Anegen Trillingsgaard

The FTF (Five to Fifteen): the development of a parent questionnaire for the assessment of ADHD and comorbid conditions

Abstract.This paper describes the development of a new parent questionnaire (“Five to Fifteen”, or the FTF) for elicitation of symptoms and problems typical of ADHD and its comorbidities. The FTF comprises 181 statements related to behavioural or developmental problems that can be endorsed as either “does not apply” (0), applies sometimes or to some extent” (1), “definitely applies” (2), plus a number of open-ended questions including some about the child’s strengths. The items are arranged into eight different domains (memory, learning, language, executive functions, motor skills, perception, social skills, and emotional/behavioural problems), most of which can be subdivided into subdomains. For each domain, a mean score ranging from 0–2 can be calculated. A representative sample (n=1350) of the total population of 6–15-year-old children was targeted. Parents of 63% of these completed a questionnaire and returned it to the researchers. Boys showed significantly more problems than did girls across domains and age. Younger children had more problems than pre-adolescents and adolescents (except in the domains of social skills and emotional/behavioural problems). Executive dysfunction was common, and 5.3% of all children in the population had clear problems suggesting a diagnosis of ADHD according to parent report. The paper provides means, medians, and 90th and 95th centiles for individual items as well as for the eight domains. The Discussion centres on whether or not the FTF can (or should) be used in school-aged children for the identification of children at risk for ADHD or other early childhood onset neuropsychiatric disorder.

Autism in Angelman Syndrome: An Exploration of Comorbidity

The aim was to explore the comorbidity between Angelman syndrome and autism spectrum disorders (ASDs). Identification of autism in children with Angelman syndrome presents a diagnostic challenge. In the present study, 16 children with Angelman syndrome, all with a 15q11-13 deletion, were examined for ASDs. Thirteen children with Angelman syndrome received an ADOS-G algorithm classification of ASD; the remaining three were outside the autistic spectrum. Ten fulfilled the criteria for autism, and three for PDD-NOS. The 10 children with Angelman syndrome and comorbid autism were compared with eight children with only autism regarding their social and communicative skills. The results indicated that Angelman syndrome is better understood in terms of developmental delay, and autism in terms of developmental deviance. It is concluded that autism might have been overdiagnosed due to the extremely low mental age of the children with Angelman syndrome.

Validating neuropsychological subtypes of ADHD: how do children with and without an executive function deficit differ?

OBJECTIVE The study investigates behavioural, academic, cognitive, and motivational aspects of functioning in school-age children with attention-deficit/hyperactivity disorder (ADHD) with and without an executive function deficit (EFD). METHOD Children with ADHD--EFD (n = 22) and children with ADHD + EFD (n = 26) were compared on aspects of ADHD behaviour, school functioning, general cognitive ability, intra-individual response variability, affective decision-making, and delay aversion. RESULTS Children with ADHD--EFD and children with ADHD + EFD were comparable in terms of ADHD symptomatology and school functioning. However, children with ADHD + EFD had significantly lower IQ and more intra-individual response variability than no EFD counterparts. Children with ADHD alone appeared more delay averse on the C-DT task than children with ADHD + EFD. CONCLUSIONS Some children with ADHD were primarily characterised by problems with executive functions and variability others by problems with delay aversion supporting multiple pathway models of ADHD. Given the exploratory nature of the study, results are in need of replication.

Executive Dysfunction in School-Age Children with ADHD.

Objective: The study examined executive function deficits (EFD) in school-age children (7 to 14 years) with ADHD. Method: A clinical sample of children diagnosed with ADHD (n = 49) was compared to a population sample (n = 196) on eight executive function (EF) measures. Then, the prevalence of EFD in clinical and non-clinical children was examined at the individual level according to three methods previously applied to define EFD, and a fourth method was included to control for the effect of age on performance. Results: Children with ADHD were significantly more impaired on measures of EF than children without ADHD at the group level. However, only about 50% of children with ADHD were found to have EFD at the individual level, and results appeared relatively robust across methods applied to define EFD. Conclusion: As a group, children with ADHD displayed more problems on neuropsychological measures of EF than non-clinical children; at the individual level, there appeared to be heterogeneity in EF impairment.

Developmental profiles on the basis of the FTF (Five to Fifteen) questionnaire: Clinical validity and utility of the FTF in a child psychiatric sample

The Five to Fifteen parent questionnaire (FTF) was developed to offer a neuropsychological dimension to the assessment of children with Attention Deficit/Hyperactivity Disorder and other child psychiatric disorders. The domains included in the FTF were motor skills, executive functions, perception, memory, language, social skills and learning, in addition to a domain for emotional and behavioural problems. The aim of the present study was to test the clinical validity and utility of the FTF with a main focus on discriminant and criterion validity. The clinical sample consisted of 155 clinically diagnosed children (ICD-10 criteria), 102 were tested with WISC-III. The parents rated their children independent of the diagnostic evaluation. The results were presented as profiles. These clinical profiles were compared to those of a Swedish norm sample consisting of 854 children from the age of five to fifteen. Results demonstrated that the profiles for the clinical groups were similar in forms and levels to those of the upper 10 percent of the norm sample (those with most difficulties). Five out of eight FTF domains discriminated significantly between diagnostic groups in the clinical sample. Influence of IQ, gender and age on the results were low. Three out of four relevant FTF domains correlated significantly with corresponding WISC-III indexes/measures. The clinical utility of individual children’s profiles were demonstrated. On the whole, the findings supported the clinical validity and utility of the FTF.

What distinguishes autism spectrum disorders from other developmental disorders before the age of four years

The increasing recognition of the benefits of early intervention for children with autism spectrum disorder (ASD) stresses the importance of early identification of children who might benefit from those programs. However, in the early years of life it may be difficult to distinguish children with ASD from children with other developmental disorders. The aim of the present study was to identify behavioural patterns that could facilitate this differentiation. Prior to diagnostic assessment, 2- and 3-year-old children (n=30), all referred to a clinic for “possible autism”, were observed in a semi-structured play interaction, and their parents were interviewed about the children’s early development from 0 to 24 months. Following diagnostic assessment, the 17 children fulfilling the ICD-10 criteria for ASD were compared to the 13 children diagnosed with other developmental disorders (outside the autism spectrum). On the basis of parent reports only a few distinguishing signs of ASD were found before 24 months of age. On the basis of professional observations in a semi-structured play interaction several distinguishing signs were found for the 2- and 3-year-olds; smiles in response, responds to name, follows pointing, looks to “read” faces, initiates requesting verbal and nonverbal behaviours, and functional play.

Reliability, validity and normative data for the Danish Beck Youth Inventories

This study examines reliability and validity and establish Danish norms for the Danish version of the Beck Youth Inventories (BYI) (Beck, Beck & Jolly, 2001), which consists of five self-report scales; Self-Concept (BSCI), Anxiety (BAI), Depression (BDI), Anger (BANI) and Disruptive Behavior (BDBI). A total of 1,116 school children and 128 clinical children, aged 7-14, completed BYI. Internal consistency coefficients were high. Most test-retest correlations were >0.70. A test-retest difference was found for BAI. Exploratory and confirmatory factor analysis indicated that the five factor structure of the instrument was justified. The BSCI, BAI and BDI discriminated moderately between the norming sample and the clinical group, and the latter group included more children who exceeded the 90th percentile of the norming sample. Diagnostic groups scored higher on relevant scales than norms. Only BSCI and BDI differentiated between diagnostic groups. The BYI showed acceptable internal consistency and test-retest stability, except for BAI. The BYI did not adequately differentiate between internalizing disorders.

The script model in relation to autism

Abstract The primary purpose of this study was to investigate autistic childrens scripts for social routines. Scripts specify familiar events in terms of who does what, when, to whom, and why. Scripts are verbalizations of mental event representations, containing and organizing generalized knowledge of how the world works. Scripts are presumed to be of vital importance for the development of shared meaning, communication, and social behaviour. In this study, children with autism were asked to explain well-known social routines, such as how you shop in a supermarket, make a cake or celebrate a birthday. The scripts of the 12 children with non-retarded autism were compared to scripts of matched normal control children. Despite the fact that all of the participating children with autism had an IQ above 90 and a mental age between 8 and 14, a significant difference in autistic and normal control childrens ability to generate scripts for familiar social routines was found. The results are discussed in relation to the same childrens ability to pass theory-of-mind tests and their verbal intelligence.

Early lead exposure and neonatal jaundice: Relation to neurobehavioral performance at 15 years of age

A cohort of children who attended first grade in 1983 was identified in a Danish community with low-level lead pollution. Two groups with high and low postnatal lead exposure were generated on the basis of the dentin-lead concentration in shed deciduous incisors. At age 8 years, examination of 162 children matched according to gender and socioeconomic status had shown lead-related deficits in verbal intelligence and visuomotor coordination. Re-examination was now carried out in 141 children at age 15 years using the Wechsler Intelligence Scale for Children (WISC), Bender Visual Motor Gestalt, Trail Making, and Visual Gestalts. In general, no lead-related effects could be detected in the group. However, in children with a history of neonatal jaundice, increased lead exposure was associated with mild neurobehavioral deficits, as indicated by lower verbal IQ scores and decreased visuomotor coordination. This finding suggested that moderate neonatal hyperbilirubinemia may have precipitated an increased sensitivity to subsequent exposure to lead.

Neurodevelopmental outcome in Angelman syndrome: Genotype–phenotype correlations

Angelman syndrome (AS) is a neurogenetic disorder characterized by intellectual disability, developmental delay, lack of speech, and epileptic seizures. Previous studies have indicated that children with AS due to 15q11.2-q13 deletions have a more severe developmental delay and present more often autistic features than those with AS caused by other genetic etiologies. The present study investigated the neurodevelopmental profiles of the different genetic etiologies of AS, and examined the evolution of mental development and autistic features over a 12-year period in children with a 15q11.2-q13 deletion. This study included 42 children with AS. Twelve had a Class I deletion, 18 had Class II deletions, three showed atypical large deletions, five had paternal uniparental disomy (pUPD) and four had UBE3A mutations. Children with a deletion (Class I and Class II) showed significantly reduced developmental age in terms of visual perception, receptive language, and expressive language when compared to those with a UBE3A mutation and pUPD. Within all subgroups, expressive language performance was significantly reduced when compared to the receptive performance. A follow-up study of seven AS cases with 15q11.2-q13 deletions revealed that over 12 years, the level of autistic features did not change, but both receptive and expressive language skills improved.