Anja Görtz-Dorten

Aufmerksamkeitsdefizit-/Hyper- aktivitätsstörungen von Kindern und Jugendlichen im Elternurteil

Fragestellung: Der Fremdbeurteilungsbogen fur Aufmerksamkeitsdefizit-/Hyperaktivitatsstorung (FBB-ADHS) ist Bestandteil des Diagnostik-Systems fur psychische Storungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV (DISYPS-II). Er erfasst in 20 Items die Symptomkriterien nach ICD-10 und DSM-IV und enthalt zusatzlich 6 Kompetenzitems. Die vorliegende Studie untersucht in einer reprasentativen Stichprobe auf der Basis der Elternurteile Symptom- und Diagnosepravalenzen, Reliabilitat und faktorielle Validitat, Korrelationen mit anderen Auffalligkeiten, Komorbiditatsraten sowie Alters- und Geschlechtseffekte. Methodik: Der Fragebogen wurde in einer per Zufall ausgewahlten Feldstichprobe von N = 713 Eltern von Kindern und Jugendlichen im Alter von 4;0 bis 17;11 Jahren beantwortet. Ergebnisse: Laut Elternurteil schwanken die Symptompravalenzen zwischen 4.5 % und 22.3 %. Die Diagnosepravalenzen auf der Basis der Symptomkriterien nach DSM-IV liegen bei 11.5 %; nach ICD-10 bei 3.4 %. Bei Berucksichtigung von Fun...OBJECTIVES The Parent Rating Scale for Attention Deficit Hyperactivity Disorder (ADHD) is part of the Diagnostic System for Mental Disorders in Childhood and Adolescence (DISYPS-II) and is based on the international classification systems ICD-10 and DSM-IV. It includes 20 items representing symptom criteria from ICD-10 and DSM-IV, as well as 6 competence items. This study analyses the prevalence rates of symptoms and diagnoses, reliability and factorial validity, correlations with other behavioral and emotional symptoms, comorbidity rates and effects of age and gender based on parent ratings according to this questionnaire. METHODS Ratings according to this questionnaire were performed by NM=713 parents of children and adolescents aged 4.0 to 17.11 years. RESULTS Prevalence rates of the symptoms varied between 4.5% and 22.3%. Using the symptom criteria of DSM-IV and ICD-10, prevalence rates of diagnosis of ADHD were 11.5% according to DSM-IV and 3.4% according to ICD-10. Addition of the functional impairment criterion reduces the prevalence rates to 7.9% (DSM-IV), and 3.0% (ICD-10), respectively. The respective reliability of the subscales Inattention, Hyperactivity?Impulsivity, the total score, and the competence scales was satisfactory to very good. The explanatory factor analyses show a factor according to DSM-IV with an inattention factor and a hyperactivity/impulsivity factor, but also a structure according to ICD-10, with separate inattention, hyperactivity and impulsivity factors. Most of the scales showed significant effects of age and gender. Moderate correlations between ADHD ratings and parent ratings of other behavioral and emotion problems were found, with comorbidity rates between 7% and 39%. CONCLUSIONS The prevalence rates are comparable to those found in other international studies. The Parents Rating Scale for Attention Deficit Hyperactivity Disorder is an internally consistent and valid instrument for use in the examined age group. By presenting the norms, the scale can be a helpful tool in practical application.

[Attention deficit/hyperactive disorders in children and adolescents as assessed by parents].

Fragestellung: Der Fremdbeurteilungsbogen fur Aufmerksamkeitsdefizit-/Hyperaktivitatsstorung (FBB-ADHS) ist Bestandteil des Diagnostik-Systems fur psychische Storungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV (DISYPS-II). Er erfasst in 20 Items die Symptomkriterien nach ICD-10 und DSM-IV und enthalt zusatzlich 6 Kompetenzitems. Die vorliegende Studie untersucht in einer reprasentativen Stichprobe auf der Basis der Elternurteile Symptom- und Diagnosepravalenzen, Reliabilitat und faktorielle Validitat, Korrelationen mit anderen Auffalligkeiten, Komorbiditatsraten sowie Alters- und Geschlechtseffekte. Methodik: Der Fragebogen wurde in einer per Zufall ausgewahlten Feldstichprobe von N = 713 Eltern von Kindern und Jugendlichen im Alter von 4;0 bis 17;11 Jahren beantwortet. Ergebnisse: Laut Elternurteil schwanken die Symptompravalenzen zwischen 4.5 % und 22.3 %. Die Diagnosepravalenzen auf der Basis der Symptomkriterien nach DSM-IV liegen bei 11.5 %; nach ICD-10 bei 3.4 %. Bei Berucksichtigung von Fun...OBJECTIVES The Parent Rating Scale for Attention Deficit Hyperactivity Disorder (ADHD) is part of the Diagnostic System for Mental Disorders in Childhood and Adolescence (DISYPS-II) and is based on the international classification systems ICD-10 and DSM-IV. It includes 20 items representing symptom criteria from ICD-10 and DSM-IV, as well as 6 competence items. This study analyses the prevalence rates of symptoms and diagnoses, reliability and factorial validity, correlations with other behavioral and emotional symptoms, comorbidity rates and effects of age and gender based on parent ratings according to this questionnaire. METHODS Ratings according to this questionnaire were performed by NM=713 parents of children and adolescents aged 4.0 to 17.11 years. RESULTS Prevalence rates of the symptoms varied between 4.5% and 22.3%. Using the symptom criteria of DSM-IV and ICD-10, prevalence rates of diagnosis of ADHD were 11.5% according to DSM-IV and 3.4% according to ICD-10. Addition of the functional impairment criterion reduces the prevalence rates to 7.9% (DSM-IV), and 3.0% (ICD-10), respectively. The respective reliability of the subscales Inattention, Hyperactivity?Impulsivity, the total score, and the competence scales was satisfactory to very good. The explanatory factor analyses show a factor according to DSM-IV with an inattention factor and a hyperactivity/impulsivity factor, but also a structure according to ICD-10, with separate inattention, hyperactivity and impulsivity factors. Most of the scales showed significant effects of age and gender. Moderate correlations between ADHD ratings and parent ratings of other behavioral and emotion problems were found, with comorbidity rates between 7% and 39%. CONCLUSIONS The prevalence rates are comparable to those found in other international studies. The Parents Rating Scale for Attention Deficit Hyperactivity Disorder is an internally consistent and valid instrument for use in the examined age group. By presenting the norms, the scale can be a helpful tool in practical application.

Reliability and Validity of Teacher-Rated Symptoms of Oppositional Defiant Disorder and Conduct Disorder in a Clinical Sample

Background/Aims: It is recommended to use information from multiple informants when making diagnostic decisions concerning oppositional defiant disorder (ODD) and conduct disorder (CD). The purpose of this study was to investigate the reliability and validity of teacher-rated symptoms of ODD and CD in a clinical sample. Methods: The sample comprised 421 children (84% boys; 6-17 years) diagnosed with ODD, CD, and/or attention deficit hyperactivity disorder (ADHD). Teachers completed a standardized ODD/CD symptom rating scale and the Teacher Report Form (TRF). Results: The reliability (internal consistency) of the symptom rating scale was high (α = 0.90). Convergent and divergent validity were demonstrated by substantial correlations with similar TRF syndrome scales and low-to-moderate correlations with dissimilar TRF scales. Discriminant validity was shown by the ability of the symptom rating scale to differentiate between children with ODD/CD and those with ADHD. Factorial validity was demonstrated by principal component analysis, which produced a two-factor solution that is largely consistent with the two-dimensional model of ODD and CD proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR, although some CD symptoms representing aggressive behavior loaded on the ODD dimension. Conclusion: These findings suggest that DSM-IV-TR-based teacher rating scales are useful instruments for assessing disruptive behavior problems in children and adolescents.

An evaluation of the pharmacokinetics of methylphenidate for the treatment of attention-deficit/ hyperactivity disorder

Introduction: Methylphenidate (MPH) plays a principal role in the multimodal treatment of attention-deficit/hyperactivity disorder (ADHD). Controlled studies have demonstrated an effective reduction in the core symptoms of the disorder following MPH therapy, although long-term studies also demonstrate that the therapeutic benefits dissipate in the absence of combined psychosocial interventions. Areas covered: This review article focuses on the pharmacological characteristics of MPH, examining its effects on brain metabolism and the neurotransmitter system. Neuropsychological and clinical effects of different immediate and extended release MPH formulations are discussed to aid clinicians in choosing the appropriate formulation. The drug’s addictive potency and abuse potential is also discussed. Data came from a literature search of relevant studies performed using the PubMed database up to June 2013. Expert opinion: MPH is effective in the treatment of the core symptoms of ADHD. Considerable clinical expertise is required to identify an individually well-adapted dosage which will produce the optimal clinical effects with potential side effects minimized. Due to low adherence to medication, especially in adolescents, motivation to treatment and attentive clinical monitoring is mandatory, as is the consideration of risks of abuse or the presence of a comorbid addictive disorder.

Bifactor Models Show a Superior Model Fit: Examination of the Factorial Validity of Parent-Reported and Self-Reported Symptoms of Attention-Deficit/Hyperactivity Disorders in Children and Adolescents

Background: Various studies have demonstrated that bifactor models yield better solutions than models with correlated factors. However, the kind of bifactor model that is most appropriate is yet to be examined. The current study is the first to test bifactor models across the full age range (11-18 years) of adolescents using self-reports, and the first to test bifactor models with German subjects and German questionnaires. Sampling and Methods: The study sample included children and adolescents aged between 6 and 18 years recruited from a German clinical sample (n = 1,081) and a German community sample (n = 642). To examine the factorial validity, we compared unidimensional, correlated factors and higher-order and bifactor models and further tested a modified incomplete bifactor model for measurement invariance. Results: Bifactor models displayed superior model fit statistics compared to correlated factor models or second-order models. However, a more parsimonious incomplete bifactor model with only 2 specific factors (inattention and impulsivity) showed a good model fit and a better factor structure than the other bifactor models. Scalar measurement invariance was given in most group comparisons. Conclusion: An incomplete bifactor model would suggest that the specific inattention and impulsivity factors represent entities separable from the general attention-deficit/hyperactivity disorder construct and might, therefore, give way to a new approach to subtyping of children beyond and above attention-deficit/hyperactivity disorder.

Effects of switching to once-daily modified-release methylphenidate from previous treatment with other psychostimulants in children and adolescents with ADHD: an observational study with clinician, parent, and teacher evaluations.

DISCUSSION To the best of our knowledge, this preliminary study represents the first well-controlled PSG sleep study of naltrexone in healthy subjects. Naltrexone at tolerable and recommended doses was associated with several significant changes in PSG parameters compared to placebo including increases in stage 2 sleep and REM latency with accompanying decreases in REM sleep. The observed increase in REM latency and decrease in percent of time spent in REM sleep seem to mimic other marketed central nervous system drugs such as benzodiazepines, tricyclic antidepressants, selective serotonin reuptake inhibitors, trazodone, and opioids. In addition, opioids, such as morphine, have also been found to increase stage 2 sleep and decrease stage 3 sleep. This preliminary study suggests the possibility of subclinical sleep disturbance associated with naltrexone use. Based on these results, further investigation with a larger sample size is warranted to examine naltrexone’s potential for inducing clinical sleep disturbances with repeated dosing.

Efficacy of Habit Reversal Training in Children With Chronic Tic Disorders: A Within-Subject Analysis

The aim of this study is to evaluate a cognitive-behavioral treatment for children and adolescents with tic disorder including habit reversal training (HRT) in a sample of children and adolescents (n = 27). Multiple outcome measures were used to assess the effects of the treatment on tic symptoms. In addition, impairment/subjective burden ratings and the self-efficacy to control tics were assessed. A within-subject design with two phases (8 weeks diagnostic; 16 sessions treatment) was analyzed using multilevel modeling (MLM). During the treatment phase, significant improvements in tic symptoms, impairment, and self-efficacy to control tics were found on most outcome measures. Treatment effects were found on the clinical rating of tic symptoms (Yale Global Tic Severity Scale [YGTSS]), the self-efficacy to control tics, and the video-observed motor tic frequency by comparing the improvements during treatment with the course of the outcome measures during the preceding diagnostic phase.