Objective: To investigate children selected from a community sample for showing extreme autistic-like traits and to assess the degree to which these individual traits – social impairments (Sis), communication impairments (CIs), and restricted repetitive behaviors and interests (RRBIs) – are caused by genes and environments, whether all of them are caused by the same genes and environments, and how often they occur together (as required by an autism diagnosis). Method: The most extreme-scoring 5% were selected from 3,419 8-year-old pairs in the Twins Early Development Study assessed on the Childhood Asperger Syndrome Test. Phenotypic associations between extreme traits were compared with associations among the full-scale scores. Genetic associations between extreme traits were quantified using bivariate DeFries-Fulker extremes analysis. Results: Phenotypic relationships between extreme Sis, CIs, and RRBIs were modest. There was a degree of genetic overlap between them, but also substantial genetic specificity. Conclusions: This first twin study assessing the links between extreme individual autistic-like traits (Sis, CIs, and RRBIs) found that all are highly heritable but show modest phenotypic and genetic overlap. This finding concurs with that of an earlier study from the same cohort that showed that a total autistic symptoms score at the extreme showed high heritability and that Sis, CIs, and RRBIs show weak links in the general population. This new finding has relevance for both clinical models and future molecular genetic studies.
Keywords: twins; genetics; autism; autistic traits
OBJECTIVE: This study analyzes whether obese children have a higher risk of attention deficit/hyperactivity ‘characteristics’ (AD/HD) than do children with other nutritional states. METHOD: This study included 35,403 participants from 486 community schools. They completed the AD/HD scale of the Strengths and Difficulties Questionnaire (SDQ) and were weighed and measured. 2879 of the participants were obese and 78 were morbidly obese (BMI>40). RESULTS: A discrete, nonsignificant, increment was found in the AD/HD characteristics of male participants with morbid obesity, as compared with the other nutritional states. Among morbidly obese females, the prevalence of AD/HD characteristics was slightly superior, although not significantly, to that found in participants with normal weight, overweight or obese (BMI<40). CONCLUSION: Among nonclinical populations with a communitarian origin, previous findings reporting high rates of AD/HD in obese children are not replicated. This increment in the prevalence of AD/HD among hospitalized obese children could be the result of selection bias.
Keywords: obesity; morbid obesity; attention deficit/hyperactivity disorder; AD/HD; adolescents; SDQ; community sample; comorbidity
Background: We measured psychopathic traits in boys with autism spectrum disorder (ASD) selected for difficult and aggressive behaviour. We asked (i) whether psychopathic tendencies can be measured in ASD independent of the severity of autistic behaviour; (ii) whether individuals with ASD with callous-unemotional (CU) traits differ in their cognitive profile from those without such traits; and (iii) how the cognitive data from this study compare with previous data of youngsters with psychopathic tendencies. Method: Twenty-eight ASD boys were rated on psychopathic tendencies, autistic traits and a range of cognitive measures assessing mentalizing ability, executive functions, emotion recognition and ability to make moral-conventional distinction. Results: Our results indicate that psychopathic tendencies are not related to severity of ASD. In addition, such tendencies do not seem to be related to core autistic cognitive deficits, specifically in ‘mind-reading’ or executive function. Boys with co-occurring ASD and CU tendencies share some behaviours and aspects of cognitive profile with boys who have psychopathic tendencies alone. Conclusions: Callous/psychopathic acts in a small number of individuals with ASD probably reflect a ‘double hit’ involving an additional impairment of empathic response to distress cues, which is not part and parcel of ASD itself.
Keywords: [none]
Person-centered planning is central to United Kingdom policies regarding the support of people with intellectual disabilities. However, little evidence exists on the impact or cost of introducing person-centered planning. We examined the efficacy, effectiveness, and costs of introducing person-centered planning for 93 people with intellectual disabilities over 2 years across four localities in England. A person-centered plan was successfully developed for 65 people. Little change was apparent prior to introducing person-centered planning. After its introduction, modest positive changes were found in the areas of social networks; contact with family; contact with friends; community-based activities; scheduled day activities; and choice. The direct training and support cost of introducing person-centered planning was $1,202 per participant; indirect costs were negligible.
Keywords: [none]
Summary: This article reports on a study of 196 parents who received telephone support over a period of 6 weeks. Children’s well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ) and parental well-being was assessed using the General Health Questionnaire (GHQ). Findings: The study showed that parents who used telephone support had children with high levels of need as measured by the SDQ. Parents experienced a range of barriers to accessing support for their children with corresponding high scores on the GHQ. Parents reported that telephone support had improved their parenting over a range of domains. Those who had received support also had significantly lower scores on the GHQ, suggesting that they were less distressed. Applications: The study suggests that telephone support may be a cost-effective way of supporting and signposting parents.
Keywords: child well-being; parental stress; telephone help line
Objective: To describe the associations between a range of baseline factors (demographic, family and clinical) and parent-reported health-related quality of life (HRQoL) of children with ADHD taking part in the ADORE study. Methods: HRQoL was rated using the Parent Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE). Forward-stepwise linear regression models were used to investigate associations with 26 independent variables. Separate models were fitted for each of the five CHIP-CE domains (Satisfaction, Comfort, Resilience, Risk Avoidance and Achievement) and two subdomains of Achievement (Academic Performance and Peer Relations). Results: CHIP-CE domain mean scores were lower than community norms, especially for Risk Avoidance and Achievement, indicating a low level of HRQoL. Clinical factors significantly associated with a poorer HRQoL included ADHD symptoms (inattention, hyperactivity-impulsivity), conduct problems, peer relationship problems, having asthma, multiple other somatic symptoms and co-ordination problems. Family factors, such as having a parent with a health or mental health problem possibly caused by the child’s illness, child not living with both parents and maternal smoking during pregnancy were also associated with a worse HRQoL in some CHIP-CE domains/subdomains. Conclusions: Numerous factors independently impact on the HRQoL of children with ADHD.
Keywords: ADHD; children; Europe; health-related quality life
Objectives: To examine the cross-sectional reliability and validity of the Parent Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE), a generic measure of health-related quality of life (HRQoL), in children with ADHD in the pan-European ADHD Observational Research in Europe (ADORE) study. Methods: Parents of children with ADHD (aged 6-18 years) in 10 European countries completed the CHIP-CE at the baseline visit (n = 1,477; data missing for one patient). Analyses included determination of internal consistency reliability, ceiling and floor effects, factor analysis, and Pearson’s correlations between CHIP-CE and other scales used to measure ADHD severity, problems and family strain. Results: Internal consistency reliability was good-to-excellent (Chronbach’s > 0.70) for all CHIP-CE domains and subdomains, and almost no ceiling and floor effects were observed. Factor analysis of the subdomains yielded a 12-factor solution. The domain-level factor analysis identified six factors, the four domains of Satisfaction, Comfort, Resilience and Risk Avoidance. The two subdomains of Achievement domain, Peer Relations and Academic Performance, were separate factors in this sample. There were moderate-to-high correlations between the CHIP-CE scales and measures of ADHD and family factors. The HRQoL of children in ADORE was dramatically lower than that of community youth, with mean CHIP-CE scores almost 2 standard deviations below community norms. Conclusions: The validity and reliability of CHIP-CE to measure HRQoL in children with ADHD across Europe was confirmed.
Keywords: ADHD; children; Europe; factor structure; healthrelated quality of life
Many young children appear to have skills sufficient to engage in basic elements of cognitive behaviour therapy (CBT). Previous research has, however, typically used children from non-clinical populations. It is important to assess children with mental health problems on cognitive skills relevant to CBT and to compare their performance to children who are not identified as having mental health difficulties. In this study 193 6 and 7 year old children were assessed using a thought-feeling-behaviour discrimination task [Quakley et al. Behav. Res. Therapy 42 (2004) 343] and a brief IQ test (the WASI). Children were assigned to groups (at risk, borderline, low risk) according to ratings of their mental health made by their teachers and parents on the Strengths and Difficulties Questionnaire [Goodman, J. Am. Acad. Child Adolescent Psych. 40 (2001) 1337]. After controlling for IQ, children ‘at risk’ of mental health problems performed significantly less well than children with a ‘low risk’ of mental health problems. Before receiving CBT, children’s meta-cognitive development should be assessed and additional help provided to those with meta-cognitive difficulties.
Keywords: child; CBT; thoughts; feelings; behaviours; meta-cognitive development
This study examined the effectiveness of the Parents Plus Programme for families of preschool children with significant behavioural problems, comparing those with and without developmental disabilities. Twenty-two parents of children with developmental disabilities and conduct problems (the disability group), and 17 parents of children with conduct problems, but without developmental disabilities (the conduct problems group), were assessed before and after participating in the Parents Plus Programme, and at 10 months follow-up. More than 70% of cases in both the disability and conduct problems groups showed clinically significant improvement on the Total Difficulties scale of the Strengths and Difficulties Questionnaire. During the follow-up period, parents in the disability group showed a deterioration in psychological adjustment (on the General Health Questionnaire-12), while parents in the conduct problems group showed an improvement. Parents in the disability group reported a higher level of goal attainment compared with parents in the conduct problem group. Parents in both the disability and conduct problems groups evaluated the Parents Plus Programme equally positively. The Parents Plus Programme requires refinement to become more effective for families of pre-school children with developmental disabilities.
Keywords: [none]
Objective: To describe the methodology and to present the baseline findings of the Attention-deficit/hyperactivity Disorder Observational Research in Europe (ADORE) study, the primary objective of which is to describe the relationship between treatment regimen prescribed and quality of life of children with ADHD in actual practice. Methods: In this 2-year prospective observational study, data on diagnosis, prescribed treatment and outcomes of ADHD were collected at seven time points by paediatricians and child psychiatrists on 1,573 children recruited in 10 European countries. The data presented here from the 1,478 patients included in the analyses describe the baseline condition, initial treatment regimen prescribed and quality of life of families with children with ADHD. Results: Patients had a mean age of 9.0 years (SD 2.5) and 84% were male. Physicians diagnoses were made using DSM-IV (43%),ICD-10 (32%) and both DSM-IV and ICD-10 (12%). Mean age of awareness of a problem was 5.1 years, suggesting an average delay of approximately 4 years between awareness and diagnosis of ADHD. Baseline ADHD rating scale scores (physician-rated) indicated moderate to severe ADHD. Parent-rated SDQ scores were in agreement and suggested significant levels of co-existing problems. CGI-S, CGAS and CHIPCE scores also indicated significant impairment. Patients were offered the following treatments after the initial assessment: pharmacotherapy (25%), psychotherapy (19%), combination of pharmacotherapy and psychotherapy (25 %), other therapy (10%) and no treatment (21%). Conclusion: The ADORE study shows that ADHD is similarly recognised across 10 European countries and that the children are significantly impaired across a wide range of domains. In this respect, they resemble children described in previous ADHD samples.
Keywords: ADHD; children; Europe; quality of life; symptoms
