Bonnie J. Kaplan

DCD may not be a discrete disorder

The primary aim of this paper is to explore some of the issues surrounding the concept of DCD as a ‘‘specific’’ learning diAculty. Questions relating to the assessment and identification of DCD are addressed. The arguments we present are derived from data obtained in a study which compared 224 children referred because of learning and attention problems (but not motor diAculties) and 155 typically developing children. These 379 children were all assessed on a range of formal and informal tests, including several sensorimotor tests. Working criteria for classifying a child as DCD were derived. In addition to the high prevalence figures obtained for DCD in this group of children, the degree of comorbidity observed between DCD and the other developmental disorders (reading disability and attention-deficit/hyperactivity disorder) was also striking. These results prompted us to re-evaluate the usefulness of discrete diagnostic categories, and to consider a reconceptualization of childhood disorders in general. It is proposed that the comorbidity found in childhood disorders reflects a single underlying etiology: Atypical Brain Development. This deficit may be manifested in a variety of ways, including DCD, and explains why some childhood disorders are so often seen together. ” 1998 Elsevier Science B.V. All rights reserved. PsycINFO classification: 2221; 2330; 3230; 3253; 3270

Atypical Brain Development: A Conceptual Framework for Understanding Developmental Learning Disabilities

This article presents ideas that are, in part, a response to the ambiguity in the neurological research on learning disorders, the growing awareness that developmental disabilities are typically nonspecific and heterogeneous, and the growing scientific literature showing that comorbidity of symptoms and syndromes is the rule rather than the exception. This article proposes the term atypical brain development (ABD) as a unifying concept to assist researchers and educators trying to come to terms with these dilemmas. ABD is meant to serve as an integrative concept of etiology, the expression of which is variable within and across individuals. ABD does not itself represent a specific disorder or disease. It is a term that can be used to address the full range of developmental disorders that are found to be overlapping much of the time in any sample of children. Although similar in spirit to the older term of minimal brain dysfunction (MBD), in that it closely links neurology with behavioral difficulties, ABD as proposed here differs in several ways. In support of the ABD conceptual framework, first, we consider the ABD concept in terms of its superiority to the older notion of MBD. Second, we provide a brief review of the burgeoning literature on the overlap of the various developmental disabilities. Third, we review some of the scientific literature that supports the ABD concept. Our sole purpose in proposing this concept is to initiate dialogue and debate on several critical issues across a wide variety disciplines. Hence, this article is not intended to be a definitive statement of a rigid perspective. It reflects neither a nonmalleable philosophical position, nor any type of condemnation of other perspectives. It does, however, reflect a data-based and philosophical trend visible in the field of learning disabilities, as well as the broader area of childhood developmental disorders.

Subtyping of developmental motor deficits

The purpose of this study was to investigate whether subtypes of developmental motor deficits could be identified: specifically, one with impairments in motor planning that would be characterized by deficits in gestural performance and motor sequencing and a second with impairments in the execution of motor skills that would be characterized by deficits in balance and coordination. Subjects included 102 children between the ages of 6 years and 10 years, 11 months, 51 who had been identified as displaying deficits in motor skills and 51 normal controls. Hierarchical‐agglomerative and iterative partitioning cluster analyses using measures of balance, bilateral coordination, upper limb coordination, transitive gestures, and motor sequencing revealed four subtypes. One group displayed deficits in motor sequencing, whereas another demonstrated deficits in balance, coordination, and gestural performance. In addition, a third group of children showed severe deficits in all motor skill areas, and a final group ha...

Retrospective reports of childhood trauma in adults with ADHD

Objective: Although studies have documented higher prevalence of abuse in children with ADHD, no studies have investigated childhood reports of abuse in individuals identified with ADHD in adulthood. Method: Forty ADHD women, 17 ADHD males, 17 female controls, and 40 male controls complete the Childhood Trauma Questionnaire and other measures of psychosocial functioning. Results: Emotional abuse and neglect are more common among men and women with ADHD as compared to controls. Sexual abuse and physical neglect are more commonly reported by females with ADHD. Although childhood abuse is significantly correlated with depression and anxiety in adulthood, having ADHD is a better predictor of poorer psychosocial functioning in adulthood. Conclusion: Clinicians are alerted that patients with ADHD symptoms have a high probability of childhood abuse.

Confirmation of a dyslexia susceptibility locus on chromosome 1p34-p36 in a set of 100 Canadian families.

Dyslexia is a common and genetically complex trait that manifests primarily as a reading disability independent of general intelligence and educational opportunity. Strong evidence for a dyslexia susceptibility locus on chromosome 1p34‐p36 (near marker D1S199) was recently reported, and an earlier study found suggestive evidence for linkage to the same region. We tested for the presence of a dyslexia gene in this region in a sample of 100 Canadian families using both qualitative and quantitative definitions of the phenotype. Using a qualitative definition of dyslexia (affected, unaffected, or uncertain), the largest multipoint Genehunter Maximum LOD‐Score (MLS) in 100 core nuclear families was 3.65 at D1S507, distal to D1S199. Quantitative trait locus (QTL) linkage analysis was performed for four measures of dyslexia (phonological awareness, phonological coding, spelling, and rapid automatized naming speed) employing the variance components approach implemented in Genehunter. Using a model with QTL additive and dominance variance and polygenic additive variance, the multipoint LOD scores maximized proximal to D1S199 (between D1S552 and D1S1622), with peaks of 4.01 for spelling and 1.65 for phonological coding (corresponding LOD scores under 1 degree of freedom were 3.30 and 1.13, respectively). In conclusion, our study confirms and strengthens recent findings of a dyslexia susceptibility gene on chromosome 1p34‐p36 (now designated DYX8).

Nutrient supplementation approaches in the treatment of ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a chronic, debilitating psychiatric illness that often co-occurs with other common psychiatric problems. Although empirical evidence supports pharmacological and behavioral treatments, side effects, concerns regarding safety and fears about long-term use all contribute to families searching for alternative methods of treating the symptoms of ADHD. This review presents the published evidence on supplementation, including single ingredients (e.g., minerals, vitamins, amino acids and essential fatty acids), botanicals and multi-ingredient formulas in the treatment of ADHD symptoms. In most cases, evidence is sparse, mixed and lacking information. Of those supplements where we found published studies, the evidence is best for zinc (two positive randomized, controlled trials); there is mixed evidence for carnitine, pycnogenol and essential fatty acids, and more research is needed before drawing conclusions about vitamins, magnesium, iron, SAM-e, tryptophan and Ginkgo biloba with ginseng. To date, there is no evidence to support the use of St John’s wort, tyrosine or phenylalanine in the treatment of ADHD symptoms. Multi-ingredient approaches are an intriguing yet under-researched area; we discuss the benefits of this approach considering the heterogeneous nature of ADHD.

Effects of Coexisting Disorders on Cognition and Behavior in Children With ADHD

Objective: To determine whether the presence of coexisting disorders affects memory, visual-motor skills, and daily functioning in children with ADHD. Method: Eighty-four boys and 18 girls (8 to 16 years old) participate in this study. Twenty children meet criteria for ADHD alone, 42 children for ADHD plus one other disorder, and 40 children for ADHD plus at least two other disorders (reading disability, developmental coordination disorder, oppositional defiant disorder, conduct disorder, anxiety, and depression). Children are assessed on memory and visual-motor skills. Parents complete measures of daily functioning. Results: No significant group differences emerge for age, socioeconomic status, or IQ. Poorer performance on tests of memory and visual-motor skills, more prevalent behavioral problems, and more impairment in everyday functioning are associated with a higher number of coexisting disorders in children with ADHD. Conclusion: The presence of coexisting disorders has a significant influence on cognition and behavior of children with ADHD.

The Emerging Field of Nutritional Mental Health Inflammation, the Microbiome, Oxidative Stress, and Mitochondrial Function

We live in a transformational moment for understanding the etiology of mental disorders. The previous leap in understanding occurred 60 years ago, which led us to incorporate psychopharmacology into our curricula to address the chemical basis of neurotransmitter function, especially as explained through the then-popular catecholamine hypothesis. The current revolution is broader, consisting of the rapidly accumulating knowledge of how inflammation, microbiome imbalance (gut dysbiosis), oxidative stress, and impaired mitochondrial output affect brain function. Suitable interventions for fighting inflammation, restoring normal gut function, reducing oxidative stress, and improving mitochondrial metabolism incorporate lifestyle variables, including nutrients and probiotics. This article invites readers to stay abreast of this emerging model of the biological basis of mental illness, given that it has particular relevance for those readers interested in alleviating the suffering of individuals with mental disorders. This overview describes the basis for a new field in mental health: nutritional psychiatry/psychology.

Attributions and perceptions of childhood in women with ADHD symptomatology

Now that it is recognized that Attention-Deficit/Hyperactivity Disorder (ADHD) often persists into adulthood, there are many adults being identified with ADHD who were not diagnosed as children. Individuals identified with ADHD during adulthood may be at risk for maladaptive attributional styles based on the notion that they were exposed to more negative feedback during childhood than adults without identified ADHD. This study examined current attributions and perceptions of childhood of 51 women identified in adulthood with ADHD symptomatology and 51 nonADHD women. Women with ADHD symptomatology had more uncontrollable, stable, and global attributions, reported more dissatisfaction in their childhood parent, peer, and teacher relationships, and felt less in control of negative childhood events as compared with the nonADHD women. Both depression and ADHD contributed significantly to these group differences, suggesting that negative perceptions and attributions are more than reflections of current thinking and mood. ADHD symptomatology also may be an important risk factor for maladaptive attributions.

Preliminary fMRI findings on the effects of event rate in adults with ADHD

Inhibition problems in attention deficit hyperactivity disorder (ADHD) are sensitive to stimulus event rate. This pilot study explores the neural basis of this increased susceptibility to event rate in ADHD. Event-related functional magnetic resonance imaging was used in conjunction with the administration of a fast (1.5xa0s) and a slow (7xa0s) Go/No-Go task. Brain activity patterns and reaction times of ten young male adults with ADHD (two of whom were in partial remission) and ten healthy male controls were compared. The ADHD group responded slower than controls with greater variability but with similar number of errors. Accurate response inhibition in the ADHD group in the slow condition was associated with widespread fronto-striatal activation, including the thalamus. For correct Go trials only, the ADHD group compared with controls showed substantial under-activation in the slow condition. The observed abnormal brain activation in the slow condition in adults with ADHD supports a fronto-striatal etiology, and underlines a presumed activation regulation deficit. Larger sample sizes to further validate these preliminary findings are needed.