2.0%). Comorbidity among disorders was common. More emotional and behavioral disorders were seen in children whose parents did not live together and in those of low socioeconomic status. Boys more often had attention-deficit/hyperactivity disorder (ADHD) and depressive disorders than girls. Conclusions:  The prevalence of disorders among preschoolers was lower than in previous studies from the USA. Comorbidity was frequent and there was a male preponderance in ADHD and depression at this early age. These results underscore the fact that the most common disorders of childhood can already be diagnosed in preschoolers. However, rates of disorder in Norway may be lower than in the USA.

PMID: 22211517 [PubMed - as supplied by publisher]

Attention across modalities as a longitudinal predictor of early outcomes: the case of fragile X syndrome.

J Child Psychol Psychiatry. 2011 Dec 29;

Authors: Scerif G, Longhi E, Cole V, Karmiloff-Smith A, Cornish K

Abstract

Background:  Fragile X syndrome (FXS) is an early diagnosed monogenic disorder, associated with a striking pattern of cognitive/attentional difficulties and a high risk of poor behavioural outcomes. FXS therefore represents an ideal model disorder to study prospectively the impact of early attention deficits on behaviour. Methods:  Thirty-seven boys with FXS aged 4-10 years and 74 typically developing (TD) boys took part. Study 1 was designed to assess visual and auditory attention at two time-points, 1 year apart. Study 2 investigated attention to multimodal information. Both tested attention markers as longitudinal predictors of risk for poor behaviour in FXS. Results:  Children with FXS attended less well than mental-age matched TD boys and experienced greater difficulties with auditory compared to visual stimuli. In addition, unlike TD children, they did not benefit from multimodal information. Attention markers were significant predictors of later behavioural difficulties in boys with FXS. Conclusions:  Findings demonstrate, for the first time, greater difficulties with auditory attention and atypical processing of multimodal information, in addition to pervasive global attentional difficulties in boys with FXS. Attention predicted outcomes longitudinally, underscoring the need to dissect what drives differing developmental trajectories for individual children within a seemingly homogeneous group.

PMID: 22211574 [PubMed - as supplied by publisher]